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Surgeon Testimonial

Pablo Gazmuri, M.D.
'Love him! He's great - takes plenty of time to talk
I am a 35 year old at-home mom of 6 year old boy/girl twins. I am 5'2.5" and went into this process at 232lbs.
06/20/06 -  222lbs   SURGERY! (-10 overall)
07/18/06 -   197lbs   (-25 this month / -35  overall)
08/22/06 -  176.2lbs (-20.8 / -55.8)       04/17/07 -  127.8lbs (- 4.2 / -104.2) 
09/19/06 -   162.4lbs (-13.8 / -69.6)       05/22/07 -  131.8lbs (+ 4.0 / -100.2)
10/17/06 -    151.8lbs (-10.6 / -80.2)       06/19/07 -  132.0lbs (+ 0.2 / -100.0)   *TT
11/21/06 -    141.6lbs (-10.2 / -90.8)        07/17/07 -  129.6lbs (- 2.4 / -102.4)
12/19/06 -    137.2lbs (- 4.4 / -94.8)        12/18/07- 128.0lbs (-104) * 18 months!
01/23/07 -   133.6lbs (- 3.6 / -98.4)             
02/20/07 -   131.8lbs (- 1.8 / -100.2)            
03/20/07 -   132.0lbs (+ 0.2 / -100.0)                      

Carolyn L.'s Blog
My Post-op journey


18 months - 1 year below goal
on December 21, 2007 7:04 am
So, it's the end of December, and I realize that it's been 18 months since that fateful day that I entered the hospital.  It's also been one year since I hit my goal weight of 135.  I've been below that goal weight ever since.  

I hover between 125 and 132, looking and feeling best where I am right now at about 128.  125 is just too thin, though the 'ideal weight' for my height of 5'2.5" is 122.  I'm muscular and large shouldered (though without hips) so at the lower weight I start to look a little scary.  

I started back at work this week after being an at-home mom for 7 years - YIKES! - as a computer programmer.  I'm still working out how I'm going to keep up with my exercising.  At least work is close enough to home that in the warmer months I can bike the 6 miles to work.  These long New England winters pose more of a challenge.

Well, that's where I am right now, just chugging along, trying to live life as a normal thin person.  What a year and a half it has been!
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Top 10 Mistakes WLS patients make...
on August 17, 2007 4:39 am

I copied this from someone else's post.  I certainly make some of these mistakes... especially drinking soda and alcohol.  But it is a good list to keep in mind!


1st Mistake:  Not Taking Vitamins, Supplements, or Minerals

 Every WLS patient has specific nutritional needs depending on the type of surgery you have had. Not only is it a good idea to ask your surgeon for guidelines, but also consult with an experienced WLS nutritionist. Understand there is not a standard practice that all surgeons and nutritionists follow in guiding WLS patients. So, it is important to do your own research, get your lab tests done regularly, and learn how to read the results.  Some conditions and symptoms that can occur when you are deficient in vitamins, supplements, or minerals include:

Osteoporosis; pernicious anemia; muscle spasms; high blood pressure; burning tongue; fatigue; loss of appetite; weakness; constipation and diarrhea; numbness and tingling in the hands and feet; being tired, lethargic, or dizzy; forgetfulness, and lowered immune functioning.

Keep in mind, too, that some conditions caused by not taking your vitamins, supplements, or minerals are irreversible.

2nd Mistake:  Assuming You Have Been Cured of Your Obesity

A "pink cloud" or honeymoon experience is common following WLS. When you are feeling better than you have in years, and the weight is coming off easily, it's hard to imagine you will ever struggle again. But unfortunately, it is very common for WLS patients to not lose to their goal weight or to regain some of their weight back.

A small weight regain may be normal, but huge gains usually can be avoided with support, education, effort, and careful attention to living a healthy WLS lifestyle. For most WLSers, if you don't change what you've always done, you're going to keep getting what you've always gotten -- even after weight loss surgery.

3rd Mistake:  Drinking with Meals

Yes, it's hard for some people to avoid drinking with meals, but the tool of not drinking with meals is a critical key to long-term success. If you drink while you eat, your food washes out of your stomach much more quickly, you can eat more, you get hungry sooner, and you are at more risk for snacking. Being too hungry is much more likely to lead to poor food choices and/or overeating.

4th Mistake:  Not Eating Right

Of course everyone should eat right, but in this society eating right is a challenge. You have to make it as easy on yourself as possible. Eat all your meals--don't skip. Don't keep unhealthy food in sight where it will call to you all the time. Try to feed yourself at regular intervals so that you aren't as tempted to make a poor choice.  And consider having a couple of absolutes: for example, avoid fried foods completely, avoid sugary foods, always use low-fat options, or only eat in a restaurant once a week. Choose your "absolutes" based on your trigger foods and your self knowledge about what foods and/or situations are problematic for you.

5th Mistake:  Not Drinking Enough Water

Most WLS patients are at risk for dehydration. Drinking a minimum of 64 oz. of water per day will help you avoid this risk. Adequate water intake will also help you flush out your system as you lose weight and avoid kidney stones. Drinking enough water helps with your weight loss, too.

6th Mistake:  Grazing

Many people who have had WLS regret that they ever started grazing, which is nibbling small amounts here and there over the course of the day. It's one thing to eat the three to five small meals you and your doctor agree you need. It's something else altogether when you start to graze, eating any number of unplanned snacks. Grazing can easily make your weight creep up. Eating enough at meal time, and eating planned snacks when necessary, will help you resist grazing.   Make a plan for what you will do when you crave food, but are not truly hungry. For example, take up a hobby to keep your hands busy or call on someone in your support group for encouragement.

 7th Mistake:  Not Exercising Regularly

Exercise is one of the best weapons a WLS patient has to fight weight regain. Not only does exercise boost your spirits, it is a great way to keep your metabolism running strong. When you exercise, you build muscle. The more muscle you have, the more calories your body will burn, even at rest!

 8th Mistake:  Eating the Wrong Carbs (or Eating Too Much)

 Let's face it, refined carbohydrates are addictive. If you eat refined carbohydrates they will make you crave more refined carbohydrates. There are plenty of complex carbohydrates to choose from, which have beneficial vitamins. For example, if you can handle pastas, try whole grain Kamut pasta--in moderation, of course. (Kamut pasta doesn't have the flavor some people find unpleasant in the whole wheat pastas.) Try using your complex carbohydrates as "condiments," rather than as the center point of your meal. Try sprinkling a tablespoon of brown rice on your stir-fried meat and veggies.

9th Mistake:  Going Back to Drinking Soda

Drinking soda is controversial in WLS circles. Some people claim soda stretches your stomach or pouch. What we know it does is keep you from getting the hydration your body requires after WLS--because when you're drinking soda, you're not drinking water! In addition, diet soda has been connected to weight gain in the general population. The best thing you can do is find other, healthier drinks to fall in love with. They are out there.

 10th Mistake:  Drinking Alcohol

If you drank alcohol before surgery, you are likely to want to resume drinking alcohol following surgery. Most surgeons recommend waiting one year after surgery. And it is in your best interest to understand the consequences of drinking alcohol before you do it.

Alcohol is connected with weight regain, because alcohol has 7 calories per gram, while protein and vegetables have 4 calories per gram. Also, some people develop an addiction to alcohol after WLS, so be very cautious. Depending on your type of WLS, you may get drunker, quicker after surgery, which can cause health problems and put you in dangerous situations.

If you think you have a drinking problem, get help right away. Putting off stopping drinking doesn't make it any easier, and could make you a lot sicker.

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The REAL reason we have this surgery!!
on July 5, 2007 1:12 pm
I just received a generic form from my PCP today that has me practically in tears.  Two years ago when I received a similar form from her the news was not good.  Then, my total cholesterol had climbed to 290, I've blacked out the rest of the numbers but they weren't good.  For years I had been in denial because high cholesterol runs in my family (I had a total cholesterol of 218 when I was 18 and in good shape), but my weight and cholesterol were truly out of control.

Today the news was quite different.  My physical was scheduled very close to my 1 year surgiversary, so I expected my numbers to be better, but I am blown away.

Total Cholesterol:  164    (desirable level is less than 200)
HDL:  66   (Desirable level is greater than 40)
LDL:  90   (Desirable level is less than 100)
Risk Factor Ratio: 2.5   (Lowest - less than 3.0)
Triglycerides:  41   (Desirable level is less than 140!)

I know I look better and feel better and now I know that I have added years to my heart!!!! 
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Almost a year
on June 4, 2007 11:45 am
Well it's been almost a year and what a year it's been...   I'm 100lbs lighter, I'm wearing a size 2P pants instead of a 22 or 24, my thyroid dose is down to 100mcg from 275 and I'm in enviable physical fitness.  I work out with a trainer 2 days a week (I started last August at 6 week out) and she tells me I have the strongest core of any of her clients.  She's had to research new exercises just for me.  Crazy.  In March I got my first (and probably last) tattoo - 3 butterflies - to celebrate turning 35 and restarting my life.  I cut my hair off and even added highlights for the first time ever.

On June 26th, one year and one week from my RNY, I'll be having a tummy tuck.  Due to my "light-weight" status and all of the core work I've done, the repair work I need is minor, especially considering I had my twins at over 245lbs!  According to my plastic surgeon a simple tummy tuck without the anchor cut (the vertical incision often needed) is all I need.  I think my butt needs some help but my ps talked me out of it.  I thought plastic surgeons were supposed to convince you that you needed all sorts of work, but she talked me out of a butt lift and talked me into waiting a couple of years for a breast lift/augmentation because she's seen a lot worse in woman my age (didn't know how to take "my age" - I'm only 35!!) who haven't lost a significant amount of weight.

I've had only 2 minor problems associated with the surgery.  The first was only a problem during the transition.  I've had hypothyroidism - completely uncontrolled - since I was 17.  I always needed more and more thyroid hormone.  After the surgery, that trend reversed itself much faster than expected.  The endocrinologists at the clinic have been fascinated - one is actually talking about doing a paper on me.  The long time effect is good - my hypothyroidism is under control at a low dose; in the short term I've spent a great deal of time taking too much thyroid hormone - they've dropped it every 2 months but man I felt like CR@P at least a week or two out of every one of those cycles.

The other problem was a few months ago I had a lot of burning in my pouch.  I had an upper GI to check for an ulcer - luckily it wasn't that.  Basically, the structure of my pouch is an artistic, customized one.  Because I told my surgeon that my tendency was to eat only once or twice a day, he created my pouch to be larger than average but the opening between the stomach and intestine is smaller which keeps the food in the stomach longer.  Basically, I had been doing things I shouldn't - drinking diet coke and appletinis and not drinking enough water.  As long as I'm more careful about these things I'm usually OK and if I get burning from acidic foods drinking a lot of water helps.  At first the water makes it worse, but if I persevere the pain goes away.

All in all I wouldn't change a thing!  Even the stomach pain is good - it reminds me to be good!
 
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Upper GI - 9 months
on March 30, 2007 11:45 am
My surgeon has ordered an upper GI because of pain in my gut.  I've been worried about an ulcer, but I couldn't possibly be that normal...

Well, I had my Upper GI this morning... actually, they did it twice.  The first time they found nothing wrong, until the last x-ray.  Then they noticed that the barium pill they had given me earlier was still at the top of my pouch.  The head of radiology joined the party and redid the Upper GI focusing on that spot.  They found a bump on the top of my pouch that pills (and perhaps food) are getting caught in.  In order to wash out the pills I need to lay on my stomach and drink water, then stand up so they won't go back in.  Hopefully when I talk to my surgeon (he'll get the report later today) he'll have a better solution.  Until then every time I take pills (or feel like something is stuck) I need to do my little laying down water trick... this could be interesting when I'm not at home!!

**Update:  I talked to my surgeon.  He doesn't think the 'bump' is a problem.  According to him the pills wouldn't stay in the 'bump' with normal moving around.  On the other hand, he noticed that the opening from my pouch to the intestine is rather small and that could be causing the problem.  He's reluctant to fix it immediately because a small opening can be beneficial in keeping weight off in the long run.  However, I need to cut out (or at least down) the 'bads' I had let slip back in like diet coke and appletinis!
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My Story

I'm going to use this as my PRE-OP story. I haven't been great about updating anything but pictures post-op so I'll start the post-op stuff in the blog. Here's a pre-op time-line:

01/25/2006 - Got referral from PCP
01/26/2006 - Attended New Patient Instructional Meeting
03/01/2006 - First appointment with the surgeon's office - 4 hours long, included appointment with psychologist, nutritionist and surgeon, plus blood tests.
03/02/2006 - Attended Community support group meeting (required)
03/09/2006 - Attended '0 to 6 month' support group meeting (required)
03/22/2006 - Appointment with surgeon.
05/23/2006 - Preop - Blended Diet Review Group
06/07/2006 - Appointment with surgeon.
06/13/2006 - Gallbladder Ultrasound
06/13/2006 - Pretesting
06/20/2006 - SURGERY!

January 2006

1/20/2006 - I am a 33 year old (soon to be 34) stay-at-home mom of 5 year old boy/girl twins. I am 5'2" and currently 230lbs (BMI 42.1). I was a slim child and teenager until my senior year of High School. After some major traumas, beginning with the death of my older brother, the weight began to climb. With the weight climb came the yo-yo dieting that put 20 - 50 lbs on each time. By the time I met my husband I was hovering around the 200 lb mark and in the last 9 years I've bounced around from 200 to 240, mostly 220-240.
I am meeting with my PCP next Wednesday (1/25) to ask for a referral. Right now I think I'm going to go with Newton-Wellesley.

1/23/2006 - I applied online for an appointment with Dr Gazmuri at Newton-Wellesley and they just called to set up an appointment. My first (4 hour) consult with him (and everyone else there) is March 1. I'm nervous and getting a little nauseous now. Am I jumping the gun? I haven't even met with my PCP to get the referral yet. Hope she give it! I've also got the New Patient Instructional meeting Thursday night. My husband, Keith is coming with me. Now if I can just get through Wednesday...

1/29/2006 - Dr Antkowiak (my PCP) was great about the referral, so that was no problem. That was Wednesday and Thursday night I went to the New Patient Instructional Meeting at Chestnut Surgical & Newton-Wellesley Obesity Associates (http://newtonwellesleywls.com/content/16.htm). My husband, Keith came with me and he came home feeling better about the whole thing. I also told my sister, who is a primary care doctor and a size 4 after 4 kids, and she was really supportive about it. She told me that she had been thinking I should do it for some time but didn't want to push me if I wasn't emotionally ready. Next weekend is my birthday and we're going down to my parents' house on Cape Cod. I'm planning on telling them at that time. I'm grateful my sister will be there on my side. My parents, like my sister are thin and healthy and really don't understand why I just can't stop eating and lose the weight already! We'll see...

February 2006

2/4/2006 - Happy Birthday to me! I'm now 34!

2/6/2006 - Well, I talked to my parents this weekend and despite all my fears, they were great. They are happy I'm going to be doing something to get healthy and are willing to help me out when the time comes. Also I signed my twins up for Kindergarten today - eek! I can't believe how big they both are.

2/26/2006 - I've got 2 appointments this week. Monday I meet with my neurologist (migraines) and Wednesday is the big 4 hour appt with Dr Gazmuri (the surgeon) and his practice.

March 2006

3/1/2006 - My appointment with the surgeon and his psychologist and nutritionist went well today. They all approved me!! They'll be sending in my paperwork to the insurance company tomorrow. YAY!! They tell me I should be able to have the surgery in June. I'm very excited! My surgeon requires me not to gain weight between now and the surgery or they'll postpone it! So I need to stay on the straight and narrow and try to lose some weight.

For "Light-Weights" with a BMI just over 40 like myself (about 42) I can allay a fear I had. I was worried if I lost weight like I'm required to and my BMI went below 40 that the insurance would un-approve me. But the only weight the insurance sees is from your first visit or from your PCP's referral, so that's not a problem.

03/13/2006 - I have a date!! I got a letter in the mail today and my surgery will be on June 20th! YAY! I could have had it in May, but I'll still be in school and so will the kids (preschool) so I chose to wait until June.

03/22/2006 - Had my second appt with the surgeon today. I was down 4 pounds (YAY) and everything else went well. My next appt with be the blended diet review on May 23rd.

April 2006

May 2006

05/03/2006 - I guess April just wasn't the month for me to update! I've been having trouble keeping my weight down. I've gained back the 4 pounds I lost between the first and second appts. Actually, I gained more than that, but I managed to get back down to my 'start' weight (from my 1st appt with the surgeon). I have a month until my next appt and I'm getting nervous.

05/10/2006 - Well, being sick with either a stomach bug or bad food for 2 days sure helped with the weight loss thing - I'm down to 220 - nine lbs less than I was this time last week. Definitely not a good way to do it. Actually yesterday I was 217, but I gained back 3 lbs once I re-hydrated myself. Hopefully I can keep off the rest or at least gain back less than 4 lbs.

05/26/2006 - I had the Blended Diet Review this week. It was very long and very informative. They actually covered a lot more that the diet. They also covered everything that will happen at the pre-op testing and everything that will happen during the time that we're in the hospital. My doctor likes to keep his patients in the hospital for 4 days after surgery so it looks like I'll be going home on Friday (surgery on Tuesday the 20th) which is good because the kids will be with my MIL from Monday until Sunday, so I'll have a couple of days home before they are there. (Weight back up to 227)

June 2006

06/13/2006 - I went through pre-op testing today. I had to bring the twins down to my parents at the cape last night, so I left the cape at 5:45am this morning to head up to Newton-Wellesley. With morning rush hour the normal hour and 1/2 ride took 3 hours so I got there just in time. The gallbladder ultrasound went well - no stones and the gallbladder looks really healthy, so that's good. Then it was across the hospital and up 6 flights to the surgeon's office for the final weigh-in. I'm back down again (to 224) so all is well there. They signed off on me so it was back across the hospital for pre-testing with the surgical center. I answered questions for a nurse, then an anesthesiologist, then an intern (who actually asked me if I've tried dieting... DUH!) then the intern's resident, then another nurse, then I went for a blood draw. By the time I left 3 hours later my brain was fried. But, my last hoop has been jumped and in 7 days my new life begins!!!!

 

 

Weight Loss Chart:

Date Weight Loss / Total

Preop 232.0

06/20/06 222.0 ( 0.0 / -10.0)
06/27/06 212.2 (-9.8 / -19.5)
07/04/06 207.6 (-4.6 / -24.4)
07/11/06 202.0 (-5.6 / -30.0)
07/18/06 197.0 (-5.0 / -35.0)
07/25/06 192.5 (-4.5 / -39.5)
08/01/06 188.0 (-4.5 / -44.0)
08/08/06 186.0 (-2.0 / -46.0)
08/15/06 180.4 (-5.6 / -51.6)
08/22/06 176.2 (-4.2 / -55.8)
08/29/06 171.2 (-5.0 / -60.8)
09/05/06 169.0 (-2.2 / -63.0)
09/12/06 163.6 (-5.4 / -68.4)
09/19/06 162.4 (-1.2 / -69.6)
09/26/06 158.4 (-4.4 / -73.6)
10/03/06 154.0 (-4.0 / -78.0)
10/10/06 151.8 (-2.2 / -80.2)
10/17/06 151.8 ( 0.0 / -80.2)
10/24/06 147.6 (-4.2 / -84.4)

10/31/06 144.8 (-2.8 / -87.2)
11/07/06 144.4 (-0.4 / -87.6)
11/14/06 142.4 (-2.0 / -89.6)
11/21/06 141.6 (-0.8 / -90.4)
11/28/06 140.8 (-0.8 / -91.2)
12/05/06 139.8 (-1.0 / -92.2)
12/12/06 137.8 (-2.0 / -94.2)

12/19/06 137.2 (-0.6 / -94.8)
12/26/06 134.8 (-2.4 / -97.2)
01/02/07 134.6 (-0.2 / -97.4)
01/09/07 133.4 (-1.2 / -98.6)
01/16/07 132.6 (-0.8 / -99.4)

01/23/07 133.6 (+1.0 / -98.4) *new scale - mine broke
01/30/07 134.8 (+1.2 / -97.2)
02/06/07 131.8 (-3.0 / -100.2) *Broke 100!!
02/13/07
02/20/07