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Surgeon TestimonialJeffrey A. HunterI only felt like I had a real, personal chat with Dr. Hunter when I met him for my first post-op visit. Don't get me wrong, he was pleasant enough the first time I met him but that was just 10 days before surgery and he was all business. On that occasion, he was trying to establish whether I had done my homework...I think. He queried why I had chosen this surgery and I responded by asking whether he wanted to know why I had opted for weightloss surgery in general or the vertical sleeve gastrectomy in particular. He pointed to the latter but I got the sense that he was trying to suss out my state of mind rather than the particulars of the different surgery options. As I belted out my response, he either nodded in agreement or corrected any misconceptions of mine. I was very satisfied that he was a consumate professional who knew his craft. That was by far the most important criterion by which I assessed the man who was going to perform intricate surgery on me. That meeting lasted all of 10 minutes.
During my hospital stay, my perception changed a little. As I was being prepped for surgery in a very little, impersonal stall, like a plane waiting for take-off, Dr. Hunter popped his head in and his beaming smile showed a different side of him. We made small talk about my trip from Canada the previous day and then he said he'd see me in the theatre. That didn't materialise because I was knocked out no sooner was I wheeled into theatre.
We did meet post-op in the ward and during the barium test and, once again, Dr. Hunter was all business. He managed a wry smile once but his general seriousness made me wonder whether something had gone wrong.
Cut to our first follow-up meeting and he was a different man, attentive but jovial. He had lots of good information for me about diet and dealing with acid reflux. He was very careful to emphasise his availability to discuss any problems that I might have and invited me to correspond by phone or e-mail whenever I wanted.
The staff in general at Virginia Mason is outstanding, equally so Dr. Hunter's. I dealt with his nurse, Steve Geary who was very caring and extremely efficient at walking me through the various hurdles necessary to get to surgery.
Both Dr. Hunter and his staff have a clinical, almost robotic way of informing you of the risks of surgery. It wasn't quite the way the advertisers of pharmaceuticals on television reel off the side effects of their products, but you got the sense that this was a mandatory, legal commitment and there was no bullshitting around it. I'm a professional and didn't mind it but people who require more molly coddling might find it a bit impersonal.
Aside from the first follow-up, there's no structured after-care other than a three-, six- and 12-month follow-up, then annually thereafter. You're also invited to attend the monthly support group meetings and info sessions. They tend to cover all the bases and leave you a bit of slack to see where you slot in.
Overall, Dr. Hunter is one of the best medical practitioners I have ever encountered and would recommend him to my own family.
If you would like to see the end result of Dr. Hunter's work, please feel free to follow my progress via. my blog on Obesityhelp.com or visit my personal one at www.neevensoodyall.blogspot.com.
Take-off on March 3, 2013 1:12 am
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The past week involved a lot of poking and prodding. It was a dual anniversary: my routine annual physical, and 2-yr lab tests since my VSG. Additionally, I have decided to resume my personal aviation interests in Fort McMurray, Alberta once I start work as a heavy equipment operator in the mines there late March. As my family doctor also does aviation medicals, I tacked one onto my annual physical to dodge the cost of duplicating some of the tests.
From a weight-loss surgery perspective, this represents several positive outcomes. My health is that of a normal person. Except for cholesterol which is marginally higher than the risk-free cap, everything else would not mitigate concern. My blood sugar levels were on the high side of normal, though coupled with other tests for diabetes, failed to indicate the disease. Resting blood pressure was one-twenty over seventy. There were no deficiencies where nutrient levels like iron, vitamin B12, calcium, etc. were concerned suggesting that there was no mal-absorption through my child-sized pouch. At the two-year mark, the surgery has been a resounding success...in more ways than one.
As a teen growing up in racially segregated South Africa, I wanted to become a commercial pilot but, in 1982 when I matriculated from high school, South African Airways did not hire non-Whites as pilots. I rejected their suggestion that I join the country's Air Force and link arms with my own oppressor. Non-Whites could become pilots at their own expense; there just wasn't any work for them with the national carrier. With full legal protection from the government, those jobs were reserved for White pilots leaving the Air Force. Twelve years later as a young, fit lecturer of economics at a University just outside of Johannesburg, I took my first flying lesson on my own dime. Within a year, just before the demise of apartheid, I went on to earn a private pilot's licence with a night rating. Pat myself on the shoulder and snub my nose at the regime, yeah! Then, disaster. Twenty years following high school, I was too fat to fit behind the controls of a Cessna and would not have passed the South African flight medical. I let the licence that I was so proud to have attained against all odds, lapse. By this point in the South African political landscape, we had a non-racial, democratic government in power. I no longer had anybody--Black or White--but myself to blame for the untimely end to my flying days.
In 2009, I was diagnosed with Type II diabetes. On the advice of my surgeons I halved my diabetes medication within two weeks following my vertical sleeve gastrectomy in December 2010. As my weight plummeted, so did my blood sugar levels. A month after surgery, I was taken off the medication and haven't needed any in the two years since. I get my blood tested every three months, and have an annual eye inspection for macula degeneration, a side-effect of diabetes. No physician in his right mind would diagnose diabetes if he were to look at my medical history of the past two years. My doctor is the only person who, whilst rubbing his hands with glee at my good lab results, still thinks that I'm controlling the 'silent killer' with diet and exercise. My surgeon, on the other hand, subscribes to the numerous research papers that point to an actual reversal of the disease in countless WLS patients, possibly through a hormonal change after the resection of the fundus. I sill eat chocolate and sweetened frozen yoghurt, and make a point of doing so the week before my blood tests. Mind you, I'm also training with weights which is known to be effective at managing blood sugar levels in diabetics. Now that I can exercise again, I'm not going to stop just to prove a point. I just wish that my doc would stop filling out forms indicating diabetes in my health history. It's already cost me a place in the Canadian Armed Forces.
I'm giddy with excitement at the prospect of flying again. My doc also gave me the nod to resume scuba. Although back on the squash courts, my return was cut short after a hamstring tear. Evidently, it hasn't registered in my brain that I sill have some 50 lb to shed before I can go flat-out. Except for the grey whiskers, all-in-all I seem to have turned back the clock some 20 years.
The Larger Circle on May 18, 2012 6:53 pm
As much as the final decision to have surgery to disrupt food addiction rests with an obese person, for many there is a circle comprising family and friends that is involved in the discussion. In this chatter, several questions are raised and answered. For example, the answer may be conclusive that the battle against weight gain has been lost and only a drastic, surgical solution is required. There may not be consensus in one's circle about that and even the patient may have doubts, but by the time you're in the operating room and about to undergo voluntarily this restructuring of your digestive system, you've pretty much come to terms with your decision. In the two weeks post-op, as you're sucking down protein shakes for your very survival and battling GERD, you may question your decision, wondering what on earth you did to yourself. As the months roll on and the incisions heal, the GERD resolves and, most-importantly the weight falls miraculously off, you may wonder why you left it this long to get your life back.
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Some pre-op questions are left unanswered and indeed are impossible to answer. Will all this weight really come off? What will life be like when it happens? How long will it take?
All the while, there is the circle to which the weight-loss surgery (WLS) recipient feels he owes answers and explanations. In the case where the cost of the surgery was picked up by someone in that circle, there is almost a guilt-driven obsession to vindicate the decision to have WLS. Understandably. But what of the others, like those who are genuinely concerned? What of the cynics, the cheerleaders, the jealous, the curious observers and the followers, all of whom might be looking for inspiration and answers their own questions, or waiting for you to fail? In the furthest recesses of your mind you can't help but feel that you owe everyone a steady update on your progress.
My immediate circle comprises my wife and she was the only person to whom I felt I owed answers. Because we live far away from our relatives, our larger circle in the Pacific Northwest of America is a group of close friends who have been nothing short of supportive. Beyond that, family and friends interact with us through the odd visit but consistently electronically and through social media. The encouragement that I have found through them has been astonishing. If the naysayers exist, they have remained refreshingly quiet. A few of my fellow WLS alumni have not been as fortunate and have endured jealousy and criticism quite unbecoming of civilized society. I hope that it makes them stronger, and that they realise that they control who remains in their circles. Life is tough enough as it is so they should surround themselves with people who make it bearable.
Along my journey that has been almost two years in the making since my first discussion with a surgeon, but 17 months since surgery, I have shared honestly my experience with my extended circle. Most of it has been positive as expected. I also wrote of the pitfalls and frustrations. Despite noble pretensions of wanting to be a role model and inspiration, a latent vanity exists. It may be a defense mechanism against a failed career (I was high school valedictorian, have an Ivy League pedigree, but now work part-time hours for minimum wage in an exploitative call centre whose employment practices are nothing short of a glorified sweat shop), an effort to show that I'm still good at something--writing, if nothing else. In the end, there's a niggling need to explain, justify and vindicate myself to everyone for a decision that was mine to make in the first place.
Hot on the heels of that morbid declaration, I find a positive. Somewhere, somehow, after a lull in motivation mostly influenced by our dreadful Winter, I have started earnestly in the gym again. My initial 13-week program last August produced fantastic results during which I gained muscle mass but lost an overall 22 lb (10 kg), then nothing. During an especially refreshing 9-night vacation in Miami, I threw caution to the wind, ate junk food, wolfed down chocolate and slurped decadent ice cream. I gained 10 lb.
At the start of this week, I found as expected that I would not be as strong as I was last year. Funny that even in Miami during an upper body weight session at the hotel, I was able to lift heavier than I could this past week. It's amazing how quickly the body loses its fitness and strength. Then again, I'm just happy that, since my WLS, I have progressed to the point where just a few sessions in the gym can bring me back to the point where I can set goals again. I saw out my sixth session this week with a bike ride this morning. It was a roller-coaster week at the beginning of which I was nowhere near my maximum training weights from last year, then ended with a lower body session where I could have lifted heavier than ever. I restrained myself to avoid injury but am eying setting some new levels next week. Even as I contemplate that, I'm making longer term plans. Come August and in time for our next onslaught of wet weather, when my membership expires at my current gym which has a swimming pool, I'm thinking of joining one across the road from me which has squash courts. I'll drop in at the pool now-and-again when my knees get shot from the squash and I want that unique cardio lung-burn from swimming.
An Active Mind on December 21, 2011 1:25 am
"Monotony collapses time; novelty unfolds it. You can exercise daily and eat healthily and live a long life, while experiencing a short one. If you spend your life sitting in a cubicle and passing papers, one day is bound to blend unmemorably into the next—and disappear. That’s why it’s important to change routines regularly, and take vacations to exotic locales, and have
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as many new experiences as possible that can serve to anchor our memories. Creating new memories stretches out psychological time, and lengthens our perception of our lives." - Joshua Foer, Moonwalking with Einstein.
Countdown to First Anniversary on December 18, 2011 1:04 am
With a week to go to the anniversary of my bariatric procedure, I have been reflecting quite a lot on what the past 52 weeks have meant to me. They will undoubtedly go down with many favourite cliches. "Got my life back," and, "Given a second chance," come to mind. Suffice it to say that there is no substitute for even improved health, let alone good health. A body that is malady-free after grand weightloss is quite simply a bonus.
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52 weeks ago, exactly seven days before a Dec 23rd surgery last year, I was becoming increasingly anxious. It was the third day of a 10-day pre-op diet comprising protein shakes for breakfast and lunch, unlimited greens from lunchtime onward, and a piece of protein and sliver of carbohydrate for dinner. The diet had two purposes: one, to reduce the amount of fat in the liver which would induce a state of ketosis (in which the body seeks fat and protein stores for energy rather than glucose) and, two, to reduce the size of the liver in order to increase the amount of space available for the surgeon to do his work, thereby minimizing the risk of damage to the liver. I was just beginning to cope with the diet as the hunger pangs began to subside. The sensation was not new to me; I had been in similarly happy states of weightloss from countless diets before. This time, it was euphoria mixed with dread and a dose of anxiety. The euphoria was the usual glee that accompanies shedding a few pounds. Also, I was still in joyful disbelief at my good fortune for winning approval of funding for the surgery. At the same time, however, I was harsh on myself for letting myself deteriorate into a preventable condition of obesity that now required surgery to correct. As often as it flashed through my mind that I could do this without medical intervention, the counterarguments flooded my thinking of how many times I had failed at dieting and what enormous secondary benefits followed WLS. High blood pressure, Type II diabetes and sleep apnea are not conditions to be trifled with so their eradication after surgery was very appealing. Finally, who isn't terrified of dying during surgery? Even the statistics of stunning rates of success and almost negligible deaths on the operating table weren't enough to console my fears.
In the week to come I would conquer many psychological lapses. Right up to the point of being wheeled into surgery, I remember thinking that it wasn't too late, that I could cancel the whole show, hop off, go home and just lose the weight by myself. By far the hardest thing to let go of was an ego-driven resistance to submitting to a surgical solution to a mental condition. The reason that I ate and ate more was not because I was hungry but because I was greedy. My stomach could stretch without limit to accommodate my appetite so it had to be cut out. The VSG was the perfect solution: an irreversible procedure resulting in a small pouch that could never stretch. Well, it was either that or a lobotomy for I was surely losing my mind from the distress of not being able to control my eating. I used to have this irrational fear of being separated from food. I dared not take even an hour-long bus ride without carrying a snack for the road. What if the bus broke down on the freeway and it would be more than a few hours before my next meal? What if I was maimed in an accident in Winter and was too injured to eat. I might as well eat the cholocate bar at the start of the journey. I feared hunger more than being attacked by hooligans on the bus or freezing in the snow. With the ample availability of cheap food in North America, the fear of hunger is irrational indeed.
As the year progressed, so did my relationship with food. It was an education in restraint, patience and reassurance. Old habits die hard. Even post-op, food is of paramount importance in one's thinking. Both you and the doctors want you to eat. You want to eat because you're conditioned to want to eat. Then you learn restraint in a most painful way, when you overeat and discover the contraint of your pouch. It only takes a few istances of that gut-wrenching pain when you feel that you cannot breathe from having eaten one bite too many, that you quickly learn to confine your meals to very small portions. The surgeon on the other hand wants you to eat to avoid your body cannibalising itself. Very early in the weightloss experience, you become accustomed to a weekly dip in the scale that seems almost magical. A fair bit of that is fat, a lot of it is water, and a hefty chunk of it is muscle. To counter the latter two, the medical staff wants you to eat good protein, the very eggs, chicken and beef that you once thought was the sole cause of your weightgain. And you start to drink more water. Eventually, the weightloss slows down to a crawl and even reverses, much to your surprise. You wonder how it is possible for your clothing to continue to get loose yet you don't seem to be bothering the scale too much. The education in patience comes from realising that muscle weighs more than fat yet occupies less space. Eventually, some semblance of stomach capacity returns, you can eat a bite more and even drink an entire glass of water. It sometimes leads to panic that you may have stretched your pouch. It's reassuring however when you continue to shed pounds and go out to eat only to find that unless you order from the appetiser menu, you're taking the bulk of your food back home with you.
Such has been my year. The literature that convinces you to consider surgery sometimes promises loss of as much as 75% of excess weight within 6 months. Just before surgery, I weighed about 330 lb. I needed to lose at least 130 lb. At the 6-mth mark, I weighed 263 lb, so had lost 67 lb or, 52% of excess. A year on, I'm 245lb so have lost 85 lb or, 65% of what I needed to. To put things in slightly different perspective, I weighed around 350 lb when I met my surgeon, needed to lose 150 lb and have since shed 105 lb or, 70% of my excess. Although my personal experience has been far below the expectation created by the literature, I could not possibly be happier with where I currently am. I am confident in my skin and my clothes, step out without looking like a miserable slob and am fit beyond my wildest expectation.
Suddenly, I'm 12 days away from undergoing a vertical sleeve gastrectomy. It is almost too much to digest that this truly is the beginning of the end of my 15-year battle of the bulge?
The long-and-short of my story is that I was a chubby kid, athletic high-schooler, super-athletic collegiate (squash team) and, league player in my twenties and early thirties. A back injury (herniated disc) whilst training for a tournament spelt the end of competitive squash and any form of athletic activity. A job for a bachelor that involves numerous lunch meetings and after-hours cocktail functions is a recipe for rapid weight-gain. The trouble with athletes who suddenly quit working out is that they retain their appetites and eat with the same care-free abandon as they did when they were burning it up in the gym. Thus began my long addiction to food. A 10-year marriage-to-date to a wonderful wife and excellent cook fuelled the addiction. Despite periodic forays into the gym and some tennis, I went from 85 kg (187 lbs) in my playing heyday to my current 160 kg (351 lbs). I've gained the equivalent in weight of another entire adult human being.
Interspersed in this 15-year saga were numerous efforts to lose the weight, the likes of which are all too familiar on this forum: cabbage soup, exchange, Atkins, etc. There was one time that I managed to stick to a so-called 'detox' eating programme that caused me to lose weight possibly at the same rate as many post-ops here. I actually fought through the back pain and starting playing squash again. It was trememndously gratifying to fit into my college clothing once more. The diet itself, though, was tantamount to starvation and led to my becoming incredibly sad. Although not diagnosed as such, I came about as close as I can imagine to being chemically depressed. It makes sense, I suppose, that if you deprive yourself of fat and not take supplements, plus cut out salt and sugar without electrolyte replacement, you're not going to absorb fat-soluble vitamins which has to affect one's sense of well-being.
Short-lived was my renewed thinness because at the end of the two-month crash diet, my resolve came crashing down too. I celebrated with a hearty double cheeseburger from the world's greatest supplier of lard disguised as food and have been supersizing ever since.
Five years ago when my doctor noticed the increase in my blood sugar levels and expressed alarm at my increasing size, I took notice but was sure I had the strength of mind to return to my athletic ways. I didn't count on the severity of my backache nor the added damage that must have been caused to my back lugging all this weight around over the years. When he asked his assistant to find out who did bariatric surgery in Canada, I really froze in my tracks. A failed business contract, the commencement of accounting studies towards a different career and a home relocation found me in the offices of a new personal care provider. I discussed my weight with my new doctor and told him what the previous one had suggested. This time, I assured him, I wanted it too.
That was two years ago. The wheels of the Canadian public healthcare system grind slowly. It took about a year to first see one of only three bariatric surgeons serving our entire province. At the time, the wait-list to have surgery here for free was around 3 years. I had two visits with the surgeon spaced six months apart. In that time, the only hospital where bariatric surgery is performed in our province announced a 60% cut in the budget for the procedure. This futher clogged the bottleneck and increased the wait-time for surgery to 5 years.
I couldn't afford to self-pay abroad so explored a not-so-well-published option of out-of-country-funding by our provincial health insurance for elective surgery. When I was approved, it felt like I had won the lottery (indeed I may have in terms of longevity). In fact, the first time I knew the outcome of my application was when I checked my voicemail one evening early in November. There was a cheerful message from Virginia Mason Medical Center in Seattle regarding a referral. There was no mistaking then that funding had been approved.
Until a week ago, I was working nights as a security guard whilst studying accounting through night classes. I kept playing phone tag with the administrator of the bariatric office until we eventually connected and set the ball in motion. Since her first voicemail on Nov 5, I have been scheduled for surgery on Dec 23 and am seeing my new, American surgeon for the first time this coming Monday. The pace of things South of the 49th parallel is at lightning speed by comparison.
I had two final exams to distract me this past week but can now fully concentrate on preparing for surgery. I'm an irreligious 46-year-old skeptic so there's some irony in getting a gift of sorts (we actually pay a sizeable premium for health insurance so it's a right rather than privilege) when the rest of the Western world is exchanging trinkets and electronic gadgets in a State-mandated spending spree. I'm deliberately trivializing the arbitrary commercialization of the Winter solstice against what in my case will amount to better health and possible longer life.