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Let me preface this by saying that I am not posting this to dissuade / convince / influence anyone against having WLS. It is funny (and uncanny) but through all of my complications I still believe that my decision to do so was sound. I cannot say that I would do it again but I am just now coming out of the thick of things. My opinion could very well change with time. I have lost 120 lbs this far ... I look and feel great.

This is my story ... it is a cautionary tale for those considering WLS. WLS is serious and potentially dangerous and life-threatening. Take this decision VERY seriously and realize what can happen to you and know that you have absolutely no control over these complications whatsover. I was that 1% that you read about ... recovery is extremely difficult -- both physically and mentally.

The series of events that follow stem from my 12/6/2010 VSG surgery:

 

1.       December 6, 2010 – VSG conducted

2.       December 26, 2010 -- I passed out at home and was rushed to the emergency room. I was diagnosed with “Bilateral Pulmonary Embolism” – blood clots in both lungs. I spent three days in the Intensive Care Unit and another 5 days recuperating in a trauma hospital. I started on blood thinner therapy (Coumadin). I was severely anemic and weak when I was released

3.       February 17, 2011 – I had been vomiting multiple days for three weeks prior to the 17^th. I went to see my surgeon and was immediately sent to the hospital. Doctors ran a CT scan and a barium swallow. They discovered that one of the sutures from the 12/6 surgery had ruptured and contents from my stomach had been steadily leaking into my body cavity. This caused septic infection and had formed a softball sized abscess in my abdomen

4.       February 18, 2011 – I had surgery to place a filter in my veins to protect against any additional blood clots

5.       February 19, 2011 – I had emergency surgery to drain the abscess, identify the specific location of the leak (fistula), and attempt to repair the damaged suture. I remained in the hospital for another 10 days. I had a peripherally inserted central catheter (PICC line) – a form intravenous access that can be used for a prolonged period of time – inserted. I was started on IV nutrition (called TPN) through the PICC on 12-hour cycles at night. Home health care comes to the house once a week to make certain that all is well with the line. They instructed me as to how to prepare the TPN mix for use. To date I have not eaten solid food since 2/17/2011. I have had a JP drain inserted into my abdomen since that time

6.       My physicians have been very aggressive in treating my condition. I have had the following diagnostic and surgical procedures since 2/17/2011

 

a.       2/19/2011 – fistula repair surgery #1

b.      3/21/2011 – fistula repair surgery  #2

c.       3/30/2011 – Upper GI series #1

d.      4/7/2011 – fistula repair surgery with stent placement #3

e.      4/15/2011 – CT Scan

f.        4/20/2011 – fistula repair surgery #4

g.       4/25/2011 – fistula repair surgery with stent removal #5

h.      4/28/2011 – Upper GI Series #2

i.         5/2/2011 – fistula repair surgery #6

j.        5/10/2011 – Upper GI Series #3

k.       5/16/2011 – upcoming fistula repair surgery #7 -- my leak is sealed but for a very tiny 1/4 inch portion of fistula tract that my surgeon wants to fill with fibrin glue. There has been no leakage at all into my JP drain for the past few weeks. My energy is back at 100% and I'm going to be released to go back to work at the end of the month.

I wanted to provide a quick status:

1. VSG on 12/6 ... really felt sick from day one but no leak was detected. My theory is that the swelling actually blocke the leak initially. As the swelling went down the leak actually presented itself fully.

2. 2/17 -- leak confirmed ... I was vomiting multiple times a day for two-three weeks. I know ... I know ... I know ... I should have gone sooner but I tried to tough it out. I was in the hospital for ten days. I got a PICC line placed and have been NPO (no food by mouth) since then ... 76 days now. I'm on TPN for 10 hours at night. I've also had a JP drain inserted into my abdomen since then. Funny how one gets accustomed to things.

3. 2/17 - Now

a. My leak was huge ... started out at 8mm ... I would sip water and see it pour directly into the JP drain.
b. My primary surgeon, Dr. Averbach, has been very aggressive in treating me and I appreciate that. I've had 9 surgical procedures since 2/17. He referred me to one of the best endoscopic therapist in the country -- Sergey Kantsevoy at Mercy Hospital in Baltimore. Both surgeons have been excellent in treating me.
c. The fistula (leak) reduced from 8mm to 5mm to 2mm ... I had my 9th procedure on Monday to close it fully and I think it worked. I have been drinking water like a camel and nothing is coming out of the JP drain. Keep sending prayers up for me ... I think we've got this thing completely closed.
d. One of the keys was Dr. A pulling the drain further and further out each week. This allowed my body to do the heavy lifting of healing itself.

I go back to see Dr. A on Friday ... if things hold up he will remove the JP drain completely ... I can advance my diet next week ... then ween off of TPN and have the PICC line removed over the next several days.

I know that it really doesn't matter but I found this picture quite intriguing the first time that I saw it ...

So ... this post will garner a "duhhhhh ... no shit" response from some and it will be an eye opener for other. Here goes:

This is about the relationship between your surgeon and your PCP and how critical it is that we Pre-Ops understand this. For weeks I have been (i) dreading a conversation with my Primary Care Physician (PCP) and (ii) trying to determine why surgeons push you so fervently to get clearance from your PCP. My thought process was that I could care less about my PCP's take on surgery so long as I did not need his clearance for insurance purposes. In my case I did not.

Now let me clarify something: my PCP is excellent. He is very well-educated and he truly cares about people (perhaps too much!). I was dreading the conversation because I believe that he fundamentally wants to see his patients diet / exercise and lose weight. It is what it is. I finally go to see him for pre-op testing and for a gout flare up that I'm having. He does not lecture me about surgery. He supports it in fact. What he did say, though, was that while my surgeon will operate on me my overall health is HIS responsibility. He said that if I have gout going IN to surgery then that is a sign that there is a chemical imbalance inside me that will leave me in a world of hurt after surgery. He knows that I'm anxious but wants me to have a complete battery of additional tests to make certain that I am chemically balanced prior to surgery.

I told him that I do not intend to delay surgery. He said that that was HIS decision and that he would see where I stood once the results of my blood work were in. I did not argue and left it at that.

I was slightly pissed until I thought about more deeply. Then I thanked God that I had health care providers -- PCP / Surgeon / NUTS -- who truly give a damn and who are responsive to my needs. Rather than fight against their recommendations I will embrace them fully. Rather do the right thing and end up on the loser's bench in good shape than buck the system and end up in dire straights.

Net: Pre-Ops -- get ALL THE TESTING YOU CAN! I say this to my team at work constantly: "The more prepared you are the less brave you have to be ..."

*** Day 1 - 7/18/10 ***

STATISTICS

1. Surgery Status:   Pre-Op - 3 weeks (8/9)
2. Weight: 401lbs
3. 6'0 tall
4. BMI: 54.4
5. Target Weight Goal: 250lbs (-150lbs) / Target BMI: 33.9
6. Stretch Weight Goal: 225lbs (-175lbs) / Stretch Target BMI: 30.5

Food: This is the first day of my pre-op diet. I did a homemade shake this AM. Salmon and vegetables for lunch. Another shake this evening. Actually not bad at all. No carbs.

Exercise: Hour long cardio workout ... low intensity.

*** 7/20/10 ***

STATISTICS

1. Surgery Status:   Pre-Op
2. Weight: 396 lbs
3. 6'0 tall
4. BMI: 53.7
5. Target Weight Goal: 250lbs (-150lbs) / Target BMI: 33.9
6. Stretch Weight Goal: 225lbs (-175lbs) / Stretch Target BMI: 30.5

NOTES:

1. Went to my PCP for pre-op testing. He is concerned about my overall well-being and wants to make certain that I am fully prepared for surgery. I love the guy but I will not let him delay this.

2. I have been suffering from a really severe case of gout. It's lessening this AM but it was killing me. I have got to get this under control. I understand that accute gout attacks are common after WLS. I have got to find a way to get rid of this.

MY OH ladies have been tremendous. I recently read back through my correspondence, though, and saw tons of great advice from my OH brothers. I thought I'd share.

Aug is right around the corner. Are you ready?  Are you doing a liquid diet before surg?  I was in and out in 55 min. I had no pain after, just a slight pressue.  lol I used my grill tongs to pick clothes up and small things off the floor.  Unloading groceries was a pain, could not lift over 5lbs so i had to make a lot of trips which tires you out fast.

I am 6'3 and I started at 435. I wore a 6xl shirt, and borderline 60w pants. Started the Gym at 305 3 weeks ago and Now I weigh 295 and can get into 42w jeans. Shirt I am at a baggy 3xl..  I even dropped a size on my feet. I can wear 13s again.

At 6 months out I could finish a yogurt. My surg was on May 15, 2009. The most of a chicken breast i can eat now is still 1/2 and maybe a bite of veggies. It really depends on how dense the item is and how much i feel like chewing it.  Last night I ate my first steak in a very long time.   A 5oz Filet and that is all i ate. It was so good too.. lol  

A lot of people do this. I stayed on the soft food diet longer so i could continue to lose more.

Make sure you buy gas x strips. They will help you a lot right after surg. Those gas pains are killer.  No drinking from straws and nothing carbonated.

Drinking water after made me queezy so i put crystal lite in it. I still do to the day.  I dont know why but it happens to everyone. Temp of the water also matters early out, same goes for food. IF you get acid reflux after no worries it goes away.  

To know you're full most people burp, lol I did. I am serious and not making this all up. You have to eat on a schedule cause for once you will not be hungry.   

Another issue for WLSers is Carb coma. If I eat bread, pasta or Rice. I will be asleep within 20min. There is no fighting it either..  If you have any questions pls ask..

dont know if you can cook, here is a site with alot of friendly recipies  http://www.bariatriceating.com/BEhealthnutrition/recipes.php ______________________________________________________ 1. Did you do a liquid diet?  OMG yes.. I like to block that part out. I was on a 6 week liquid diet. I lost 35lbs on that alone. the weight i would have lost after surg I lost before.  So in reality I've lost 105lbs on the surg but the inches i've lost is unreal. I have not weighed in the two's since who knows how long..
 
Any recommendations for that?  I drank 4-5 protein (whey isolate) shakes a day.  www.nutrabio.com  This is equal to Unjury but without the cost. It does not have a funky aftertaste either. Does not clump and mixes well in everything. I buy the plain and flavor it myself now. Put into food, muffins ect.

Do not buy chicken broth it is filled with sodium. It will taste better and cheaper to make your own. I went to the chineese carry out and bought 5 lrg wonton soups minus the wonton. This way you have the prefect container to store your broth in.  I always save my shrimp shells, put them in zip lock bags and freeze them. You boil the shells to make shrimp stock so i made a tasty searfood flavored broth to drink..  I did add a bulion cube to the stock I made for flavor but there is so much water that it didn't change the sodium levels. Put some veggies in thats stock too helps. Strain them off

I ate Sug free jello, SF popsicles, lots of Crystal light, SF Tea, SF drinks  you have to change the flavor of the water because you are drinking so much of it, its the only way to get it in.   Do not watch TV, lol all the commercials are about food.  Low Sodium V8 Juice.

2. You lost 130lbs without working out at all?  Since I dropped the 35 pre op. I lost 105 without doing anything. My Dr. see's the pre op as part of the surg loss. Walking that's it. I helped someone move and lost 6lb from the cardio.  I went to the mall and walked there and walmart, its hot here in the summer. I had been dealing with a leg ulcer that cleared right up after the weight loss. I had the damn thing for almost a year, very very painful too. 
 
When did your doc tell you it was OK to begin lifting weights? I think it was 2 months after

3. You mention water temperature. Do you tolerate cold or room temp better?  Mainly room temp, to slightly cold but not ice cold.  I can drink cold but most times there is a bit of discomfort. It's harder to get all your water in if it's ice cold, the stomach clinches up and then starts to argue with you. (growling) Same goes for food right after no hot or spicy.  You need time to heal and dont want to irritate the stomach.  _______________________________________________________ It is no problem. I did my reseach on the matter before hand. A few more things.  I ate out of pyrex custard cups after surg. I found this was a good size and only holds so much. use a small spoon.   For later get some smaller plates to eat off of.  7-8" this way with food on it your plate looks full.  (Its a mental thing trust me)

Things will be tuff your first few months, you have to eat slow and really chew. You are testing what you can eat, some things will not agree with you right after, don't worry give it time. Please don't be one of these people who eat a bite of pizza 2 weeks out and wonder why they are sick..

You can not miss meals. You can not drink with meals so watch the sodium. You can not drink 30-45 min after a meal.   If you eat to fast you'll drool.. LOL if you eat to much you'll drool. just go outside and spit it out. haha. If you eat to much to fast, you'll drool..   There can be pain or pressure with any combo..  When you get the feeling, I should not take that last bite, guess what dont take it. Cause you will have pain and you will drool.  Same goes for trying to drink to fast. baby sips take it slow..

lol no matter how much i tell you, you'll be laughing after cause it's going to happen to you. Just letting you know what to expect so you dont freak out.   You can not take the womens advice on the vsg, they make everything dramatic.

If you dont have one buy a magic bullet. Its a small food processor. This is prefect for people who had WLS.  When you get to mushy food stage you can puree everything in it and clean up is fast. 

This site saved me. I can cook very well but adapting what I make to fit the WLS lifestyle was a different story.  She has recipes for protein ice cream.. Amazing stuff I make it all the time. It's just a healthy option.  http://theworldaccordingtoeggface.blogspot.com/

stay off the scale... throw that thing away now!!

will send more info as I think of it. _______________________________   Way 2 Go Dude.  The hardest part is now behind you.  Now you'll have have the 2 week pre surgery liver shrinking diet, the presurgery cold feet (do I really need to do this?) and the ultimate "don't risk death to loose weight" speech from a close friend or family member.  These are all pretty regular and normal.  Don't lose your focus.  Write your self a list of reason you want this surgery and another things you want to do as a thinner person that can include stuff a s simple as sitting in a restaurant booth without a shoe horn to pry yourself in or as exocit as skiing or hang gliding.  Keep these two things to reference post-op.  They are motivational 6, 12, 18 ,months out.  I still read mine at 4 yrs post-op.  and it will also be good to get some pre surgery pictures at a location and in positions you can replicate post op so you can see for yourself how your body is changing as you shrink.

Hey, its a great ride.  Very excited for you. Big Congrads!!!!

Oh and do not stock up on foods and drinks before surgery, your tastes are gonna change after surgery.  Trust me.  The only thing you can be sure of is vitamins, supplements, water, ice, and maybe beef broth.  (Walgreens has a generic (their brand) very small mutil-vitamin with iron; chewable were tolerable but nasty; I started with Flinstones but was quickly looking for alternatives that weren't horse tablets.)

I'm naming the next 14 weeks "Operation Bad Ass" -- aka OBA. The goal of OBA is three-fold:

1. Get me fully prepared for surgery
2. Get me through surgery and recouperated
3. Get me in a strict, comprehensive physical fitness regimen desgned to get me in optimal health and to re-shape my body into peak condition

OBA Motto: "Work hard so God can approve you ..." 2 Timothy 2:15

Look for upcoming OBA Status Reports ...

Both the NUTs at Dr. A's office are excellent. I sent Nancy Lum a note yesterday about specifics of the pre-op diet. She responded to my note immediately and gave me a call this morning to make certain that I understood her response.

Here is how it works:

4 Protein Shakes a day  -OR- 2 shakes + a moderate meal consisting of ONLY proteins and vegetables ... PLUSall the 0 cal drinks I can stand :-)

Nancy's thing is that a person would starve to death without the option of some solid food. I completely agree :-) She is highly experienced and has an amazing perspective on bariatric surgery and a keen understanding of bariatric patients.

... I have an updated personal (THIS DOES NOT INCLUDE WORK) to-do list of easily 100 things. I'm going through both a State and Federal Tax audit. I just told the mortgage company to go to hell. They can take this fucking $800K mortgage if they aren't willing to renegotiate this damn thing down. The friggin house is worth half that now! The folks at work "love" me and they continue to give me more responsibility and what I like to call "opportunities for success."

I could easily NOT have surgery and blame it on timing. The reality, though, is that there is never a good time to stop and take care of yourself. If I dropped dead right now folks would think about me as long as a hand leaves a print in water. I tolkd my SVP a week ago that I was going to be out for a week. I know he was thinking ". . . damn, this couldn't be worse timing." To hell with it -- I've got to get this taken care of so that I can be here for my family and be an even more productive member of my firm.

My philosophy -- relish and absorb all the business.

Frozen Fruit Dream
Mix one vanilla protein supplement according to directions with ¾ cup water and 1/3 cup orange juice. Then add ½ ripe banana, three frozen strawberries and 3 ice cubes. Blend at high speed for 45 seconds and enjoy.

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Blueberry Protein Shake
1 cup blueberries
1 cup nonfat milk or yogurt
¼ cup protein powder
Place the fruit and milk or yogurt in a blender and blend until uniform.
Add the protein powder and mix for an additional 10-15 seconds until
well blended.
(Fruit substitutes: strawberries, raspberries, grapes, peaches, banana, mango or apple for blueberries)

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Bahama Freezer Protein Shake
1 packet vanilla protein powder
2/4 cup frozen peach slices
½ cup fresh pineapple chunks
1½ cup nonfat milk
Place all ingredients in blender. Mix until smooth. Add ice, if desired.

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Berry Blizzard Protein Shake
1 packet vanilla protein powder
½ cup fresh blueberries
½ cup fresh raspberries
½ cup fresh strawberries
1½ cup nonfat milk
Place all ingredients in blender. Mix until smooth. Add ice, if desired.

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Blend one scoop of protein pwder, 1 cup of diet V8 Splash, and 1/2 cup of ice in a blender.

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Mango Madness Protein Smoothie

4 oz. water
4 oz. vanilla soy milk
1 scoop vanilla protein powder
1/2 cup fresh or frozen mango chunks
2-3 ice cubes

Place liquid in the blender first, then powder, then additions. Blend on low then high till well blended.

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Mango Banana Protein Smoothie

8 oz. water or 4 oz. soy milk/4 oz. water
1 scoop of vanilla protein powder
1/4 cup frozen mango chunks
1/2 a banana
2-3 ice cubes

Place liquid in the blender first, then powder, then additions. Blend on low then high till well blended.