My Gastric Sleeve Surgery

(Fair Warning Again - Another long post ......Written between post-op days 5 through 7)

I finally did it.  After years of saying I wouldn’t, but secretly wanting to, I had bariatric weight loss surgery.  In the back of my mind for a while, I truly thought this would be the “easy way” to get rid of my weight problem…cut down how much I can eat, and problem solved, right?  I have come to discover that this isn’t easy, it isn’t GOING TO BE easy, and if I could give anyone any kind of advice, I would tell them to think this through VERY carefully...if you are anything like me, you will want to eat again as early as the afternoon after your surgery.  My problem with food is not in my belly.  It is in my head.  No surgery for that, folks.

I have been overweight pretty much my entire life.  I have rarely NOT been the biggest kid in my class.  I grew up constantly hearing, “She has such a pretty face.  If only she could lose that weight…”  I had wonderful friends in high school who accepted me for who I was, but my head kept telling me that I was fat.  

I tried diets…my pattern that began in high school (I’m 47 now) was to lose anywhere from 20-30 pounds and then fall off the proverbial wagon to begin eating old-style.  Sometimes diets lasted weeks, and sometimes they lasted months.  Nothing ever changed, though.  I guess I thought some inner switch would click, and I’d magically develop a distaste of potato chips and bologna.  Who knows?  Also, as my age increased, my weight increased.  I’m not an exerciser anymore, never really was even though I had “active” times in my life, so that probably “helped.”  My highest weight has been around 282, I think…I tended to avoid weighing at this time in my life, for obvious reasons.  You know – a problem doesn’t really exist if you can’t see it.

While I was hiding my eyes, my weight stayed high, and my activity level decreased further – what a surprise.   I developed type 2 diabetes, my hormones got more and more out-of-whack, I keep fairly consistent ankle edema that is more pronounced in my left ankle, I discovered I’m infertile (probably thanks to PCOS), my diabetes contributed to neuropathy in my feet, I became further depressed, I woke my husband in the night with my snoring, my blood pressure and cholesterol levels went down unsavory paths, and I took lovely meds/supplements for a lot of this…and I HATE taking pills, so that, of course, just pissed me off.  Mostly, I felt utterly helpless, but somewhere in there, I was angry….at myself, at life, at choices, at “luck,” at my parents, at people who judged me, at short seat belts, at WHATEVER I could be angry at.  I felt desperate.  Maybe I’d hit my “bottom.”

So, several months ago, after a lot of thought and a bunch of initial research about weight loss surgery, I finally asked my primary care physician, “Do you think I’d be a good candidate for weight loss surgery?  Am I crazy for thinking about doing this?”  Her response, without hesitation, was, “Yes, you’d be a great candidate for it.  And I think you’d be crazy NOT to do it.”  I think this was the moment in time when the curtains opened, the clouds floated away, the sun began shining, and I began smiling for the first time in a long time at all the possibilities of life.

My research continued through internet digging and talking with family, friends, and acquaintances who had undergone weight loss surgery.  I quickly discovered that the gastric sleeve was my preference.  The reports of disease resolution (diabetes) almost immediately after surgery were a huge factor in my decision.  Also, since swallowing pills isn’t my preference, I liked the idea that a “sleeve” of my original stomach would remain to absorb nutrients.  (I still have to take a few pills, though, but I can handle this!)  There were other reasons, but disease resolution and vitamin/nutrient absorption were the biggest reasons why I chose the sleeve.  (Note:  Disease resolution is common with roux-en-y/bypass surgery, too, but the drastic nature of the RNY was a huge turn-off, for some reason.)

Fast forward a few months, and I had jumped through all the necessary hoops for my insurance (BCBS of MS) to cover my surgery.  For anyone interested in/needing to know everything that was involved for me, I will TRY to recall everything and include the price I paid.

**Documentation of weight problems for 2 years

**6 consecutive months of documented weight loss management visits with a physician

**Psychological evaluation - $450

**An initial orientation group meeting at my surgeon’s office that provided general info on different surgeries, etc. – free unless you met with the surgeon after - $150

**A group nutrition meeting where you learned a new way to eat in preparation for surgery - $45

**A follow-up one-on-one meeting with a nutritionist to examine a menu/chart you kept to see how your eating has been going - $45

**Another group nutrition meeting where you learned about how to eat after surgery - $45

**Pre-op testing (an upper GI, lab/blood work, chest x-ray, and an EKG) - $150 deposit with hospital where I had it done locally (after the results from these reached the surgeon’s office, surgery was officially scheduled)

**A couple of days prior to surgery, I pre-admitted with my surgeon (met with him, reviewed the procedure, discussed changes that must be made on my part in order for the surgery to be successful long term,  got a bag of goodies and a couple of prescriptions – pain meds and anti-nausea patch – and other directions from the nurse, and paid his office)

**Pre-admitted with the hospital (verified information and paid them).)  (All of my fees applied to my deductible, so the amounts I paid to the surgeon and the hospital were the remaining portions of my deductible before my insurance paid 100%.  Total out-of-pocket for myself at this point was around $3,000-ish.)  FYI…I live about 90 miles from my surgeon’s office and the hospital where my surgery was done.  Cost of transportation is not calculated in my grand-ish total.

My surgery was officially scheduled for Tuesday, June 17, 2014.  On Monday, 6/16, I was restricted to clear fluids (water, Crystal Light, low sodium broth, Gatorade) all day.  At 5pm, I had to put an anti-nausea patch behind my ear and begin drinking a bottle of magnesium citrate.  Directions at this point were to “stay near a bathroom,” so that’s what I did.  Nothing by mouth was allowed after midnight.  I despise needles, so I was determined to be well-hydrated the day before surgery so any poking and prodding would be as flawless as possible.  I was fortunate to be able to stay the night before surgery in a hotel nearer the hospital than where I lived…thanks, Mom!  I was scheduled to be at the hospital by 5:15am.

Once I arrived, I was thoroughly scrubbed from head to toe, even inside my nostrils, and my IV line was inserted.  (Unfortunately, that was the only poke that was easy while I was there – OY!)  I was wheeled into a surgery room, dressed in a cute little blue cap, given some oxygen through a thick mask, and blinked once…maybe twice.  When I opened my eyes, I was waking up in recovery.   However, according to my husband, here’s something closer to the real schedule:

6:30 – I left prep room for holding/pre-op

7:00 – Hubby and mom got a card with an ID number and color-coding to follow surgical process

8:00 – I went into operating room

8:35 – Surgery began

10:00 – Surgery completed

10:15 – Hubby and mom met with surgeon who said it was a “boring” surgery

11:00 – I arrived in hospital room

All things considered, the pain was not that bad.  The hospital staff was great, and I have no complaints – other than the inability to hit a vein on the first try.  They were prompt, helpful, and friendly about any and all requests I had.  Lunch was happily delivered - about 20cc of chicken broth, a 20oz bottle of water, and an individual Crystal Light lemonade mix to put in the water.  Supper was the same, but the broth may have been vegetable broth, and the lemonade was now peach tea.  I remember getting a couple of Flintstone’s chewable vitamins and some chewable antacids, as well as a couple of doses of liquid Reglan for nausea prevention (of which I had NONE).  Besides this, I watched television and napped all day.

I did not anticipate the gruffness in my throat due to intubation, and thankfully, I had a “cough buddy,” a hard-stuffed teddy bear, to press against my incisions to help me get the flegm up and out.  (I was resistant to using this, but eventually, I figured out and trusted that it wasn’t going to hurt nearly as badly when I coughed if I pressed that bear to my belly.  This dear bear came in handy later at home when I needed to blow my nose and protect myself from random cat visits.)  The roughness in my voice was markedly better the following day, and was pretty much gone within 2-3 days.

My belly, post-op day 7,
with its 6 lovely incisions.

My worst pain has come primarily from my largest incision, where, I’m told, the surgeon either had the camera or removed the stomach.  I am 5 days post-op (Sunday), and it is still tender and a bit uncomfortable when I stand up straight – as if letting it hang is pulling on something uncomfortably inside.  In the photo, it's the incision on the bottom left. (I look bloated!...I probably am!)  While I was in the hospital, these steri-strips covering the incisions were also covered with a large patch-band-aid thingie.  Those were removed before I went home, but they have left me with some itchy spots.  The steri-strip covering the uppermost incision fell off today during my bath.  Yay!  (I NEVER thought I'd ever put a picture of my belly online for the world to see!)

I dealt with a bit of a gas problem, due to the laparoscopic nature of the surgery.  Some research had me expecting pain in my shoulder, but I discovered that it centralized just below my diaphragm (near the bottom of my ribs) after a couple of days.  I eventually found that taking 2 Gas-X strips at night before bed helped me tremendously.  I incorporated a little walking, per internet recommendations, but that was uncomfortable for me since I felt a bit of pain trying to stand up straight.  And, hunching over for extended periods created fatigue in my back.  My movement mostly involved prepping my meals/fluids, going to the bathroom, showering, minimal housework (doing dishes, picking up clothing, feeding the pets) and rolling over in bed – something that required more of me than I anticipated.  I did walk; I just didn’t do as much as I was told to do.

I have been following a liquid diet, and with the exception of about 2-3 tablespoons of applesauce mixed in with some yogurt and milk yesterday, I have stayed with it.  I average about 70-75 grams of protein daily through protein shakes, skim milk, and no-fat plain Greek yogurt, I take 2 bariatric multivitamins with iron, 2 bariatric calcium citrate supplements, and 1 B-12 supplement, all chewable, and the rest of my time is spent hydrating with water, sugar-free popsicles, sugar-free Jell-O, Crystal Light, and Dasani Drops.  (I’m trying to stick to Splenda as an artificial sweetener right now because aspartame has given me headaches in the past.)  My calorie intake averages about 760/day.

Random Unanticipated Things: 

I needed help during my first shower to wash my feet and dry crevices that required bending.  Second shower at home was uncomfortable and slow, but I did it all myself.  I also THOROUGHLY enjoyed letting very warm water run down my back to ease the hunching-back pain.

I missed giving my nose a good blow.  I couldn’t do this until about 6 days post-op, and only with the help of the “Cough Buddy” bear.

I didn’t poop until 6-7 days post-op, which is odd for me because I’m a daily pooper – sometimes twice in a day.  Considering, though, I had had liquids on 6/16 ending in a laxative that evening, and I had not had anything but liquids since the surgery.  I decided to employ the Walmart brand of Miralax.  I took two doses – midday and evening, on post-op day 5.  I had a BM first thing in the morning day 6, and the remainder of the day was graced with about 4-5 gaseous, minimally-productive bathroom trips.  In retrospect, I probably should have had only one dose of the “miralax” around post-op day 3 and let that be that.  I am still considering another dose, just in case, but I haven’t had that third quite yet.

The pain has truly been minimal.  With the exception of the one major incision and some gas pain, I could classify any other pain related to surgery as minimally irritating.  I took 4 morphine hits in the hospital just to help me relax and sleep...not for pain.  Since I've been home, I've had only one dose of pain meds for the same reason.  The gas pain subsided around post-op day 5-6, and the major incision isn't even really tender to the touch, depending on how hard you push on it.  I even sneezed yesterday, and though I imagined my guts flying out of my abdomen simultaneously, I gently pressed my flattened palm on the incision as if I had my “Cough Buddy” bear and felt no pain at all.  I do feel internal pain, but only a bit, when I move, so I still move slowly.  Today is post-op day 7.

I have read that many gain weight during the first week after surgery, citing the fluids received in the hospital.  This has not been my experience.  As of this morning (post-op day 7), I am down 11 pounds.  I am happy to report that I now weigh less than my husband…by 2 pounds.  I giggled.  He scowled.  The weight has, so far, dropped steadily…a pound here, two pounds there.  It is nice to watch my face, specifically the part that I call my “fat beard” that goes from ear to ear along my jaw line, fading.  I hate that thing; it makes my face look like an equilateral triangle…so unflattering, in my opinion.

I am thoroughly enjoying looking at my real ankles.  No swelling in sight!  I still have my neuropathy issues, though.  I wasn’t really expecting to get rid of that, but I was hoping.

My blood glucose levels are not at “normal” (below 90) yet, but the 110-ish I’ve been getting here lately is far better than the 140-165 I was getting.

I am tired of eating.  I just want to rest and relax and watch television.  Don’t get me wrong – I do have energy to do things, but I am tired of eating every few hours.  (Keep in mind that it will take about an hour to eat a protein shake at this point.  Drinking fluids – sipping, not gulping or guzzling – takes a while, too, and since I’m always doing one or the other, I’m always “feeding” myself.)

Some people reported having problems with cold or hot beverages.  I have more problems with cold things, except for popsicles, for whatever reason.  The thicker the mixture, too, the more uncomfortable it is.  Here’s what I mean…My meals alternate between protein shakes (a scoop of protein mix and 8oz. of water or skim milk) and yogurt smoothie-type things (1/2 c. skim milk, ½ c. FF Greek yogurt, water enhancer flavoring).  These yogurt drinks give me just a twinge of discomfort about 20-30 seconds after I swallow most every sip.  I get a similar feeling when I drink plain ol’ water with Crystal Light with ICE.  I’ve started omitting the ice, and that helps.  I have yet to discover why I don’t have a problem with the SF popsicles, though.  THOSE HAVE BEEN A GODSEND.  So glad I stocked up!!  They taste good, I feel like I’m actually eating something, and I’m getting hydrated all in one.  Win-win-win.

Going ahead and buying the bariatric surgery optimized supplements was a GOOD INVESTMENT.  They are not disgusting, though not my favorite things in the world, and since they are optimized and pretty much have twice what you need from regular chewable supplements, you don’t have to be taking them every second of the day.

I think about eating a LOT.  I thought I would stop after I had the surgery – why, I don’t know – but I didn’t.  Even the day I had my surgery, as I was walking around the hospital floor, I was KEENLY aware of the smell of chocolate cake every time I passed by the nurses’ station.  OH MY GOSH!  And now, seven days out, I’m bored with liquids, and I’m researching things to eat in Stage 2 (pureed) and beyond, so I really want to chew on something tasty.  There are those Frito’s or honey buns on top of the fridge calling my name, and one of the fish sticks my husband made last night just smelled wonderfully delicious and would make a tasty little mini-sandwich.  Fish is GOOD FOR YOU, RIGHT?!?  ARGH!  Honestly, though, I am NOT HUNGRY.  I just want to eat.  I guess this is what they call “head hunger.”  I will be working on this, for sure, and I am glad to have read about it ahead of time and be AWARE of it.  The bright side is that I have this craving for all these salsas I keep seeing – cucumbers, chick peas, feta, quinoa, etc.  Not a bad craving to have, if I have to say so myself.  Come on, Stage 3!!

My husband happily reports that I am not snoring like I used to...its is a quiet snore.  So, he's definitely getting better sleep as a result of my surgery.  And when Papa is happy....well, who cares.  How's Mama doing?  Just kidding!!

After the first few days of tiny sips, I realized that I could actually take a fairly normal-sized/average swallow of water….not an entire mouthful, mind you.  And, I don’t recommend doing this multiple times in succession, either.  While water pretty much goes straight through, it does take it a few seconds.  I will be taking average swallows with pauses between each.  I have not had a problem with overfilling my pouch (The word “stomach” becomes “pouch” post-op, interestingly enough.), but I realize that, with fluids, I don’t have to baby it as much as I thought.  FYI…I learned that protein shakes/liquids/yogurt/soft foods can be referred to as “sliders” because they essentially slide through the pouch.  Later, with “normal” foods, it will be essential for me to monitor the amount I’m eating and keep it under 4oz.

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I guess I’m discovering that my experience will be similar to some and different from others.  No surprise there.  I’m also discovering that this is not the “easy way out” of losing weight.  It does take work.  It does take commitment – commitment to change, to improvement, to health, to exercise…to recognizing that the way I thought before surgery was full of hooey, and I need to re-think a lot of things.  Old thinking got me close to 300 pounds of person.  I cannot allow that thinking to take hold again – EVER.