kmac32244
A Journey Through the Laparoscopic Roux-en-Y Weigh Loss Surgery Experience
WHERE I AM NOW
7 weeks post op, 50 pounds gone, feeling fine. Down 50 lbs now and under 300. Feeding tube is gone and healed over. Started exercising moderately, working up to a more strenuous workout. Weight loss is pretty steady at 5 pounds a week. Taking no meds: Blood Sugar is below medicated pre-surgery levels (in the normal range). Blood pressure is below pre-surgery level (in the normal range). Excess water weight is gone. Sleeping without CPAP machine for sleep apnea and getting a good night's sleep every night. Eating soft foods and trying others. Haven't had any problems to speak of. Tolerating everything I have eaten.
WEIGHT LOSS HISTORY
21 Nov 06 349 lbs/BMI 50
28 Nov 326 lbs/BMI 47 -23 lbs/BMI -3
05 Dec 323 lbs/BMI 46 -26 lbs/BMI -4
12 Dec 318 lbs/BMI 46 -31 lbs/BMI -4
19 Dec 313 lbs/BMI 45 -36 lbs/BMI -5
26 Dec 308 lbs/BMI 44 -41 lbs/BMI -6
2 Jan 07 304 lbs/BMI 44 -45 lbs/BMI -6
9 Jan 299 lbs/BMI 43 -50 lbs/BMI -7
INTRODUCTION
The first thing I'd like to say is, since beginning this process, I have been so impressed with the helpfulness and kindness of everyone I have met and talked to along the way.
I have learned a great deal online on web sites such as this and the ability to chat with some of you has been invaluable to me. I want to document my experiences as well as I can, not only so I have a record for myself, but in the hope that just one person will benefit from what I have experienced. If that happens, I'll know the effort was worthwhile.
I had laparoscopic Roux-en-Y performed on 21 Nov 06. Like everyone else who has a procedure like this performed, getting to this point has been the culmination of many years of struggling with my weight. At the time of my surgery I was 5'10" and 349 pounds with a BMI of 50.
The reasons I decided to pursue bariatric surgery are probably pretty much the same as everyone elses. The list is long. Carrying the extra weight was beginning to wear me down. Although I didn't have severe problems with my hips and knees yet, I could tell it was only a matter of time until I did. Getting out of deep chairs was putting stress on my knees and I was waking up with pain in my hips from sleeping wrong. Walking for distances was tiresome. Walking up stairs left me badly out of breath. And then there are the everyday things you just have so many problems with when you weight too much. I won't even go into those.
Of course, I had some serious health issues. I had Hypertension, which was under control with medication (Enalapril). I had Type II Diabetes, which was also under control with medication (Metformin). I had a wicked case of Sleep Apnea. I was able to sleep through the night using a CPAP machine. I also had excess water weight (swollen ankles) and high cholesterol, both alright under medication(Lasix, Potassium and Simvastatin).
Bariatric Surgery was the best option for curing these things. Just 10 days post surgery, taking no medications, my blood pressure and blood sugar were at the medicated levels or better.
PREOP (28 Oct 06 thru 20 Nov 06)
I am very fortunate to have an insurance carrier, Tricare Prime, who believes in the long term benefits of Bariatric Surgery. My medical insurance coverage is the most valuable benefit I have to show for 20 years of service in the United States Navy. I don't know how many military members, active and retired, really appreciate what we have in Tricare. In the last decade, they have certainly come light years in the service they provide. I know some people struggle for years to get approval to have Weight Loss Surgery performed and my heart goes out to each and every one of you. If you are awaiting approval, I wish you luck.
The internet is an incredible source of information and, when researching bar iatric surgery, I found the information online to be outstanding. I researched the recommended surgeon thoroughly and found Dr. Muhammad A. Jawad, in Ocala, Florida, to be outstanding in every respect. http://www.jawadmd.com/ I have found Dr. Jawad to be everything I would want in a surgeon. He is confident, but not arrogant, knowledgeable, skillful, experienced and efficient. He is a quiet man, but possesses a great sense of humor. Dr. Jawad has surrounded himself with an incredible staff. They have many of the same traits he does and they do a great job, especially when you consider the pace under which they operate. The staff is very specialized and each is an expert in their own arena. Their facility is 100 miles from my home, but I found the trip to be worth it in every way.
The initial consultation on 28 Oct 06 with Dr. Jawad was very well orchestrated and informative. He indoctrinates new patients by group, with a thorough briefing on the issues pertinent to reaching a decision regarding the potential procedures the patients may or may not choose. The benefits, drawbacks and potential complications of each procedure are covered. Dr. Jawad's credentials, experience and complication rates are discussed in depth. After the group lecture, patients are examined individually and their questions are answered. A decision is reached at that point as to which procedure the patient would prefer and pre-qualification requirements for that procedure are discussed in depth. By the end of this process, I left the office knowing:
- The Roux-en-Y procedure was the best option for me.
- Dr. Jawad was the correct surgeon to perform it.
- Exactly what I had to accomplish in order for the Dr.'s staff to submit my package to the insurance company for approval.
I was never interested in having anything other than a laparoscopic procedure. When a skilled laparoscopic surgeon is involved, I could see absolutely no benefits to having an "Open" surgery. The many benefits of the laparoscopic process are well documented. In general, it is less invasive, carries less risk of infection and other complications and offers quicker recovery times.
Deciding on a procedure is certainly a personal decision. My two options were effectively Roux-en-Y and Lap Band. In my case, the only advantage I saw in the Lap Band was that it was less invasive. With Dr. Jawad's experience (nearly 2000 laparoscopic Roux-en-Y procedures) and his incredibly low complication rate, I felt that the non-invasive nature of the Lap Band offered only a minor advantage. RNY offers several advantages the Lap Band doesn't. It has a greater success rate than the Lap Band. I wanted the best chance for success I could get. It offers a greater percentage of weight loss than the Lap Band. I obviously wanted to lose as much excess weight as possible. And it also has the side effect of the "Dumping Syndrome." It isn't often that getting sick is a positive benefit, but if it keeps me from wanting to eat concentrated sugar products, I see it as a great benefit. These are the factors which influenced my decision to have the RNY procedure.
Pre-qualification for me consisted of completing a Gall Bladder Ultrasound, Blood Work, Nutritional Evaluation, Psychological Evaluation and obtaining a letter of recommendation from my Primary Care Physician (PCP). Beginning on 30 Oct, I completed these tasks on the afternoon of 6 Nov, with the exception of obtaining the letter from my PCP. On 8 Nov, while still waiting on the letter from my doctor, I got the call telling me I had been approved for the surgery! Tricare approved the procedure in less than 24 hours. Wow! I was offered a surgery date of 21 Oct and gladly took it.
Why undergo weight loss surgery the Tuesday prior to Thanksgiving? I just didn't want to wait any longer and what better time to start? I had to start on a high protein diet immediately and it quickly made me sick. At least I didn't have very long to wait.
Having only 12 days to prepare physically and mentally for this surgery was a stressful occurance. I wasn't adjusting well to the high protein diet and that made things worse for me. I tried to get as much done as I could, but the 12 days flew by pretty quickly. In no time, it was the night before the surgery. No food or drink after midnight, bags packed and a few short hours of sleep and I was ready for the 100 mile trip to the hospitaL.
SURGERY (21 Nov 06)
My surgery was scheduled to begin at approximately 11:30 am on 21 Nov 06. I arrived at the hospital at 9:00 am, 30 minutes earlier than required, accompanied by my mother, who would also be providing the immediate aftercare at her house. I was told there had been a scheduling complication and the doctor was ready for me now. I was quickly taken back to Preop. After changing into the familiar hospital gown, the nurses took my vitals signs and started the IV. That began my waiting period. I had no watch on, as required and really lost track of time at that point. After what seemed like an eternity, my mother was allowed back into the Preop room to visit me. It was already 12:30 by then. Shortyl afterward, the anesthesiologist showed up, gave me all the required information and had me sign the release.
My surgeon's first patient of the day, Paul, had an issue with his EKG which had to be cleared up. This caused a ripple effect in the rest of the day's event's and I was the last surgery on the schedule. Paul had been at the hospital since 6:00am. He and his wife had a very long day as a result of the problem and it certainly wasn't his fault.
Around 2:00 pm I was finally given something to help me relax, which was also supposed to make me forget what ocurred. It didn't really have any effect that I could tell. After waiting awhile longer, I met another anesthesologist, who would be replacing the first one I'd met. This was another result of the ripple effect.
Eventually, I was wheeled back to the operating room by the OR techs. Once there, I was transferred to the operating table and my arms were strapped straight out from my sides. The Anesthesiology RN introduced himself and told me it was "Nighty night" time. My wait was over and it was time to have the surgery done. That's the last thing I remember until I woke up in the recovery ward.
RECOVERY WARD AND HOSPITAL STAY (21 and 22 Nov 06)
I have decided not to talk about my experience in the recovery room here. Everyone is different when it comes to handling the effects of anesthesia and surgery and my experience may be entirely different from what yours will be. I know people who had no pain at all and people who had varying degrees of pain. I'll just say of my experience, that nothing I felt caused me to regret having the surgery at any time. I wasn't pain free, but you could be.
I spent around 4 hours in the recovery room. I was well medicated and sleeping through most of it, so I don't really remember all that much. They do their best to keep you comfortable. I was taken up to my private room around 9:30 pm. Once they got me settled in, they let me sleep.
I was awake of and on through the night and always had the nurse's attention when I woke up. She kept me comfortable and I was able to go back to sleep easily.
At 4:00am I was finally out of bed and able to walk down the hall. Walking was pretty easy, but I didn't go all that far without getting a little tired. Upon returning to the room, I had a few ice chips for the first time and I was able to sleep for a couple more hours sitting up in the recliner. I'd had enough of the bed by that point.
At 6:00am I walked again and then had the catheter and NG tube removed. It was really great getting rid of the NG tube as it was very irritating at the back of my throat. I had more ice chips again, which really felt good.
At 7:00 I was taken in a wheelchair to the Radiology department for an Upper GI. They had me swallow the wonderful toxic mixture they provided and verified that nothing inside was leaking. I got to take about 6 swallows of this great stuff, but it was worth it to find out that everything was properly sealed inside of me. If you leak, they have to go back in. Not exactly what I would want to happen.
Once declared "Leak Free", it was time to eat. My tray of "food" included bacon, eggs, hash browns and pancakes. I wish! I had a snack pack sized tub of sugar free strawberry Jello, the same sized container of sugar free grape juice, a cup of broth and a cup of hot tea. I honestly had no appetite at all and the food didn't look good at all. I had a few sips of juice and a couple little bites of jello. That was good enough for me at the time.
The rest of the morning was spent preparing to go home. Dr. Jawad made his rounds and released me. The Nutritionist came by and went over the rules of eating for the next couple months. I spoke to the Physical Therapist about exercise. My "Angel" came by and talked about her experiences with the surgery and answered a few questions for me. She showed us before and after pictures of herself. She looked great and was very encouraging.
The lead RN on the Bariatric Ward spent about 45 minutes with me. Kelli is a fantastic nurse and has such a great sense of humor that you can't help but feel good around her. She removed my drain tube and showed us how to change the dressings. She taught us how to use the G-Tube as well and went over the rules of the game again. All that done, I was ready to go home, or at least to my Mom's house for a few days.
I was discharged the day after surgery, the day before Thanksgiving, at 2:00pm. Upon request, the last thing I got before I left was something for the 100 mile ride home: a nice dose of Demerol and something to prevent nausea. I got the standard wheelchair ride to the door, loaded into the truck and we were on our way. I slept for most of the trip, so it really wasn't that bad, although the bumps in the road did hurt a little.
FIRST 10 DAYS PREOP (22 Nov thru 1 Dec)
The first few days after the surgery were spent at my mother's house. If I had to, I could have managed by myself, but having someone else around is a good thing for many reasons. My surgeon recommends no driving for a week after surgery. As long as you are taking pain medication, this is definately a great idea.
I stopped taking the pain medication after the second day. I still had pain in my left shoulder from the anesthesia, but it was bearable. It lasted for about four days. I also had pain on my left side, above the feeding tube. This lasted for most of the first ten days. It actually got worse for me and peaked at a week out, then got better quickly. The pain in the side was bad enough to limit my movement and to make it hard to get out of bed. I was glad when it went away.
I took it easy and basically sat around for the first five days, which were over the Thanksgiving holiday anyway. I drove myself home at the end of the 5th day, but didn't do much for several days after I got home. On the tenth day, I drove 100 miles to my doctor's office for my follow up and 100 miles back with no ill effects. I was feeling pretty good at that point.
Comfort wise, I think it's important to have a few things going for you. A bed that's easy to get in and out of is imperative. If you have enough pillows so you can sleep propped up in a sitting or semi-reclining position, you will not have to face the painful sitting up process in the morning to get out of bed. With the pain in my left side, this was the worse couple minutes of the day for me. It's also in your favor if you have a chair which is comfortable enough for you to sleep in. When I couldn't get comfortable in the bed, the recliner was a good alternative place for me to sleep.
I did have problems sleeping. I'm not sure if it was because I couldn't get comfortable or that my mind was racing. It may have been a little bit of both. I think we are undergoing some major changes in our life during the pre-surgery, surgery and post surgery stages. It's only normal for us to be hyped up mentally. I wasn't using my CPAP machine for my sleep apnea either, at my doctor's request, and that didn't make things any easier.
Pre-surgery, we are jumping through hoops trying to get approved. We are apprehensive of the unknown elements of the adventure before us. No matter how well we are prepared for the actual surgery, it is normal to be apprehensive. Again, we have an unfamiliar situation facing us. We don't know what to take to the hospital, what being there will be like, will there be pain, complications, etc. Add to that being removed from your everyday life and the worries we have about who will feed the dogs, how bad things will stack up at work and other issues of that nature. Then there are also the post surgery questions. How long will it take to recover? When can I go back to work? How will I feel with my new plumbing? Will I miss food as I've always known it?
The truth is, we adapt and get through these things much easier than we think we will. Still, there are things we can do to help ourselves. Do your research ahead of time. Find out as much as you can about the issues which are on your mind by talking to your doctor, people you know who have been through this process and by utilizing this, and other, web sites. There are people here who will answer any questions you have. Use this to your benefit. Plan as much as you can ahead of time and prepare for the days after you come back home.
That leaves the subject of appetite and eating post surgery. I had NO appetite following surgery. What I ate and drank, I had to make myself eat and drink. For me, this lasted for about three days and then began to improve.
I was on a clear liquid only diet for the first two days. It didn't matter, I didn't want anything anyway. I managed to get down some sugar free jello, but not much. I worked hard on getting as much water down as I could, but definately didn't meet the recommended intake.
It took a few days before I was able to drink more than a sip at a time. It takes quite a few sips to drink a 12 oz. bottle of water. After a few days I was able to take bigger swallows, so it was easier to increase my fluid intake. I am able to drink several swallows in rapid succession now, but that isn't a good idea. Post surgery, there are differences in the way it feels to drink. I can feel the water go all the way down, especially if the water is cold. I've become used to the feeling. I am more sensitive to cold liquids though. If I drink several swallows of cold liquid too quickly, it cause cramps. The cramps aren't very bad and they don't last long, but they are enough to make me not want to experience them. If I am drinking something cold, I drink it slowly, and in smaller swallows, and I don't have any problems.
The feeding tube (G-tube) is another issue. If you don't have to have one, or get it taken out quickly, you are lucky, as long as you don't have any complications. In general, it's just a nuisance, and nothing to be apprehesive over. Having a rubber hose sticking out of you is a foreign feeling. It's there as a precaution. It allows you to take nutrients, or medication, directly into your residual (old) stomach. If you have problems eating, this would allow you doctor to treat you more easily. It also allows you to drain your residual stomach over the initial days of the post surgery period while the junction leading to your intestines heals. Some surgeons require you to feed yourself protein shakes through the tube to supplement what you are eating normally. This is an effective way for you to get your required protein.
In general, by the time the first ten days had passed, I was feeling pretty good. My energy level was up, although I could wear myself out by doing too much. The the pain was pretty much gone. I had lost 23 pounds already and my blood pressure and blood sugar were under control without medication. I was able to work (my work isn't physically stressful) and drive without any issues. I feel like it's a great start.
THROUGH THE FIRST MONTH
The first month went by quickly. I had a follow up on 27 Dec. My G-tube was removed and I was snet on my way. My next follow up is at the end of March
The thick liquid diet got old after awhile, but it didn't last long and then it was time to move on to soft foods. It gets easier to drink more water as time goes on. By the end of the first month, I was still having to work at it to get as much water in as possible. Drink wise, nothing seems to taste good to me, so the plain water is gettign a little monotonous. I have tried a multitude of different products, but none seem to hit the spot. Seems I have grown very "sensitive" to the taste of Splenda and it just doesn't taste good to me in most products. I'm hoping to find Stevia to my liking.
Have experimented extensively with different protein options. Am currently mixing both the Chocolate and Vanilla flavors of "Pure Protein" brand powders with a variety of other things to make shakes. Half a frozen bananna goes in almost every shake I make. A few small pieces of frozen fruit does wonders as well. I am also using fruit flavored, clear liquid protein drinks daily. "New-Whey" by IDS and and "Profect" by Protica are what I'm drinking. They are 3 oz each and have 25 grams of protein. Three ounces equals three swallows, so they go down pretty quick and I'm done. They're easier to drink than a shake and have about the same amount of protein. Works for me.
I joined a local support group during the first month and have become active in the group. It is definately useful to be around others who have had Weight Loss Surgery. I highly recommend it. I am working on a web site for the group and will post the URL once it's up and operating. I feel the more you know about weight loss and weight loss surgery, the better your chances at succeeding. The site I am developing will be another source of information and knowledge, just as this site is. Obesityhelp is a great resource to us all and having another on the net can only help.
