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Obesity & Me

Describe your behavioral and emotional battle with weight control before learning about bariatric surgery.

My behavioral battle has involved a long history of dieting, beginning at age 8, followed by weight regain when my hunger drive would finally overcome my self-discipline. Eventually my body became so efficient at conserving its calories that more and more severe diets were require to achieve wieght loss. Exercise did not enter the equation until age 26 or so, and taking diet pills was added to the pattern at age 38. I took a long hiatus from dieting from age 40 through 48 during which time I did not experience ANY change in weight, and felt strong, comfortable and healthy, albeit fat. I only returned to dieting after repeated pressure from a new PCP (after the death of my previous PCP). This resulted in an initial loss of 20 pounds followed by regain of 30 pounds, in conformance with my previous experiences. However, this last ten pounds pushed me over the limit of comfort and accommodation into the scary realm of super morbid obesity and related health and lifestyles issues. Even though this process of lifelong yo-yo dieting resulted in net weight gain over time, I developed a preference along the way for healthy foods, fish, whole grains, unprocessed fruits and veggies, both raw and cooked, and lost my taste for chips, snack foods, and most sweets. These preferences do not result in weight loss for me, but my nutritional level has been great! I have never gotten used to the discipline of eating less than I want to eat. The emotional battle was much more devastating. I cannot bring myself to go back over all of the pain, shame, ostracism, and self-loathing I experienced during my adolescence and early adulthood, but I will try to give an overall picture by telling of the passage out of that hell on earth. At age 26, after many diet failures, and weighing in the high 200s, I began a medically supervised Protein Sparing Modified Fast (PSMF). Although I eventually gained all the weight back, and with interest of course, it took many years to return. This was one of the most profound experiences of my life as the five years of slimness and another five of being overweight (just veiwed by others as a fat person, not as a freak) gave me an opportunity to find a place for myself in the world, to develop social skills and self-confidence, and the bravery to go out in the world and accomplish things. As I gained the weight back I never lost the sense of myself that I learned during those years. This gave me the ability to function in the world even after I regained weight and began to feel ashamed and guilty again. I never felt the same level of self-loathing or complete unworthiness after the PSMF as I did before, although I felt despair at my regain and subsequent dieting failures and the discovery that I could not repeat that weight loss as hard as I tried. At least I know how to "act" in the world and could function well enough that I no longer felt apologetic for taking a share of the world's common supply of air. Although I still had difficult emotions I no longer had the need to withdraw from participation in life or to destroy my own interpersonal relationships. Once I gained back up to the high 200s I started to feel a lot of apprehension again about meeting new people or making public appearances, but I had now mastered the art of convincing others that I was actually outgoing and confident, and to postpone my negative obsessing until I was alone. The next really profound thing that happened for me was reading an ad in Ms Magazine for Radiance magazine. Radiance really set me on the path so learning to love and accept myself as a real and valuable person who happens to be fat. This released me from the emotional extremes associated with weight loss and gain: when losing weight I had super high feelings of pride and power, and unrealistice fantasies of how beautiful and desirable and thin and fashionable I would be, and how everyone would love me; when regaining I would be so overwhelmed by the guilt of my failure and disgusted with myself and my body that I would wish to die until I imagined other people having to deal with my repulsive fat corpse and then I would be as afraid of dying as I was of living. After Radiance I was able to view my own size and fatness, as well as changes in my weight, as physical events, that did not detract from my value as a person, or as a friend, lover, mother, employee, trainer, speaker, writer, or even client and customer. So I believe that I became psychologically healthy (well, more or less so!). I eventually succumbed (after resisting for about a year) to pressure from my PCP to diet with him, using pills. I had such a hard time finding a doctor with a location and schedule that fit in with my work needs, and who took my health insurance, and was accepting new patients. (Things are a little different in the non-urban areas of Puerto Rico than they are in the in the cosmopolitan area, or in the continental US.) I just got tired of fighting with him and I had some other issues that I was trying to work out with him. So I took the pills, followed the diet, more or less, and lost weight which I enjoyed. I actually liked the pills because they helped me to stay awake at work. (During the pre-op studies for WLS I discovered that my daytime sleepiness was related to the very low levels of oxygenation that I have while sleeping, which should improve after WLS.) I didn't take the loss or subsequent regain too seriously on an emotional level. However, this last regain, took me into a whole new level of obesity. With my weight now in the 300s it has exacerbated my arthritis and sleep disorder, and is causing me difficulty in mobility, reach, excercise, personal care, etc. The prospect of dieting my way up to a future of disability and dependency is so disturbing to me that even though I no longer feel ashamed or unlovable, I am determined to stop this harmful cycle. I am grateful for these two experiences, the PSMF and the Size Acceptance movement for helping me to develop self-confidence and a sense of self-worth. Without them, I know that I would not even be able to give myself the opportunity of WLS, and I beleive that those same qualities will not only enhance my ability to benefit from WLS by working with it as a dependable tool, but will help me to avoid the psychological pitfalls that can accompany such a major life change.

What was (is) the worst thing about being overweight?

This is a hard question to answer because there are so many horrible things. So I will have to give three worst things, but the order of badness changes everytime I think about it! Here they are: 1. Physical discomfort. The worst is being hot and sweaty under the belly and between the thighs, with the belly sitting on the lap covering the thighs, and getting yeasty rashes where the air never circulates. See, I had to say "the" and not "my" because it is sooo hard to own that yuckiness! 2. Physical limitations. I can't keep up with my husband and kids. We have always walked and hiked together and now everyone has to slow down and wait for me while I huff and puff along behind them wondering if I will have enough stamina to get back afterwards. 3. The harsh judgment of other people who believe that being fat is the result of lack of character and some kind of really bizarre behavioral defect. It is more acceptable in our society to be a crack addict or ex-con than to be fat.

If you have had weight loss surgery already, what things do you most enjoy doing now that you weren't able to do before?

I like working more than I did, mostly because I have enough energy to get through the day now. I like getting dressed for work in the morning a lot more now. I am looking forward to doing more active leisure activities with my family soon. Perhaps there will be some vacation time available for this in a while.

How did you first find out about bariatric surgery and what were your initial impressions of it?

I have known about weight loss surgery for many years, but I only began investigating the procedures, success rates and complications in the 1980's. At that time the risks did not seem to outweigh the benfits in my personal case, so I set the idea aside, and only began to reconsider after the Carnie Wilson publicity following her surgery.

Describe your experience with getting insurance approval for surgery. What advice, if any, do you have for other people in this stage?

My doctor's office handled the whole thing. All I did was to provide them with my info. I think the experience that you have is very dependent on the insurance that you have. I was shocked that it was so easy, especially here in Puerto Rico where we expect everything to be a "Mejor Proyecto", major project!

What was your first visit with your surgeon like? How can people get the most out of this meeting?

He was very curt and I am almost positive that he behaves like that on purpose to test the commitment of his potential patients. I brought my daughter with me so that I could get more objective feedback from her. My surgeon seemed competent and knowlegeable, just brusque. He was much friendlier after I completed all my trials which included about 20 separate "appointments" at various stops along the way.

What made you finally decide to have the surgery?

The descisive factor for me was attending my first support group meeting. The room was full of beautiful, friendly, HAPPY people. I had never seen so much happiness in one place than in this gathering. They were all embracing their new beginnings and I want some of that, too!

How did you decide which proceedure to have?

My doctor was the first in Puerto Rico and he does the surgery that I thought seemed best, the roux en Y, but there really was no choice, as far as I could tell. I was sorry that he didn't do the lap, but I am glad that he will do it in the way that he thinks is best.

What fears did you have about having complications or even dying from from the surgery, and what would you tell other people having the same fears now?

I think that the risks are pretty low, but it seems that this is a procedure in which if something goes wrong it is extremely unpleasant. I can't say that I am scared because without the surgery I am looking towards a pretty poor quality future anyway. I signed a living will to prevent being left alive in a vegetative state or to suffer a long drawn out but inevitable death. That would be a fate worse that either death or fat.

How did your family and friends react to your decision? Would you have communicated anything differently if you could now? How supportive were they after your surgery?

This is a tough one. I did not inform very many people because I did not want to waste any more energy on other people's conviction that if only I would exert some control over my lifestyle, i.e., diet and exercise, I could be (stay) thin. The first people that I took into my "inner circle" were my husband and daughter. They were very supportive although unsure if it was the best choice. They both felt that they could respect my ability to work through the decision, and that they would support me with what ever choice I made. I am not sure if being so secretive was the best option but it was the one that I felt most prepared to deal with. I expect that it will be easier for me to discuss it with others when it is an accomplished fact that cannot be undone, and arguing would be futile. Those that love me will grow to understand or at least accept my choice. Those that wish to be judgmental or condescending probably alreaday are so!

How did your employer/supervisor react to your decision? What did you tell him/her? How long were you out of work?

I still haven't explained the type of surgery to my boss. He knows that I am keeping something from him but has resisted the urge to pry into it. He signed my leave request without any further explanation than "major abdominal surgery". I just left the request on his desk. Instead of coming to me he went to my work friend who happened to be the ONLY person at work who knew. She said "She needs this surgery. Just sign the slip. Punto." And so he did. I arranged for six weeks of leave (without pay) although I don't know if I will really need it all. At the last moment my boss requested 120 hours of work from home during that time. I said that I would do as many hours of work as I felt up to, but couldn't make a commitment ahead of time. So we left it open. This is actually a very genereous arrangement because if it turns out that six weeks is more than I need I can start earning again without having to deal with dressing, schedules, carrying my food, driving, etc.

What was your stay in the hospital like? How long where you there? What things are most important to bring?

My stay in the hospital was horrible. Hospital customs are completely different in Puerto Rico and being so "messed up" from surgery I also forgot all my Spanish until the last day or two. So every hidden deposit of cultural dissonance came free and overwhelmed me. On day #5 my daughter arrived and everything got easier. She grew up here and has a more bi-cultural consciousness, and better Spanish. I stayed for seven days. In Puerto Rico you bring everything! But the most important thing to bring is your own "nurse"/companion. The hospital provides a pull-out sofa bed and sheets for the companion.

Did you have any complications from the surgery? If so, how did you deal with them?

No, not really. I had to stay an extra day due to a low fever that tuned out to indicate a slightly collapsed lung. My doctor said just keep walking and I did, which resolved the problem.

In the weeks after you got your surgery date, how did you feel? How did you cope with any anxiety you might have felt?

I was very happy and optimistic after I got my date. I was frantic to finish up at work and to prepare everything at home for my absence and return so I was too busy to be bothered by anxiety.

Describe your first few weeks home from the hospital. What should people expect from this period?

My time was entirely taken up with getting in my fluids, protein supplements, vitamins, walks, showers and naps. After the first week, which was spent in the hospital, I was able to take care of all of those things by myself but I was completely useless for anything else, and was still very uncomfortable. My daughter came to stay with me but it turned out that I was able to take care of myself without help. She ended up seeing to my chores instead, e.g. dog care, grocery shopping, laundry, etc., which took a lot of burden off my husband, and she was good company for me. I never had the grumpy moods or weepiness that I had been warned about, but I was definitely operating on low power in every way.

How far did you travel to have your surgery? (If far, how did this affect your aftercare?)

About 20 miles. I had contemplated this surgery for several years but did not want to travel off the island (Puerto Rico) for it, and worry about not getting the proper aftercare. When WLS came to Puerto Rico I was ready for it. I am glad to have my aftercare and support group easily accessible, and feel much safer this way.

What was your actvity level in the days and weeks after surgery?

I have been pretty dedicated to my walks. I started out with six walks a day of 10-minutes duration and by six weeks post-op am now doing one two-mile walk per day. I am taking almost an hour to do the two miles but I'm going a little faster everyday. I didn't do much else during the first six weeks and then went back to work. My energy is a little low but it gets better each day. I slowly began to take back a few of my chores like laundry and vacuuming the pool, and each time I do a chore it is easier to do than the time before.

What vitamins and/or dietary supplements have you taken since your surgery?

I started out with Bugs Bunny chewable multi-vitamins and Proteinex. I am now (6 weeks out) back to the one-a-day vitamin and mineral tablet that I took before surgery. The proteinex didn't last too long before I started to gag just on looking at the bottle. I took Zoic for a while longer before I couldn't stand that either. Now I am using unflavored soy isolate powder and it seems OK. I got had my first blood tests done and will see at my 2-month appointment what my doctor feels that I might need in addition.

What side effects (nausea, vomiting, sleep disturbace, dumping, hair loss etc.) were worse for you? For how long after surgery did they persist? How did you cope with them?

I was uncomfortable sleeping for about four weeks, and coped by sleeping in several short shifts with walks in between. The walking seemed to really help alleviate all of the various discomforts/pains that I experienced. I have had no nausea, vomiting, dumping (I haven't tested it) or hair loss so far.

What was the worst part about the entire bariatric surgery process?

The hospital experience. Once I got home everything was better, and even the pain was easier to bear.

What aftercare support group/program do you have? How helpful/important is this?

I belong to a local support group. I'm not sure how helpful it is post-op. I miss alot because it is in Spanish and my Spanish is pretty elementary. However, the people that I have met there are wonderful and were very inspirational in helping me get started on my way. The aftercare visits with my surgeon and nutritionaist have been more helpful, especially with my nutritionist who suggests useful changes as needed. The most helpful group for me has been the obesityhelp.com website.

What is your scar like? Is this what you expected?

My scar started out as a thin flat red line. As it is healing it has become a little more irregular, wider and raised than it was. It is still not bad and is way better than I expected. I don't find it ugly at all. It remained quite sensitive for the first couple of months, but now at about 11 weeks it is much more comfortable.

Please describe any plateau experiences you have had since surgery.

I have had a series of plateaus followed by abrupt wieght losses. It looks like a pattern. I just keep doing what I am supposed to be doing and trust that my weight will do what it is supposed to do as well. It is not that hard to endure the plateaus because I feel and look so much better than I did before, and I see constant improvement is those areas even when the scale does not move.

Do you notice people treating you any differently now?

Well, my friends and colleagues are very excited about how good I look and my higher energy level brings more positive interactions with people at work. Mostly I find that people treat me as if I an normal and do not avoid me as a freak, inlcuding young people who are more apt to be critical or afraid of someone who is different. I think that I have passed into the level of fatness that people are accustomed to encountering and have left behind the level that causes people to be horrified or morbidly fascinated.
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