Loris

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It sure is frustrating to travel this journey when we start out super morbidly obese.  Our smaller counterparts reach goal in a year or so and the lightweights get down right thin in less time than that.

Some SMO WLSers never reach a "normal" BMI for many different reasons including the weight of excess skin, the inability to be active enough and the body just refusing to let the last excess pounds go.

I think a more realistic goal is a healthy weight.  What weight would be considered heart and joint healthy?  Face it, none of entered into this be beauty queens.  We have always been beautiful.  We want to live long and comfortably and to feel attractive.  One does not have to be tiny to do that, but we do have to be in a healthy range.  What does our surgeon and PCP say?  How does our body feel?  Strive for health and except less than perfection in the dressing room.  We are all winners!

My goal was always to reach a normal BMI.  That would have been 135 pounds.  Now at 4, yes 4 years out, and 202 pounds lost I am calling 142 goal with a BMI of 25.8.  I look good and feel good.  I wear an 8-10 petite on the bottom and a 12 petite jacket.  I started out in a tight size 34. 

I know if I had been more diligent I could have reached goal faster.  I am satisfied with how I did.

I was in intensive therapy before WLS.  It enabled me to be mentally healthy enough to even have the surgery.  I didn't need much more than tweaking as I went a long.

I tried not to take myself too seriously during my journey.  Read my earlier entries.

I went to local support groups in the beginning.  I had a WLS mentor.

Life is easier now, because I am more mobile.  Not including my plastic surgery I have been hospitalized several times for non WLS surgeries or illnesses.  It was so much more managable thinner.  My sleep apnea and diabetes are in remission.

I am so much more at ease in social situations and I have always been out going.  I feel more mature and lady like.

I tried to remember that we are all different and are walking a different journey.  That we walk at a different pace.  I try to remember that I have not walked a block in your shoes, let alone a mile.

I don't reach out to help others as much as I should.  I don't fortify myself from others as much as I should.  I come on too strong.  But everyday I try a little harder to grow.  I never give up.  Thanks to each and everyone of you.  This community is all that.  Loris

If I made the plastic surgery seem like a piece of cake I didn't mean to.  A few things I left out were my back pain after my lower body lift.  This was due to an existing back issue, but painful none the less.  The drains are a hassle, but they are doable.  One of mine was in 3 1/2 weeks.  Stool softeners are a must to avoid constipation.  I still needed a few suppositories.  It took a lot to ease myself back into my bed both times.  I longed to sleep on my side the second time.  I could go on, but why?  Read the PS board for a long time before you dive in.  You really need to know what to expect.

Where am I today?  I am going to have my left nipple lifted in an in office procedure when I am ready which will be in August and my six months mark.  I still feels a tingle here and there.  My numbness in my tummy area is going away a tiny bit.  I am still spitting a few stitches from the UBL.  I am still slightly sore to the touch from the thigh lipo.  I am making an effort and am losing more weight.  I weight 157.4. Gotta count the .4.  LOL  My butt is tighter and I can lift it my flexing the muscles.  It would really respond to exercise.  Who me, exercise?  My scars are fading nicely. 

I am super pleased with my results.  My arms and thighs are sagging, but I am content.  The operative word is content.  I am thrilled with my breasts, lower abdomen, my outer thighs and butt.  I am content with the rest of my body except my upper tummy and I am losing weight to address that.  My true contentment comes from within.  I am happy with Loris the woman.  The days I am not happy with me, I take stock of my personality and my heart, not my body.

I had a lower body lift on 10/17/2007 and had 15 pounds removed, more from the butt and hips than my stomach.  I am very pleased with the results.  He postponed the liposuction on my thighs because of the increased risk of blood clots with lipo and lower body work.  With my history of blood clot it is safer to do it at my upper body lift.  I had the typical little issues in the hospital such as low blood pressure. 

At home my recovery was uneventful.  I started feeling OK after ten days.  I wore a binder only and sleep in a recliner for at least two weeks.  I took a lot of pain medication along with Ativan. 

I realized the 15 weight loss and I have now lost 178 pounds.  My butt looks so good.  My upper tummy is not flat.  After much diplomacy, Dr. K. said it would require more weight loss.

Riding 123 miles each way for post-op care was a hassle.

Round two upper body lift  on 1/23/2008.  The first week was a blur due to the pain meds and Ativan.  I went around telling people the upper body lift was a peace of cake.  I had lipo on my outer thighs which was easy,  removal of back fat and a breast lift.  I couldn't tell any difference in my thighs until the swelling went down, but now they look great. He went to great lengths to preserve my breast tissue and I lost about a cup size from 38DD to about a 38D.  I was bigger on the left before.  Right now I am much bigger on the right.  I had a large scab on the left nipple.  It healed nicely, but the true color is not restored yet.  The scar around the nipples and down the breasts is very thin.  It is still puckered underneath the breasts.  The back is pretty smooth.   It has been painful partly because my bra band rides up into the incision and partly pain in general in my breasts and in my axilla and back.  The second week was hard.  I retained up to 14 pounds of fluid.  Dr. K. said I was doing too much and to cut back on salt.   I wanted to tell him the only thing I was doing was riding to see him.  At about 12 days out, Dr. Kreiger gave me two tiny doses of Lasix at my request and I slowly peeded off the fluid.  I am now a few ounces below my lowest weight.
 LOL

I came back from Florida having realized a few things.  One is yes, I have felt thin for a long time after a 165 pound weight loss.  I am not thin.  I am fat.  No flames here.  To be at a normal BMI, I needed to lose 50 pounds.  That gives me an obese BMI.  I needed to except the reality that I looked sloppy. in my body, skin and most of all my nice clothes.

Two, my 22 year niece lost 40 pounds.  She went from being fat to being thin.  She looks fabulous!!

Today I realized that after losing 7.5 pounds of the ten I gained on my own and losing 4 on time out I am now  only 14 pounds from an overweight BMI.  Why will I settle for obese (unhealthy) when I can be over weight (more healthy)?  Then it is just a few pounds from my engagement weight...

Day one Time Out Weight  181.8

I had a bathroom run after each nectar, pun intended.  I had two shakes and had five Ritz and some lean ham and cheese for dinner.  Lots of coffee with half and half.

Day two Time out  Weight  180.2

Same as yesterday without the Ritz.

Day Three  Weight  179.2

Three drinks, lean ham, cheese, coffee, half and half


Day four  Weight  177.8

 I am finishing up day four of timeout.  It was much easier today.  My stomach is completely settled.  I am not hungry tonight except some head hunger.

Day six 9 AM  176.4

It's worth it.  I am still having a protein snack before bed.  It doesn't seem to be hurting anything.

One of our members is writing a paper and asked for post on what held us back as an obese person and how it made us feel and I wrote the following.  I thought it was important to record it here for myself.

As a super morbidly obese person I couldn't fit in a auditorium seat at a casino in Biloxi, Miss.  I didn't even come close because it was a very small seat.  I was humiliated.  Movie seats were very tight so I avoided them.  I avoided all lawn furniture and any chairs with arms.  I of course couldn't sit in booths.  It became a real issue to stand to sing in church because of the limited distance between the pews caused me to stand at an odd angle which really hurt my back. 

Public restrooms where a problem, because there wasn't enough room for the mobility required for cleanliness.  Doctor's office usually didn't have the correct size gowns which was embarrassing and didn't afford me the dignity other women have at the doctor.  I put off going to the gyn for this reason and because I was embarrassed of my size.

It was a real struggle to get in and out of the back seats of two door cars or up off upholstered  furniture.

I got stuck in a shampoo chair once and it made me feel terrible, because my friend was doing my hair.  I avoided going back there for a while until after my WLS.

I got to where I couldn't walk through Walmart due to mobility issues.  The skooters were all busy and they didn't have a wheel chair big enough for me to sit in so I didn't go back to Walmart until after I lost weight.

I now weigh less than I did on my wedding day.  But alas I was a chubby bride of 180 pounds  and 29 years old.  I got engaged 9/29/1987.  One month later I was assaulted and gained 30 pounds before my April 1988 wedding.  I didn't let the weight gain bother me.  People had seen me heavier before.  Sadly, I continued to gain and I am under 180 for the first time since.

I was tweezing my brows the other day and didn't recognize myself in the mirror.  I was like who is that old lady?!  The last time I didn't have a double chin and I could see my strong jaw line I was 29.  There were no lines around my mouth or slight waddle in my neck.  Actually, I look darn good for 48.  I couldn't be more pleased.  When my husband and I  feel in love as teens we talked of growing old and gray together and God is allowing us that dream.  We should have dreamed to grow old and rich together.  :)

(I drink alcohol and thought this was very interesting.  Loris)

Alcohol after Surgery

Many thanks to Dr. Cynthia Buffington for allowing us to reprint her article on the use of alcohol. I think you will find it very interesting.

A 32-year old male 5 months out from gastric bypass surgery was issued a DUI after attending his brother’s wedding reception. According to the patient, he had only consumed 2 glasses of champagne, although his blood alcohol levels were above the legal limit to operate a motor vehicle.

A female patient 50 years of age and one-year post-gastric bypass hit and killed a pedestrian with her automobile after having less than 2 glasses of wine. When police arrived she had difficulty with her coordination, slurred her words and seemed somewhat confused, although her alcohol test suggested that her blood alcohol levels were shy of the legal limit.

Were these patients telling the truth about the amount of alcohol they had consumed or did their surgery affect the way the body absorbs or metabolizes alcohol?

A recent study reported in the British Journal of Clinical Pharmacology found that the gastric bypass procedure significantly affects alcohol absorption and its inebriating influence. According to the study protocol, a group of gastric bypass patients, three years post-surgery, and their non-surgical controls consumed an alcoholic drink after an overnight fast, and blood alcohol levels were examined over a period of time. The data showed that blood alcohol levels of the gastric bypass patients were higher and required much less time to peak than those of the non-surgical controls.

The more rapid absorption of alcohol and heightened blood alcohol levels would cause the bariatric patient to have a more pronounced feeling of inebriation during and shortly after drinking. And, such effects could have serious ramifications with regard to driving an automobile or performing other skilled tasks such as operating heavy machinery, piloting a plane or any other task that may influence the safety of the individual or that of others.

Why would alcohol absorption be higher for someone who has had a gastric bypass (or other surgical procedure that reduces the size of the stomach, i.e. biliopancreatic diversion with or without the duodenal switch, gastrectomy)? With the gastric bypass procedure, more than 95% of the stomach is bypassed. Alcohol passes directly from the stomach pouch, usually without restriction, into the intestines where, due to the large surface area of the intestines, alcohol is rapidly absorbed.

In addition to anatomical changes that influence alcohol absorption, the bariatric surgical patient may be more sensitive to the effects of alcohol because of low calorie intake. Several studies found that alcohol absorption is more rapid and blood levels higher if alcohol is consumed on an empty stomach than if provided with a meal or drank soon thereafter. During the first several months following bariatric surgery, total daily calorie intake is quite low. Drinking alcohol, even small amounts, at this time, would increase significantly an individual’s risk for intoxication.

Metabolic changes that occur with rapid weight loss, as well as the morbidly obese condition, can also alter the rate that the liver is capable of clearing alcohol from the body by the liver’s primary pathway for alcohol metabolism. Reduced clearance of alcohol by this pathway may further increase blood alcohol levels and the risk for intoxication and alcohol toxicity. Metabolic changes that occur with massive and rapid weight loss may also increase the clearance of alcohol by a secondary pathway of alcohol metabolism that substantially increases the risk for liver damage while, at the same time, makes an individual more sensitive to the toxic and cancer-promoting effects of pollutants in the air, industrial solvents (such as those in household cleaners), and certain drugs.

Alcohol use can also cause brain damage, a loss of consciousness or even death by reducing the supply of sugar (glucose) to the brain. Muscle, heart, liver and other tissues use fat and sugar (glucose) for fuel. The brain, however, needs sugar to function. To avoid a depletion of sugar, the body stores sugar in the form of glycogen. Glycogen stores, however, can be depleted in a short period of time with prolonged work or exercise, fasting or a diet low in carbohydrate. Furthermore, alcohol reduces the process that allows sugar to be stored as glycogen.

The bariatric patient, particularly in the rapid weight loss period and if on a low carbohydrate diet, may have low amounts of stored sugar (glycogen). Drinking alcohol could deplete those stores and cause blood sugar levels to decline. The body, however, has another mechanism to maintain appropriate amounts of sugar in the body. This process is known as gluconeogenesis and is a chemical pathway that converts certain components of protein, lactic acid and other substances into sugar. However, alcohol reduces the production of sugar by this process and can, thereby, cause hypoglycemia (low blood sugar).

Usually when blood sugar levels fall, there are certain hormones produced that restore blood sugar levels to normal. However, when someone drinks alcohol, the response of these hormones to low blood sugar is blunted. To make matters worse, hormone responses to low blood sugar are also blunted or depressed in postoperative bariatric patients. The bariatric patient, therefore, would have a much higher risk of becoming hypoglycemic (having low blood sugar) than someone who drinks that has not had the surgery, particularly if the patient drinks alcohol during the rapid weight loss period.

Since the brain and nervous system need sugar for fuel, low blood levels could adversely affect neuromuscular and cognitive functions, causing a loss of coordination and balance, slurred speech, poor vision, and confusion. These are all conditions that mimic those associated with intoxication. The patient described earlier, who appeared extremely intoxicated even though her blood alcohol levels were not high, may have been hypoglycemic. Low blood sugar, over a period of time, can result in a ‘black out’ or loss of consciousness, brain and nerve damage, and even death.

The use of alcohol after surgery could also cause irreversible brain and nerve damage, coma and possible death by inhibiting the absorption of important vitamins, including B-complex vitamins such as thiamin (B1) or vitamin B12. Alcohol inhibits the absorption of thiamin and other B-complex vitamins, reduces activation of certain vitamins, and stimulates the breakdown of vitamin A, pyridoxine, and folate. These vitamins may already be deficient in bariatric patients because of nutrient restriction, malabsorption or impartial digestion of foods produced by the prospective surgery. Alcohol use, then, would compound the negative effects that bariatric surgery has on vitamin/mineral status and increase the risk for associated health problems, including nerve and brain damage, defects in metabolism, a decrease in the ability of the body to heal, low immunity, fatigue and more.

Alcohol has numerous other toxic effects in the body. Not only does alcohol cause liver disease but also negatively affects other tissues. Alcohol’s influence on the heart inflammation (myocarditis), a loss of heart tissue (cardiomyopathy), and irregular heart beats (arrthymias) that can lead to sudden death. Skeletal muscle is particularly susceptible to alcohol with loss of skeletal muscle fibers and strength. Alcohol also causes inflammation of the intestinal tract, gastritis, pancreatic, acid reflux disease and increased risk for gastric and esophageal cancer. And, alcohol causes damage, often irreversible, to the brain and nervous system.

In addition to the numerous health problems that drinking alcohol after surgery may cause, the bariatric patient should also be cautious of alcohol addiction. The prevalence of food addiction and associated eating abnormalities, i.e. binge eating, carbohydrate cravings, are high among individuals with morbid obesity. With bariatric surgery, the addictive tendency for food and aberrant eating behavior are considerably improved. However, individuals with addictions often transfer their addiction to yet another substance, such as alcohol. According to the findings of Austrian psychologist, Dr. Elisabeth Ardelt, addiction transfer may occur in as many as 25% to 30% of bariatric patients.

Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss. One 12-ounce can of beer, for instance, contains 150 calories; 3.5 ounces of wine contains 70 calories; 1.5 ounces of gin, rum, vodka or whiskey contains between 97 and 124 calories; and 1.5 ounces of liquor contains 160 calories.

Are there guidelines for using alcohol after surgery? Presently, there are no official guidelines that have been established pertaining to the use of alcohol after having bariatric surgery. However, based upon knowledge of changes in the absorption and metabolism of alcohol, coupled with the metabolic state of the bariatric patient at various stages postoperatively, the following suggestions are recommended

• Do NOT drink alcohol during the rapid weight loss period.
• When drinking, remember that small amounts of alcohol can cause intoxication or can result in low blood glucose with serious consequences.
• Do not drive or operate heavy equipment after drinking alcohol, even small amounts.
• Eat if you plan to have a drink.
• Make certain to take your bariatric vitamin and mineral supplements.

Cynthia Buffington, Ph.D.
Reprinted with permission

The 10 Most Common Mistakes Weight Loss Surgery Patients Make National Association for Weight Loss Surgery

While weight loss surgery (WLS) is considered the most successful treatment for morbid obesity, it is just the first step toward a fresh start. Weight regain is a common phenomenon, as is illness when weight loss surgery patients do not follow recommended guidelines.

 

Breaking old patterns, establishing an effective post-WLS lifestyle, and addressing the emotional issues that often complicate obesity takes more than commitment; it takes support, information, and resources.

 

The National Association for Weight Loss Surgery (NAWLS) helps WLS patients shape new lives. We teach people what they need to know and help them makes the changes they need to make to achieve long-term WLS success -- physically, mentally, and spiritually.

 

In a November 2005 poll conducted by NAWLS, the following were identified as the top 10 mistakes WLS patients make:

 

 

1^st Mistake:  Not Taking Vitamins, Supplements, or Minerals

 

Every WLS patient has specific nutritional needs depending on the type of surgery you have had. Not only is it a good idea to ask your surgeon for guidelines, but also consult with an experienced WLS nutritionist. Understand there is not a standard practice that all surgeons and nutritionists follow in guiding WLS patients. So, it is important to do your own research, get your lab tests done regularly, and learn how to read the results.

 

Some conditions and symptoms that can occur when you are deficient in vitamins, supplements, or minerals include:

 

Osteoporosis; pernicious anemia; muscle spasms; high blood pressure; burning tongue; fatigue; loss of appetite; weakness; constipation and diarrhea; numbness and tingling in the hands and feet; being tired, lethargic, or dizzy; forgetfulness, and lowered immune functioning.

 

Keep in mind, too, that some conditions caused by not taking your vitamins, supplements, or minerals are irreversible.

  

 

2^nd Mistake:  Assuming You Have Been Cured of Your Obesity

 

A "pink cloud" or honeymoon experience is common following WLS. When you are feeling better than you have in years, and the weight is coming off easily, it's hard to imagine you will ever struggle again. But unfortunately, it is very common for WLS patients to not lose to their goal weight or to regain some of their weight back.

 

A small weight regain may be normal, but huge gains usually can be avoided with support, education, effort, and careful attention to living a healthy WLS lifestyle. For most WLSers, if you don't change what you've always done, you're going to keep getting what you've always gotten -- even after weight loss surgery.

 

 

3^rd Mistake:  Drinking with Meals

 

Yes, it's hard for some people to avoid drinking with meals, but the tool of not drinking with meals is a critical key to long-term success. If you drink while you eat, your food washes out of your stomach much more quickly, you can eat more, you get hungry sooner, and you are at more risk for snacking. Being too hungry is much more likely to lead to poor food choices and/or overeating.

 

 

4^th Mistake:  Not Eating Right

 

Of course everyone should eat right, but in this society eating right is a challenge. You have to make it as easy on yourself as possible. Eat all your meals--don't skip. Don't keep unhealthy food in sight where it will call to you all the time. Try to feed yourself at regular intervals so that you aren't as tempted to make a poor choice.

 

And consider having a couple of absolutes: for example, avoid fried foods completely, avoid sugary foods, always use low-fat options, or only eat in a restaurant once a week. Choose your "absolutes" based on your trigger foods and your self knowledge about what foods and/or situations are problematic for you.

 

 

5^th Mistake:  Not Drinking Enough Water

 

Most WLS patients are at risk for dehydration. Drinking a minimum of 64 oz. of water per day will help you avoid this risk. Adequate water intake will also help you flush out your system as you lose weight and avoid kidney stones. Drinking enough water helps with your weight loss, too.

 

 

6^th Mistake:  Grazing

 

Many people who have had WLS regret that they ever started grazing, which is nibbling small amounts here and there over the course of the day. It's one thing to eat the three to five small meals you and your doctor agree you need. It's something else altogether when you start to graze, eating any number of unplanned snacks. Grazing can easily make your weight creep up. Eating enough at meal time, and eating planned snacks when necessary, will help you resist grazing.

 

Make a plan for what you will do when you crave food, but are not truly hungry. For example, take up a hobby to keep your hands busy or call on someone in your support group for encouragement.

 

 

7^th Mistake:  Not Exercising Regularly

 

Exercise is one of the best weapons a WLS patient has to fight weight regain. Not only does exercise boost your spirits, it is a great way to keep your metabolism running strong. When you exercise, you build muscle. The more muscle you have, the more calories your body will burn, even at rest!

 

 

8^th Mistake:  Eating the Wrong Carbs (or Eating Too Much)

 

Let's face it, refined carbohydrates are addictive. If you eat refined carbohydrates they will make you crave more refined carbohydrates. There are plenty of complex carbohydrates to choose from, which have beneficial vitamins. For example, if you can handle pastas, try whole grain Kamut pasta--in moderation, of course. (Kamut pasta doesn't have the flavor some people find unpleasant in the whole wheat pastas.) Try using your complex carbohydrates as "condiments," rather than as the center point of your meal. Try sprinkling a tablespoon of brown rice on your stir-fried meat and veggies.

 

 

9^th Mistake:  Going Back to Drinking Soda

 

Drinking soda is controversial in WLS circles. Some people claim soda stretches your stomach or pouch. What we know it does is keep you from getting the hydration your body requires after WLS--because when you're drinking soda, you're not drinking water! In addition, diet soda has been connected to weight gain in the general population. The best thing you can do is find other, healthier drinks to fall in love with. They are out there.

 

 

10^th Mistake:  Drinking Alcohol

 

If you drank alcohol before surgery, you are likely to want to resume drinking alcohol following surgery. Most surgeons recommend waiting one year after surgery. And it is in your best interest to understand the consequences of drinking alcohol before you do it.

 

Alcohol is connected with weight regain, because alcohol has 7 calories per gram, while protein and vegetables have 4 calories per gram. Also, some people develop an addiction to alcohol after WLS, so be very cautious. Depending on your type of WLS, you may get drunker, quicker after surgery, which can cause health problems and put you in dangerous situations.

 

If you think you have a drinking problem, get help right away. Putting off stopping drinking doesn't make it any easier, and could make you a lot sicker.