Those of you who have followed me for some time are probably aware that I suffer from debilitatingly Severe Clinical Depression and Anxiety. Often, people will PM me and ask me if and what type of impact RNY had on my depression and on the medications that I take to try to mitigate and manage my depressive symptoms.

I have to say that I have a great psychiatrist and she was really very good about closely monitoring me after my surgery to watch for signs that I might not be getting the full effect of the medications. When I had my surgery, there were not yet any studies documenting what happens to patients taking SSRIs which are among the cornerstone of the medication arsenal for dealing with depression. A small recent study released March 2012, examined the impact RNY has on patients that had been taking SSRIs to see how it effected level of the SSRIs found in their bloodstream. Their clinical research bears out what happened to me. Basically, the patients had been taking the drugs prior to their RNY. They tested the level of SSRI in the patients prior to the RNY, 1 month post op, 3 months post op, 6 months post op and 12 months post op and found that about 2/3 of the patients were likely to experience about a 50% loss in efficacy about 1 month post op, but that most patients were experiencing a rebound to close to normal levels by the time they were 6 months post op.

Here is a link to an article about the study.

I think that the take away here is that if you are on anti-depressants, you want to be sure that your health care providers are aware of this short term issue and that they monitor you closely to ensure your mental health. Remember that there are a number of other issues also at play when you have any surgery, but especially WLS because you are losing a coping mechanism that you have come to rely upon since you no longer have food as a crutch/drug of choice to lean on after surgery. Hopefully, if you do have depressive issues, you'll be working with a counselor through your weight loss phase to help you navigate the feelings, concerns, and issues that come up in a way that will allow you to maximize your weight loss opportunity and long term maintenance.

Five years ago today my life changed when I had weight loss surgery to resolve my health issues and lose the excess weight I had been carrying since I was in grade school. I am delighted that the health issues I had that led me to investigating and finally having weight loss surgery have resolved and I am maintaining the loss of the excess weight.

My Type 2 Diabetes Melitus (T2DM) has resolved with an HbA1C that runs between 5.1 and 5.3, so I no longer take medications to keep it under control.
My blood pressure which is normally about 100/65 is excellent and had dropped about 20 points.
My LDL and HDL cholesterol is fair, but considering my family history of high cholesterol, I'm delighted.
My Hereditary Hemachromatosis is well managed; I have not had a phlebotomy since my surgery.
My breathing while I sleep is much better and I no longer use a CPAP to ensure that I get enough while I sleep.

My quality of life has really gone through the roof. Among other things:

I can fit ANYWHERE; an airplane seat, booths, turnstiles, amusement park rides, etc...
I can buy clothes in any store, as long as I have enough money in my purse.
I can handle the heat of the summer so much better.
I can work in the yard without passing out.
I can tie my shoes or paint my toenails and breathe at the same time.

During the past five years, I lost all of my excess weight. I experienced a regain. I learned how to leverage the power of my tool, taking off the regain and learning to maintain a stable weight.

My only regret is that I didn't do this sooner. Not only has it improved my health and quality of life, but it has also has had a positive impact the lives of my family members.

I'm delighted I made the decision to do this and would do all over again.

The following is an excerpt from a response I made to someone who asked about getting back on track. This person has been very successful in her weight loss journey, but has recently experienced some regain. Statistically, her regain is within the norms for 'bounce back' weight, but it was how she regained the weight that distressed her and it was nearly a mirror image of what happened to me a few years ago. I really felt her distress and fear, so I wanted to reassure her that all is not lost, that we always have our tool and we can get control of it now, even when we couldn't for so many years before. So if you have have arrived at maintenance and are struggling with some unwanted regain or if you are only thinking about WLS or in the process of losing and want to know if you can and will be able to maintain your weight after you lose it, read on...

Okay, so the real question is how to get back on track and if it's a realistic possibility and probability. I'm here to tell you that it is both possible and probable that you can reverse the tides and get back to where you are happy and be able to stay there. I have to tell you that I too was just terrified because I knew from my previous experience that 'diets' just don't work for me. I'm an overgrown 3 yr old and if you tell me I can't have something, then.... I will. That scared the proverbial pants off of me. After mulling it over a bit, I decided to try a new tact. One to get the unwanted extra pounds off and another, related tact to keep my weight where I want it to be.

So, to take off the weight, the two biggest things I did were to log my intake and activity and to cut back on simple carbs... cut back, not cut out. I made sure to 'take care of business' with every meal and snack, making sure I was eating 5 to 6 times a day. When I say 'take care of business' I mean that I made sure that I got in 4 to 6 ounces of protein, then followed that with colorful, complex carbs. I also made sure that I wasn't drinking any fluids within that 30 minute window before, during and after my meal so that I could allow my pouch to work for me and help me really regulate my intake to ensure I wasn't taking in more calories than I needed. I maintained a caloric intake of about 1000 to 1200 calories a day when I was working on losing the weight. Logging really helped me think about what I was ingesting and if it was supporting my goals or undermining them. This helped think of things in a positive light. Is this choice going to help get me to where I want to be or submarine my attempt to achieve and maintain a healthy and active life? If not, I often would think twice and let it go without the burden and baggage that comes with feeling deprived. I have to say that I did occasionally indulge while I was losing, but not often because I had my eye on the proverbial prize and I was delighted at the result I was getting; most of the time the 'indulgence' I wanted at the moment faded when I 'weighed' it against my goals. To be honest, the weight came off relatively easily. Much more so than I thought it would.

Now that I've taken the excess weight off, I don't really log anymore unless might weight ticks back up out of it's normal range. If that happens, I start logging again and am able to easily trim off the few pounds.

I honestly think that losing the weight and then maintaining it, all comes down to awareness and accountability. If you think about it, I'll bet that you've been playing a bit of 'hear no evil, see no evil, speak no evil' as it relates to what you are consuming. You 'know' you are going off track, but tend to not want to see the evidence of it. We all have to find ways to be aware and accountable and to be honest what works when we are losing is not necessarily what works in maintenance; I think that this is one of the main reasons we tend to falter in maintenance. Whatever we did to maintain awareness and accountability in our weight loss phase may not necessarily work for us anymore. Unfortunately, no one has told us that we need re-evaluate how we are going to remain aware and accountable as we work to maintain our new found weight and it's resulting health and quality of life benefits. It took me a while to find what works for me. It may take you a while to find what works for you, but I'm sure that you can and will.

 

I had to spend the afternoon in a recliner at an infusion center this afternoon to receive a dose of InFed, in iron infusion.

As some may know, I have a hereditary condition called Hemochromatosis that causes my body to load iron excessively. Untreated, it can and does cause significant damage to all major organs. One of the reasons that I chose a malabsorbtive procedure was to leverage the malabsorbtion of iron. Before my RNY, I had regular phlebotomies to drain off the excess iron from my body. After my RNY my iron levels dropped to and remained at a safe level. For many years, I have been a Red Cross blood donor, but I hadn't donated for a couple of years. When the Red Cross contacted me last year to ask for a donation, I said I'd be glad to donate and did twice. My serum ferritin dropped. This year I did the same thing, and my serum ferritin tanked down to 5, but I didn't think about the correlation of the donations to the drop in my serum ferritin level. Now I feel like an idiot. I should have realized that donating was risky for me. At any rate, I have been suffering from severe bouts of insomnia, extreme ehaustion, feeling achy all over, especially in my hands and feet, along with restless leg syndrome. I've also been experiencing more significant depression, confusion, fragmented thoughts, short term memory loss, etc... Today I saw my Hematologist and she said that all of the symptoms I'm experiencing are related to Iron Avidity. She ordered an InFed iron infusion for me this afternoon and cautioned me to no longer donate to the Red Cross; while it is a worthy cause if you have the bandwidth, I no longer am able to make donations and maintain a healthy serum ferritin level. She believes that once my serum ferritin is brought up through the infusion, I'm likely to be able to maintain it as long as I don't make any more donations. I am hoping to see improvement soon. 

Someone recently asked me what I thought they needed to do to make sure that they were successful  at losing the excess weight and just, if not more importantly, keeping it off. I think that one of the things is being open to change. What that means to each of us can be very different from one person to another. It is clear that we each have to find what works best for us where we are in our own journey. Not only do we need to realize that what works for one person may not work for another, but what worked for us at one juncture of our journey, may not be as effective in another. I guess I'm saying that we need to be open to change.

When I was losing weight I developed a whole set of skills and tools that helped me to take off the excess weight. Of course, my surgery did a great deal of the work for me. More than I think I acknowledged. That said, I too worked hard; I followed my program's dietary plan. It also meant that logged my intake and activity on a daily basis. This helped me develop an awareness of my intake and the value of that intake. All of these things helped me get the weight off, but they were not enough to help me keep it off.

As I got closer to maintenance, I thought that I understood what I needed to do to maintain my weight loss. While I had developed some skills that helped me be more aware of the value of my intake and activity, I didn't really fully appreciate weight of understanding the correlation of food and emotion. Learning to identify and more importantly for me, acknowledge dangerous behavior patterns have been key to my long term success in keeping the weight off. The tools and skills I use now to keep the weight off, are related to, but different than the skills I used to get the off.