First DS Surgiversary - VERY LONG!

What a difference a year makes...

Exactly one year ago today, I was wheeled into the largest operating theatre at St. Joe's Hamilton with an excited entourage of doctors, residents, nurses and students for my long anticipated Duodenal Switch. Most of those involved, other than Dr. Hong, had never participated in such a surgery before and were excited about it. I met and shook hands with a dozen people before going under. I had a nice little chat with Dr. Hong and the very nice French anesthesiologist, was strapped down to the table and then I was out like a light. I awoke 6 hours later in recovery, being hovered over by two very nice nurses who made me very comfortable. I spent the next 5 days in hospital recovering. My bowels were slow to move, drinking was HARD and the pain was tolerable, but more than I had honestly expected. I didn't get out of bed the day of surgery or the next morning but by late in the afternoon, I was walking around the floor. It wasn't until the 3rd night that I passed any gas or stool, but it eventually happened. I had nothing but positive experiences with all the medical professionals (with the exception of one nurse *****fused me pain medication for several hours). The only bump in the road was that it took them a couple of days to sort out finding me full fluids rather than just clear fluids, but I didn't much feel like eating anyway. By day three my blood sugars were normal, I was no longer borderline diabetic.I was discharged with one drain sticking out of my belly into the loving care of my husband and sister to recover at home.

I felt like crap for the first 3 weeks. Moving, eating, drinking, going to the bathroom, doing basically anything was a chore. I needed pain meds and my heating pad was my best friend. I was constantly nauseated, but that improved when I started taking my Prevacid twice a day. The weight fell off, but I couldn't even care. A few days after I was discharged I got my drain out; that was an experience. Very strange sensation. Weeks 3-6 showed slow, gradual but steady improvement as I begin to eat real food, get all my supplements in and kept my focus on hydration, but my weight loss stalled about 5 weeks out for 3 weeks. I knew this was totally normal, but it was still frustrating, but things soon picked up again.

At about 10 weeks post-DS I underwent my second major surgery of the year; double jaw and chin surgery as a part of my orthodontic treatment. It was another 6 hour surgery and I spent 4 nights in hospital. The first couple of weeks was very hard and my recovery was slower due to the two surgeries being so close together. If I could do it over again, I don't think I would have elected to have them so close together! I was on a fluid and then soft diet again for a month after the jaw surgery and more pain killers (the jaw surgery pain was worse than the DS). Slowly into late June, I started to feel more like myself and I finally went back to work in mid-July. I started to notice I had more energy and I was going through clothing sizes at an alarming rate!

Over the summer, I noticed for the first time that I wasn't sweating all the time everyday, and that the heat was tolerable, even in my un-air-conditioned office. It was easier to walk everywhere and the pain that I'd carried in my ankle and knee from an injury were practically non-existent, even after a whole day on my feet. Because I had been low in vitamin A prior to surgery, I was getting labs done monthly to keep a close eye on my iron and vitamin A. I have to mention my incredible GP here, Dr. Rahim, who has been nothing but extremely supportive and encouraging at every step of this process. She took the time to educate herself about the DS and understand and support my diet and supplement needs and potential medical complications/issues. When I went to her in January with a suspected bacterial overgrowth, she heard me out, found it reasonable and prescribed antibiotics according to the info I had brought her about treating this issue in DSers from American surgeons familiar with it. She's incredibly collaborative and thorough. If anyone needs a great family doc in downtown TO, I cannot recommend her more highly.

By September my weight loss had slowed quite a bit. I had started at 235. A healthy BMI at my height would be 135. I had hit the 150s in September and was thrilled. It was the smallest I'd been since I was a teenager and I was feeling fantastic. I traveled to Germany and England for two weeks and had a fantastic time with lots of energy. I had no trouble traveling with my protein powder and slew of supplements. I unfortunately picked up a UTI and eventual kidney infection from a bath house (ewwww! I know!) but I was treated incredibly well and promptly in England - their healthcare system is fantastic if the hospital I attended is any indication, and no payment was accepted even though I am not a British citizen. Amazing!

Over Sept-Nov I slowly lost a bit more weight. I hit the mark of a healthy BMI and 100 pounds lost just before my 8 month surgiversary. Unbelievable. I really didn't expect it and when I continued to lose a few more pounds I was even more shocked. My body settled into a weight around 125lbs in November and has pretty much stayed there since. I have gone as low as 123 an as high again as 129, but I'm generally right about 125 on any given morning, naked, after my BM.

So what has changed for me? I've mentioned the energy, the lack of pain in my knee and ankle, the reversed diabetes. I've also stopped having migraines and my IBS symptoms are much improved - so much so that I've been able to stop taking my medication for both of these issues. People don't recognize me. Family members, colleagues, friends have to do double takes because I look, literally, like a different person. People at work joke that I'm in witness protection. That part of it has been a real mind *** (excuse the language!). Even though the person I am on the inside has not changed, people's perception of who I am now, because I look different, is radically different. I get treated much differently, especially by strangers. For the first time in my adult like, I'm not invisible and it's like I've suddenly been granted the keys to a secret city. I'm suddenly so much more likeable and fun and attractive now that I'm thinner! At least other people think so. It's amazing the way we are so judgmental about others and how it influences even the most mundane interactions of our day. So, for those pre-ops reading this - be prepared for this. I have tried not to react to it with resentment, but it's hard, because it is unfair. I've made a point of being very open about my surgery and when I meet new people, telling them about my weight loss, as a means of educating others about obesity. People are so ignorant.

My labs have been great and I am uber diligent about my supplements. In my opinion, this is the single most important thing for a post-op. More important than exercise or diet. You have to get your vitamins, minerals and protein (which I consider a supplement) - EVERY SINGLE DAY. Not doing so will make us sick and nobody had this surgery to get sicker. It's a serious issue and anyone who knows me from these boards knows it's an issue I take seriously and I have serious concerns that the assessment centres are not properly preparing people or advising them to supplement enough to keep post-ops healthy. You will need to advocate for yourself and educate yourself about what your body needs to be healthy! Never go by what someone tells you, go by your labs and take what your body needs, not what what someone tells you you ought to need or what should be enough. Here's a rundown of my daily supplements:

After breakfast: 1500mg calcium with added magnesium, 400mg vitamin E, 50mg vitamin K2, 50,000IU vitamin A, 50mg zinc, multivitamin

After lunch: calcium and multivitamin, 50,000IU vitamin A, 50mg zinc

After snack: calcium and multivitamin

Bedtime: 600mg polysaccharide iron, B100 complex, 500mg vitamin C, 50,000IU vitamin D (x3 per week, not daily)

Plus I get a monthly injection of B12. I still take one prevacid daily, in the morning to keep my acid low as too much acid seems to make me nauseated.

So what does my diet look like? Low carb (under 100g per day for maintenance, but under 50g per day when I was losing), gluten-free, high protein (100g per day minimum) and high fat. I love my diet.

Typical breakfasts for me: Two scrambled eggs made with butter and whole milk served on top of one piece of gluten free toast with butter and cheese whiz. Breakfast sandwich made with two pieces of gluten free toast, one fried egg, 2-3 slices of bologna or 3 strips of turkey bacon with cream cheese, cheese whiz and sugar reduced ketchup. Breakfast crepes made from 2 eggs, 2 oz of cream cheese and vanilla whipped in blender, fried in olive oil, and served with lemon juice and a sprinkle of sugar. Makes 3 medium crepes. I usually enjoy one of these options with a couple of cups of tea and it take about 10-15 mins for me to eat. I make breakfast for my husband and I every morning and he eats whatever I'm eating.

During the day I usually have a protein shake with 30-35g of protein, lunch is usually a stir-fry with chicken and veg in peanut sauce, a green salad with swiss cheese and proscuitto and lots of dressing, or a greek salad with gyro meat or chicken, or a burger (if I can't find a gluten free bun, I get whole wheat and only eat the bottom or none at all) with lots of cheese, and fried onions and mushrooms. If it's a big burger from one of those gourmet burger places, I can usually eat half of one at a time and finish the other half 3 hours later for my afternoon snack. Snacks are often baked goods made with almond flour, like muffins or scones that are easy to eat on the run, high in protein and low carb. Pizza crust made from almond flour is delicious and cold leftover pizza slices loaded with meat and extra cheese make an awesome high protein snack for after work. Dinners are usually some sort of meat/cheese/veg combination like tillapia parmesan or a stuffed chicken breast with sauteed vegetables, or bell peppers stuffed with pizza toppings or ground meat/cheese/spinach/tomato sauce. We rarely eat rice, bread, pasta or any other 'carb' that isn't a vegetable with dinner. I save those as a special treat when we go out to a restaurant. With a diet like this, I don't even miss it! On the rare occasion we do have pasta, it's gluten-free and in small servings compared to the protein involved. My husband has embraced our new way of eating and has noticed that he is getting leaner as well. If I crave something sweet in the evening, I will have one or two pieces of candy or a little piece of chocolate and it satisfies me. I no longer feel the need to compulsively eat an entire bag of anything, because I know it will make me feel sick, and I know that I never want to go back to where I came from. Carbs are what the road to weight loss hell are paved with! Carbs make me feel sick and can give me gas and just generally make me feel gross, so why would I want to eat them anyway?

As for the DS rumours about BMs and gas? It's vastly exaggerated. I go once a day, everyday, normally, in the morning, like most normal people. Yes it smells worse than before surgery, but all **** stinks. I do not have any more gas than I did before surgery, actually, I probably have less now that I eat a gluten free diet, but when it does happen, it does smell worse, just like my poo. This hasn't been an issue though, because, again, like most normal people, I don't do this around other people. I've never had any problems with urgency or accidents. If this is a concern for you about the DS that is holding you back - it's really not worth worrying about. In January I had a couple of weeks where I started to notice a sour taste on my breath and was having nausea and painful bloating that caused more and smellier gas than normal, and this was a bacterial overgrowth easily treated with a course of antibiotics and probiotics and it hasn't recurred. Such issues are potential complications that can arise after any kind of bypass procedure and I accept that and consider it a minor inconvenience for what have been incredible rewards.

So what's next for me? Plastic surgery and continuing with my maintenance, which means staying diligent about protein, supplements and labs. I'm going to continue to do labs every 6 months for the next couple of years at least to ensure that nothing can slide too far without me knowing about it for too long. I've consulted with two different plastic surgeons in the past month and discussed a number of different options and procedures. Both surgeons agreed that as I was a light weight and am weight stable for 4 months now that I'm ready for plastics. Nothing more will be gained, for me, by waiting longer, so I'm going to go ahead and doing it now (most people will not be ready this fast, but I am and I'm excited). Today I booked my tummy tuck and breast lift for March 28th. After I recover from that procedure, we will evaluate the best procedure for my thighs/butt. The surgeon I've chosen (the 2nd one I saw) is telling me that he thinks I'm a candidate for the mini-thigh lift which will not leave me with a giant scar down my legs (which was what the first surgeon wanted to do!), which makes me very happy. Hopefully I'll be able to have my second procedure by the end of May and be well recovered in time for summer and possibly even rock a bikini for the first time in my life by the time July rolls around!

So - parting thoughts... this entire process will require you to educate yourself and advocate for yourself. No one will ever care about your health more than you and it is up to you, and you alone, to ensure you are taking care of your health. This means no excuses or messed up priorities. If you're struggling, ask for help and get support. Seek out healthcare practitioners who are willing to understand and work with your needs and become educated about WLS. Take care of yourself and enjoy the new life that will result and the options that are available to you that were not before. Embrace your body and challenge yourself. I'm planning a two week hike in Nepal next year, which is something I never, ever could have done before. That's exciting!

I'm not on the board as much as I used to be, my life has become so much more busy and full and I expect it to continue to be as I plan to go back to school. If you ever want info on the DS, or supplements, or just to check in with me, please feel free to send me an email at [email protected] if you have trouble reaching me here.

Thank you to everyone on this board who has shared their support, experience and knowledge. This is a great place. And thank you to those of you as well who have been a pain in the ass, because you have been entertainment and motivation and give me a reason to keep coming back here! Best wishes to all for health and happiness in your WLS journey!

That is a great posting, thanks for taking the time to post. It is especially good for people who are looking to have the surgery. One question. I was told to not take the calcium and multi together. You do not appear to have an issue with this. Since you have been having your blood tested I am assuming everything is okay. I hope you do not mind me asking why you take K2 and zinc?

Calcium should not be taken with anything containing iron, so if the multi vitamin contains iron then they should not be taken at the same time

Thanks. I didn't realise that. So I can take centrum 50t at the same time as my calcium since it has no iron. Thanks

You have it backwards - iron should never be taken with calcium as calcium blocks the absorption of iron. It is absolutely fine to take your calcium and multivitamin together. This is because the calcium in the multivitamin ALREADY blocks the absorption of the iron in the multivitamin. Adding in more calcium doesn't change the absorption of the iron, it's already been blocked. It only takes 40mg of calcium to block the absorption of iron taken at the same time. Check any multivitamin with iron, they ALL have more than this amount. This is why bariatric multivitamins often don't have any iron in them at all, because it is useless. This is why is is completely inadequate to rely upon the iron in a multivitamin as your iron supplement - you can't absorb it due to the calcium in the multivitamin.

Taking your calcium with your multivitamin is fine. They tell you not to because calcium blocks the absorption of iron, but this doesn't matter as the multivitamin already has calcium in it, blocking the absorption of the iron in the multivitamin, so it makes no difference whether you take them together or not - you're not absorbing the iron from the multivitamin either way. This is why a separate iron supplement is absolutely necessary and must be taken separate from your calcium and multivitamin.

My zinc has been low-ish by times, so I take it to prevent a deficiency. K2 helps with calcium absorption and I have thin bones so I take it to help with bone density.

Thanks. That makes sense. I am menopausal so I do not need the iron. I will however have it checked regularly incase. I appreciate your answer

Wow congrats!! Great post.

The rumours about DS and stinky gas can be true.....but you eat a proper diet and it doesn't happen to you :P I know a few DSers (over 5 years out) and when they eat crap, they smell really really bad (i've been in the house, it's terrible), but when they eat like we are supposed to eat, it's slightly smellier than normal, but not terrible.

Shouldn't scare anyone away from DS....I would think having the smelly poops would make you want to maintain a healthier diet! LOL

they need to learn some hygiene and cleaning secrets (Lysol every time!) and install good ventilators in bathrooms. I eat crap all the time and my house doesn't stink (I have kids over for play-dates all the time and they would say!)

LOL. Lysol might help, and probably the ventilators would be the big key. The fan at the one place did not work well at all, and I have never smelled anything so bad.....and that drifts through the house.