Jean M.

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This Thursday will mark my 2-month surgiversary. I'm still struggling to adjust to eating and living with my sleeve. My surgeon & dietitian, my internist's NP/diabetes educator, and a nurse at Anthem BC/BS all seem to feel that if I could eat more than 1/4 cup of food at a time, I wouldn't be so hungry only an hour after eating. Since eating more than 1/4 cup makes me sick, I'm not able to test that theory right now. I'm getting a lot better at knowing when to stop eating and at avoiding dumping, but having to eat every 1 to 1-1/2 hours (which is what the NP/diabetes educator recommends) is a pain in the butt, especially when I'm at work, where I'm not allowed to eat or drink except during my one 15-minute break. And this isn't a nagging hunger. It's a screaming hunger, because my blood sugar has nose-dived and my body thinks I'm about to starve to death and cranks up the production of grehlin and other hormones to motivate me to eat again.

The other problem is my fatigue and low energy. I've been tested for anemia, dehydration, and various vitamin/mineral deficiencies and hope to get the test results today.

The good news is that I've lost 17.4 lbs so far and I'm fitting into smaller clothes again. I'd forgotten that it can be fun to go closet-shopping. I still can't fit into last winter's clothes but today I'm taking a bag of fat clothes to Goodwill.

I went to Memphis for my 6-wk post-op dietitian appointment last week. I didn't get a lot out of it other than the suggestion that I might be anemic and dehydrated, so I'm pursuing that with my internist this week. But I did get a funny story out of it.

I'd never met this dietitian before. She started by weighing me: 150 lbs. Then she looked at my chart in consternation, then over at me, then back at the chart. Turns out she was confused because the last time I was weighed at that office was in February, before my complete unfill and before my band was removed. At that time, I weighed 137 lbs. The look on this woman's face was priceless - she's thinking, 'Um, she just had weight loss surgery but has gained 13 lbs? Something's not right here.'

It took a while to get that one straightened out.

....That's me!

The other day, an acquaintance asked me if I'm a "sleever" now. My beloved band is history and I do indeed have a sleeved stomach (thanks to successful surgery on August 16th). My intensive 19 seconds of research revealed that the correct answer to the question is that I'm now a sleevester - a bandster who became a sleever.

I'm finding that recovering from sleeve surgery is harder and lengthier than recovering from band surgery. I feel OK, but have little energy and get tired easily. I've lost 12 lbs since the surgery, so that's cause for celebration. At my 2-week post-op appointment, my surgeon encouraged me to start transitioning from purees to solid food, and said that the hunger I'm having is because purees don't have the staying power of solid food. Well, I already know all the words to that song, but I'm still wondering about the hunger. I can eat only a few bites of solid food, and about an hour later I'm fiercely hungry again. It's very frustrating. Eventually my body should regenerate the cut nerves in my stomach as well as realize that 75% of my stomach is gone now and ratchet down the production of grehlin (hunger hormone) and acid. The sooner the better as far as I'm concerned.

I'm trying to learn my new "stop eating" signals. With my band, my main stop signals were pressure in my chest and a fullness at the back of my throat. Now I feel pressure or a burning sensation in my upper abdomen, and sometimes the fullness at the back of my throat. If I don't notice any signals and overeat, I feel slightly sick. My surgeon refused to tell me a maximum amount to eat at one time, so the overeat & get sick thing was been very tiredsome. Finally the dietitian said that the maximum amount is 1/2 cup. I'm lucky to get in 1/4 cup before feeling ill.

And speaking of sick...it turns out that sleeve patients can dump (something I thought only bypass patients experience). My surgeon says that's because the stomach is too small to store food and therefore rapidly "dumps" it into the intestines, where it spikes the blood sugar and makes me miserable (hot, sweaty, dizzy, nauseated). Sugary foods are a big culprit, and I'm finding that sugar lurks where you don't expect it, like creamy poppyseed salad dressing and my favorite Click vanilla latte protein shake. Giving up the Click saddens me because I love that stuff, but sugar in liquid form causes havoc so quickly that I just can't do it, even if I try to drink the Click slowly. So I'm searching for other breakfast options that are quick, easy, and satisfying. I've also found that eating too fast triggers the rapid gastric emptying and dumping. Apparently I forgot a lot of my band eating skills in the 3.5 months I lived without my band.

One of the arguments in favor of VSG surgery is that you're basically done when you leave the operating room. No fills, no unfills....it is what it is. But that's also an argument against VSG. Except for further surgery (which in my case would be duodenal switch since I'm already halfway to the switch part), there's no adjusting my stomach or restriction...it is what it is. So I have to find a way to live with what I've got, like it or not.

My 2nd attempt at the sleeve will be on August 16th, 2 days before my 59th birthday. So I can celebrate my birthday with a protein shake with a candle floating in it!

The new gastro doc was able to dilate my stricture from 13mm to 17mm this week and a rep from his office called today to say that Dr. Y. will be sending Dr. Weaver (bariatric surgeon) a  note saying it's OK to go ahead with my sleeve gastrectomy.

Although Dr. Y. doesn't believe I have achalasia and feels that the one dilation is enough, I can't help but worry a little that 17mm isn't big enough. The 40 bougie Dr. Weaver tried unsuccessfully to use last month was 13.33mm, so in theory that ought to fit through a 17mm opening, though not with a lot of room to spare. There are smaller bougies, but the smaller the bougie, the greater the risk of staple line leakage.

At any rate, I feel like I'm making forward progress. The next step is to convince my insurance company to approve the sleeve as a stand-alone procedure, which Dr. Weaver feels confidant her insurance coordinator can accomplish.

Thinking back on my talk with Dr. Y. when I first met him, I've probably had "silent" reflux for several decades. I can remember going to an ENT specialist in the mid 1980's because of a persistent dry cough. He told me I probably had reflux, but I didn't believe him because I'd never had any heartburn or or frankly acid/reflux-related symptoms. So years go by, I acquire a gastric band, and when the band proves to be too tight, the reflux damage worsens and eventually results in the stricture.

Reflux is a common symptom after VSG, apparently treatable with omeprazole, and eventually it subsides. RNY  surgery would eliminate reflux, but the malabsorption feature could make adjusting my medication doses a challenge that I'm not prepared to deal with.

The new gastroenterologist I saw this week thinks I don't have achalasia of any type. He thinks my esophagus was damaged by reflux. I had difficulty understanding him (because of my hearing impairment) and am more confused than ever. He's going to dilate my stricture (via upper endoscopy) on May 30th and may have to dilate it again before we can consider a sleeve revision.

I have no idea why 3 doctors say I have achalasia, a serious condition that involves difficulty swallowing and eating, when I'm able to eat without any problems at all. I hope to learn more about that when I go to a new gastro doc on May 21. Whether or not I post about that here on OH remains to be seen. I'm not feeling the love here lately.

On 4/27/12, I had my band removed but was not able to have a sleeve revision because my surgeon was unable to pass the 40 bougie through my esophagus into my stomach. I have a stricture there. I'm able to eat and drink OK, but it's not something I can ignore indefinitely.

Yesterday was my 2-wk post-op visit. Mr surgeon says that I have primary achalasia, a congenital dysfunction of the esophagus, which was aggravated but not caused by my Lap-Band. I asked her why my local gastro doc didn’t notice the stricture during my EGD in February and she said he probably assumed that the narrowness of the opening was due to my band. Also, the scope he used was a lot smaller than the bougie she was unable to pass through the stricture. She has referred me to a gastroenterologist in Memphis who can definitively diagnose the problem by performing esophageal manometry (they put a probe into your esophagus, have you swallow water, and measure the muscular response of the esophagus during the swallow). If that test shows minor achalasia, it can be treated by dilating the esophagus during upper endoscopy. If the test shows more advanced achalasia, I would need to have some pretty serious surgery to fix it. Serious because I don’t have a “virgin” belly now – I’ve had many abdominal surgeries and a lot of scar tissue from that. Dr. Weaver says there should be no problem do the sleeve once the stricture has been dealt with, and feels confident that she can persuade my insurance company to pay for it as a stand-alone procedure.

 

I’m not going to be able to get away with ignoring the achalasia. According to Dr. Weaver, eventually it will get so bad that I won’t be able to eat anything at all. Which has a certain appeal at this point, 20# heavier than my goal weight, but it’s a serious problem.

 

She OK’d me to return to work and the fitness studio effective 5/20/12.

Because of problems with esophageal dilation and motility caused by a too-tight/too small band, I'm having my band removed and revising to vertical sleeve gastrectomy on Friday, April 24, 2012. I'm not thrilled about it, but I'm lucky to have another surgical option for lifetime weight management and even luckier that my insurance will pay for it.

I'll always be a bandster at heart, though.