sleevicidal_maniac

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This is a brief update. It's also my favorite one so far.

I think I may finally be getting the hang of this. Tomorrow marks five weeks for me since getting my VSG done, but it's my wife's birthday and I won't be able to post - she celebrates her entire birthday week (frankly, she's in the shower now and I just snuck away). Anyway, without wasting any more valuable time, let me give those of you who are behind me a few bright spots to look forward to and those ahead, maybe a nice memory or two.

First and most importantly to me, I'm pretty much pain free for the first time in a month. My sutures must have dissolved, or mostly dissolved, and I can do everything I could do before without debilitating and crushing pain - everything except sneeze and stretch/yawn with my hands over my head. I can deal with those things, the sneezing, of course I just hope to avoid and the stretching, well, it can wait a few more days. Without the pain, there's no need for the vicodin suspension! -1 med.

Thanks to the calendar soldiering forward, my script for the Neurontin has stepped down to twice a day from three times. And, without the constant twinges and painful reminders that I had stitches through my nerve, I don't have the edge and soreness that had me taking 1600mg of ibuprofen four times a day either. -2 meds/8 pills.

I started the Actigall med last week, just once a day instead of twice, to allow my body get used to it. I also was instructed to take it with OJ to aid in absorption, since the Prevacid kills the acid. Now, this pill was an issue because it needed to be taken two hours after and one hour before antacids, which needed to be taken an hour before meals and an hour away from the Neurontin. Because the Neurontin was stepped down two twice a day, I can take it with the Actigall in the morning and before bed now with my multi and my beta blocker and I only need to take the Prevacid midday and carry one pill with me to work. With the week behind me and no symptoms except a little more regularity... full dose starting today, 2 pills. Bonus, though, is that I can eat as I am hungry instead of by the alram on my phone and I can sleep an extra hour. +2 pills and 2-3oz of orange juice (awesome!), -1 scheduling nightmare.

Friday, after applying all the instructions that I could handle from my surgeon/nut visit last week, I promoted myself to soft solids. The PMAS (puke myself awake syndrome) and overeating (ha ha, still funny when I say that) are under control and I got myself back to regular visits from the doctor by adding a bowl of grits for breakfast every other day. I bought the Metamucil as instructed, but haven't had to use it yet! -1 gritty, sandy, make you poop at defcon 3 beverage, +SOFT SOLIDS!

I just mentioned it a second ago, but for the glory of it all, and because it deserves its own paragraph, I'm finally on soft solids. I ate some of the best tasting foods I have had in a month. My first meal was scrambled eggs with three whites and half a yolk. It was so delicious and awesome I think I cried into my plate. I made some turkey chili from scratch with veggies from my garden, 99% FF ground turkey and pinto beans that might as well have been fois gras or filet mignon it tasted so amazing just chewing something with texture and more than a single flavor... In my travels with the wife and the girl this weekend, I went to two restaurants. I went to Qdoba (like Chipotle for those who aren't familiar). I didn't order anything, instead I had the filling from one of my kid's chicken tacos and a forkful of beans. I was full, and strangely enough, not sad. Later that evening, my in-laws invited us to a local restaurant for dinner and I ordered a sashimi app and fought through half of it - I loved it and have a nice little meal for myself today with what I couldn't fit into my pinky finger sized stomach.

Best yet about the solid foods, I filled up much faster than with the densely concentrated purees and, even though I had an extra meal in place of my snack, I lost 3lbs over the weekend, breaking a two-week creep that had the makings of a stall. 

I will make an appointment with my PCP next week to get off the beta blocker and see if he wants me back on my regular BP meds and I might even schedule a plain old physical just to see what I can start working on. After this week, I am back to full duty so I will be able to get back into the shop and start working on my race car, in earnest, in time for the winter tours and challenge races. I will also be able to get a little more aggressive with my exercise and finally get to try out my new kayak. I am happy to say that my life is beginning to feel somewhat regular again.

I'm still hungry all the time, because my tiny little stomach continues resisting arrest, but I am finally beginning to understand how much food I can eat without feeling like sh!t. My surgeon promises that my pyloris will adjust and that the reduction in gherlin will eventually get the hunger vs full feelings to correspond.

I'm 95% pain free, down to taking pills when I get up and go to sleep, plus one little capsule on the way to work which is easy to live with, I'm losing weight again, I went out and ran around with the wife and the girl, I sat in restaurants, ate a little food and didn't have any breakdowns or food rage - any maybe best of all - I just feel great. I mean, I feel terrific - best I've felt in years. I've been this weight before but it was always a diet and exercise struggle and I always felt deprived. This time feels different - I know there's a lot of work ahead of me, but it feels more permanent. So, this was not the milestone post I had hoped for, but it was significant in that it seemed like a big turnaround. 

If any of you out there are having a rough time post-op, browse back over a few of my prior blog entries and compare notes. Point being - it gets better. I swear, I must have popped a squat under a rainbow this weekend. I'm so freaking excited about going forward and learning more about my new physiology and shedding the next 50lbs to get back down to an ideal weight!

I am 4 weeks out and had my one month post-op visit today.  Let me start off with some stats. So far, I have lost 42.6 lbs, more than 6" in my waist (I'm a guy, so I never measured, I just know based on the jeans I'm wearing), have my BP totally under control - 114/73 today at the doc's office, zero sugar issues, no more fat and swollen ankles and generally, I'm feeling pretty good. All that said, I am taking five different pills, four times a day, eating five different meals and snacks, five times a day, cannot eat within two hours of this pill or suspension, can't take this pill within three hours of that pill, can't eat after I wake up or before I go to sleep, can't sleep if I eat, can't drink before or after I eat, but definitely not during and have only pooped twice in three weeks!

Holy sh*t, I'm out of breath just typing that out. So, I went to the doc's on a mission. This needs to be simplified. I need to drink more water, eat my food (no matter how much, or little, it is) and take the meds that I need to get back to my life. I can barely tell if I'm coming or going, and it's taken something that's really going great and just making it confusing and a little exhausting.

So here's the scoop. First the PA - on the scale, BP, incentive aspirometer and check my incisions - this is pleasant because she's easy on the eyes and British (I think) but has a sexy accent nonetheless. I'm tall, and carry my weight OK, so I can easily picture her batting her eyes at me as she's "checking my pulse" and touching my incision sites... Good job on the scale, dropped around ten since last appointment two weeks ago, BP is great like I said, I breathe in the tube for her and my wounds look great - straight vitamin E twice a day after showers while the skin is soft, supple and the pores are open - you can barely find two of the five. So, she tells me I'm awesome and goes on her way to send the doc in. Oh, by the way, I brought my wife so I restrain myself from making any of my typical little comments or trying to act cooler than I am. She knows I dig the British chick and this will come back to haunt me later, somehow. Oh well, I do great with her and wait for the doc.

Alright, so in comes the doc and he immediately starts by discussing the pain that sent me to the ER a week ago. He put me on a reduced dose of nerve blocker and I have been weening myself off the vicodin and, honestly, I'm feeling pretty good. We (he still seems to count on me, and my wife, to make decisions) decide that the suture must be working its way out and that a steadily declining dose of Neurontin should do the trick. That's great. One pill down, four and a liquid to go.

Next subject is Actigall - for those of you who aren't this far along yet, Actigall reduces the threat of developing gallstones in post WLS patients. Since we soon-to-be ex-fatties are much more likely to develop them, I am into this one. Of course it causes nausea, vomiting and diarrhea in some patients, so I'll probably get those, but they're all better than gallstones and two out of three are better on a Sunday. So, Actigall, plus one, right back to where I started.

Having already undone my progress, and wanting to switch the subject, I start talking about exercise. Even as a fatty, I was an outdoorsman. I do a lot of boating and fishing. I love bicycling and my new hobby is sea kayaking. After a spin in the Channel Islands with my daughter and I in a tandem, I got reinvigorated on the sport and bought myself a new boat. I want to start... well, he looks at me crosseyed - check back in a month. I see where this is going and tell him, I went offshore fishing for tuna and swordfish Sunday and yesterday and he says, "a little too soon, don't you think?"  Ah, screw it. Back to food, this is going nowhere.

Now onto what's up with my eating. I have been on purees for two weeks. In those two weeks, I have found some things that are just fine to eat. Very normal fare which, in fact, has helped me out because I can sit down with my family and eat dinner. Not the same food mind you, but at the table nonetheless. Those of you on liquids understand that even sitting at the dinner table sucks, blows, or both. But purees actually involve putting a fork into my piehole, I feel like I'm eating, therefore, I must be. During the same two weeks, I have also encountered a problem. Four or five times, I have woken up at 2 or 3am with a mouthful of puke. Well, it tastes like puke, but not as sour. Turns out it's reflux. So, what's the cause?

Doc says to sleep with the bed elevated 30 degrees. No problem, I am lucky enough to have a Tempurpedic bed with adjustable head, feet, massager, etc.... but, no dice because my wife is a side sleeper, so I need to choose between sleeping without puking in my mouth and ever getting fancy with my hot wife. So, I have to stack up the pillows because even though I prefer sleep to vomit, I prefer sex to both. No big deal, but the doc also wants me to not eat or drink (even water) three hours prior to sleeping. Sh*t. I'm plus one pill and minus three hours of food scheduling.

Worse, though, I had to open my big mouth about the PMAS (puking myself awake synodrome), so now, I just bought myself another week on purees to find out if I am eating too much, too fast, the wrong foods or if I am still in post-op stress and not ready for even pureed food. Dumba$$. Plus one pill, minus three hours to eat, no graduation to soft solids...

So, after the PMAS discussion, the no soft-solids fiasco, don't enjoy your new kayak yet schpiel, and the gallbladder health clinic, I'm off to see the nutritionist, who I previously dubbed the "Prosecutor". She winds up, delivers and strike three goes screaming across the plate right in front of my face. She opens her interrogation by saying, "So, did the doctor say it's alright to eat soft solids?"

I immediately answer, "Yes," only to be instantly corrected by my wife. Puree-gatory it is. So, the prosecutor continues with her interview... "what did you eat?", "uh huh, hmmm, and how did you feel?", "I see."  "Have you tried the fat free one?" Mostly she's just talking with my wife who has now cost me a possible flirtation with the British PA and at least a week of food... oh brother. Anyway, I get the coveted soft solids menu and program. But, I only get to hold it for a second before the wife rips it from my hand so fast that I get a paper cut that would put a soldier down. I should even look at the menu yet, I can't have it anyway. OK, thanks. First we need to figure out why I have PMAS. The nut wants me to eat the same amount of pureed food every day - 6-8oz - only an ounce at a time, and separated by no less than an hour and take fifteen minutes each time!

Oh my God. Walk through this with me. assuming I eat 6oz of pureed food a day under this new plan, It will take me 7 1/2 hours to get my meals in. I have to finish three hours before bedtime, which makes it 10 1/2 hours, I can't eat for an hour after I wake up because of the nerve blocker, which means it's now 11 1/2 hours. I also can't take my Prevacid within two hours of the Neurontin, but I must take it 30 minutes before eating, and then I need another dose of the Neurontin and I need another hour break before eating, which is technically impossible without spacing out two of my meals by 1 1/2 hours on each side. Now my food zone is a whopping 14 1/2 hours and I have to get up at 530 if I want to eat all my food, take all my meds and go to bed by 1130pm. Is anyone else exhausted? I didn't even mention that the 6 times I eat it's a single ounce of food and that leaves no space for snacks. If I were to be bold and try to eat 8oz I would need to tack another 75 minutes onto this program, which means get up at 445 and go to bed around midnight. Hold the freaking phone people! This is not happening. I'm just gonna eat slower and shave back a quarter oz here and there and see how I do.

So that was my 4-week post-op checkup. Crazy right? Darned straight it was. But, do you know what? I walked out of that office grinning ear-to-ear. Maybe it was because I lost a bunch of weight. Maybe because I don't think the pain meds are with me much longer, maybe because I scored a bunch of points with my wife by bringing her and letting her ask the questions, interpret the answers and be involved in the process.

Ya know, I don't care about the plusses and minuses that today brought. I will be med free in six months and should be close to my goal (which my doc forcefully revised up on me - we'll see about that). My wife loves me, I have some friends that check on me a lot and are having fun at my expense (like eating a big pile of ribs from the Fire Pit BBQ place next to my office and telling me they suck... I'd do the same, so I appreciate the humor) and most of all, I have my kid who is just the light of my life and I know that soon, there will be almost nothing that my weight will keep me from enjoying with her.

I am getting close to halfway there and it's only been a month. I have had nothing but trouble and pain, but I wake up smiling and go to bed smiling. I hope this is what being a "regular" sized person is all about. I'm sure I will continue to have my share of problems, but for some reason, they have all gotten easier to deal with. My first milestone is going to be at 50lbs and I think it will be my next post. See you then.

So... two - two and a half  weeks post op everything's going great. I'm losing, the carb deprivation syndrome is behind me, I've had my follow-up with my surgeon and nut, my incisions are all uncovered and all the sites look great, a little vitamin E and the two small ones are practically gone, I get a big pat on the back and I'm finally graduated to purees. Good for me, right?

I am sitting in the doctor's office and complaining about pain akin to a hernia. Now, I had a slight hiatal hernia pre-op but the doc thought it was small and benign enough to just leave alone. Maybe I aggravated or made it worse? Maybe I put a little strain on my staples or the sutures (I have three because of the go-back surgery) in my stomach wall muscle? Maybe I tore something or herniated a different incision, maybe I.... shouldn't worry about it because the doc says it's just normal healing and if you have no vomiting you're fine.

So, I leave the office and go back to work with this pain. Now I have faced pain. In 2007, I cut all the fingers off my left hand with a mitre saw. I got most of them back, but my hand will never be the same. In 2009, I broke my toe while in Mexico so severely that it required surgery and an implant. Earlier this year I jumped from a roof, to a lower one at work and landed on a standpipe and tore my ACL and MCL , got a massive hematoma in my shin and broke all of the toes on my left foot in one fell swoop. These are just the highlights - I've had more hospital visits that Eval Kneival. They pale in comparison to what Sunday brought.

I spent Sunday, September 8th, just two and a half weeks from surgery, curled up in the fetal position in my bed alternating between trying to catch my breath and being on the brink of sobbing. I was sucking liquid vicodin from a bottle like a wino would swill MD 20/20 from a paper bag. I prayed a lot and called my surgeon's answering service. He didn't call back. The surgical fellow did and asked the same battery of questions - fever? can't tell. vomiting? no. dizziness, naseau balance problems? can't leave the bed. bowel movements? two in three weeks. His conclusion, "It's normal pain from healing, take it easy and call me tomorrow."

Tomorrow came and I suffered through a shower, grabbed my toiletry bag and went directly to Princeton UMC's ER. This cannot be normal. So, I'm OK when I'm driving - just standing up, laying down or walking. So, anyway, I'm driving out there. I call the doc's office at 9:01and of course only the wonderful and awesome (really - she's wonderful and awesome) receptionist. I tell her the deal - pain's a 10 outta 10. She tells me to keep going to the ER and she will send the doc there before he starts his appointments.

Four hours, six X-rays, an ultrasound and a 3D ultrasound later, still no doc. PA from the ER and the same surgical fellow. So, it seems I should have "played the lottery" since "the odds of this happening are so low that they don't list it as a surgical risk", but these guys put one of the go-back sutures into a nerve that wrapped around my back and ended in the stomach's muscle wall. He says, "I can't believe you could take the pain."

It took all I had to not freak out and kill him, plus I was hooked to an IV and writhing in pain. "I couldn't take the pain, that's why I called you and that's why I came here." How is this funny? It's not, right? Anyway, some Neurontin and horse choker Motrin later, I can stand up and walk. I can walk right over and get a Medi-Alert bracelet because now I have to take a nerve blocker. Really? Come on.

Moral of the story? I got 2000cc of ringer's, an IV morphine and a shot of local into my stomach with a syringe that looked something like a snorkel. A couple more prescriptions and I was back on my way. The IVs gained me about a pound and a half and three of the four meds I am on now cause weight gain so I had a slow week. I still lost two pounds and I can walk, bend and sleep - all of which are plusses. Next Tuesday is my 4-week and I hope to be graduated to soft-solids and get my 3-month blood panel script.

I'm gonna stick with this if it kills me, and it just might.

I wasn't there that day. I guess I was in a recovery suite in the ICU with a breathing tube in my throat and my arms and legs still lashed to the board. I had been drowned with saline solution, opened back up and had my sutre line reclosed with staples without any surgical prep because I had just come out of my original surgery. They kept me in an induced sleep for 24 hours to see if the bleeding would slow and my vitals improved.

The subsequent blood draws showed the hemoglobin levels beginning to rise and on Saturday morning they woke me up. I really have nothing to report for Saturday or Sunday. I remained in the ICU, had violent bowel movements in bed, another catheter, 3 IVs in my arms which would easily have won an award among heroin junkies, 2 surgeries, no showers, a high fever and very high BP. I was mortified and without a shred of dignity. Strangely, I felt better. 

After I got over the humiliation of the situation at hand, the ICU nurses assured me that they would take good care of me and that they would get me home to my daughter, and fast. They kept their word.

My lost day, plus Saturday, Sunday and half of Monday and they got me shipped back to the skyboxes on the second floor. They brought me strawberry Jello, cranberry juice and ice chips. Gave me some medicine cups to portion out 30ml and took walks around the floor with me as soon as I could get up. Every one was a little bit sweeter, nicer and more upbeat than the one before. On Monday afternoon, I asked the nurse if I could shower - she said, someone would have to watch me - while I thought about it for a second, I settled on some kind of mousse-antiseptic soap and a nice long sponge bath.

I shaved, washed my face with the hottest water I could stand and put on a fresh gown and traction control socks. Now get me the heck out of this place. Granted on Tuesday, early AM. I was in the hospital for 6 days and had two surgeries. I still don't know what happenned. I was weighed in the hospital by the bed at 300lbs - full of fluids, IV and whatever saline remained from the second operation. I couldn't believe that I just had my stomach cut out and that I weighed 3lbs more than when I went in. WTF David Blaine? No bueno so far. At least I was back in my wife's car headed back home to see my kid and my dogs and to, maybe finally, get some sleep. 

 University Medical Center at Princeton rivals some of the better hotels I've stayed in. The facility is amazing, a 5-star hotel. The staff was awesome, from registration through every nurse and orderly, the attending docs and even the housekeeping staff. Just spectacular. 

I checked in at 615am on Wednesday morning. I was hungry,  but not starving, nervous but not scared and anxious to move things along. 

A few IVs, and a hundred times stating my name and birthday later, and I was getting prepped for surgery. My surgeon came in and briefed us ad nausea and asked over and over if we had any questions, then that was it. didn't see him again until after. Saw the Anesthesiologist. Different story altogether.

I remember waking up in an awesome private room in the hospital around 1230 or 100pm after going through what was described as a perfect and complication-free surgery. I felt like I had been in a fight, but otherwise, really no specific pain, discomfort or complaints. Four holes, butterflied and saran wrapped and a JP drain bulb hanging out of my right side, near where my elbow would hit my stomach if my hands were clasped and my arms laid flat on my body. This would turn out to be an important indicator.

The doctor came in and spent 20 minutes discussing how well everything went and telling me and my wife that the section of my stomach that he removed was bigger than any he'd ever seen - hmmm.... that made me feel better but that everything seemed great and he would be back later. By the time he returned, everything had rapidly plunged from good to bad to ugly.

My vitals were in the toilet, the drain bulb was full with blood, I was totally enemic and my heart rate was 120 bpm. I was pretty whacked, but I'm pretty sure my surgeon turned green,, then white and finally settled on a sallow shade of yellow and he just stood there. Yep, he was about to lose his first patient.

He literally couldn't speak. He called into Dr. Brolin, from the same practice and consulted him on the phone and just stood there in my room and waited for the surgical fellow, Dr. Juha to get to my room and talked with him as well. On checking the hemoglobin counts in the blood that was drawn, it was plummetting and it became very apparent that I was bleeding internally, and that whatever was coing out of the drain was just the beginning. Now what?

Reminiscient of how a veteran segreant would accept orders from a green lieutenant in a war because he had to, but would never do anything to endanger his men, it was the physician's assistant, Stuart, who finally started making some decisions. They would draw blood again in the morning, put me on a beta blocker to try and control my BP and heart rate and see if there was any improvement. Needless to say, I didn't sleep a wink in the next 12 hours and my nurse sat right next to me all night long and talked to me, almost as if she didn't want me to sleep.

By 6am a phlebotomist was in the room drawing blood and the results came back from the lab by 8am. Hemoglobin was lower than the prior test, BP was 220/160 and my heart rate was now tapping on 200 bpm. I couldn't keep my eyes open. I wasn't scared, mostly angry. This is how I was going to die, on a hospital table, with my ass out of a gown, a catheter in my thingy and docs representing 5 million in annual earnings scratching their heads, clueless.

Finally, when the docs left the room for a minute the nurse brought my wife in by the hand and woke me up. She said, if your surgeon won't go back in, I will give you a number of another one. You need to do something fast or you're gonna get rolled out of this room and not ever come back. Now I was a little scared. I still couldn't open my eyes.

My surgeon came back in and my wfe throttled him. "Figure out why he's bleeding. Figure out who's going to be with you in case you can't figure out why he's bleeding and get the OR as soon as possible. I brought you a healthy man, and you f*ck%d him up." I remember that clear as day.

I guess he followed her instructions, because I passed out. I remember being awoken by the anesthesiologist only to sign here, here and here and then getting strapped to the table in the OR. It was Thursday night at 900pm. 

 So, I got through the 90-day diet, easily flew through a psych eval (I actually sold the doc a security camera system during the appointment) worked with the sleep center and business admin to get my results from eighteen months earlier in a presentable format, and made an appointment with my regular doctor.

I get to the doc's office and check in and told the receptionist that I had an urgent call to address and please stick her head outside when the doc was ready for me - small town, small office, no problem. I went outside and started pacing the parking lot as fast as I could while having a fake phone conversation. That 15 minutes was the most exercise that I had consciously participated in in months and, of course, resulted in my BP being the highest it ever had been during a checkup. I got a script for Zestril and took it directrly to the the bariatric practice.

I had my approval, finally. It was June 1st, they could schedule me for August 15th. My wife planned some crazy summer for my daughter which included a trip to CA from the 11th until the 19th. I already had to postpone my surgery... turned out they had a case opening on the 22nd, the following week so we grabbed the appointment and I tried lke heck to enjoy my summer.

Funny, though, somehow I never really did. I was always thinking about my weight, trying to enjoy food since it would surely be a while and doing the things that I could before S-Day, but everything just whizzed by. We never went anyplace for the sake of eating a nice dinner, never went to any BBQs, we even went through CA on some kind of bizzare dietish plan because we jammed so much activity into our trip a nice dinner was never an option and my daughter and her 11-yr old friend, collectively ate like a small bird. I went hiking and kayaking and swimming and despite my weight preoccupation, I stayed pretty upbeat, looking forward to returning and getting the VSG over with.

I got home on a Sunday night, and had a quick visit to my GP for a final surgical clearance, it was the 20th of August and surgery was scheduled for 2 days later, Wednesday the 22nd. My appointment was at 1045 and he asked me to quit eating at midnight on Sunday so he could check my triglyceridess, lipids and cholesterol levels. I complied, he approved and that was that. My wife and daughter took me to get an ice cream cone on Sunday night, a kind of last, sacrificial indulgence. I liked the idea and went. It was the last thing I ate for 17 days. I weighed 297lbs.

I haven't reached my goal yet, but I feel like being fit and trim and active has to be the polar opposite of fat and miserable, so the 90-day supervised diet must be kind of like purgatory.

I worked with a nice nutritionist, who i will call the prosecutor. Each of my 5 visits (I had extras) went the same way. The prosecutor would say, "On the scale, OK, well you lost 6lbs, what did you eat?" I just stared at her with a blank look like "I don't know" I work from 7am until 10pm or later, I had 60oz of coffee and whatever the $5 footlong is.... or maybe I didn't even eat for a day, and then ate a large stromboli because I was getting hypoglycemic. My eating habits were atrocious, but that paled in comparison to my sleeping, or lack of sleeping, habits.

I fish offshore, own and drive a race car, am active in my daughter's school, coach her basketball team and, oh yeah, own two full-time businesses.... when the heck am I supposed to sleep?

So, the good thing is that I started tracking my eating, sleeping and excercise on a little custom spreadsheet that I made. It had 4 days on one side, 3 on the other and averages for the week. This way when I went in to see the nutritionist, at least I could tell her what I ate. She forced me to cut back to one cup a day of coffee - which worked out, because post-op I got wicked headaches from the caffiene deprivation- and kept my weight level. After 90 days I had lost about 11lbs. No major feat, but considering my only goal was to not gain so I could get qualified, it worked for me. 

I failed myself in that I didn't put much energy into studying what I was supposed to eat and why, what my diet would switch to post-op or just generally preparing myself for what I was about to undergo. I would handle it like everything else - bare minimums. Minimum time in surgery, minimum time in hospital, minimum amount of recovery and minimum amount of disruption in my life.... you know where this is going right? 

 After the roller coaster ride and an emotional civil war with myself, I went back to the surgeon in January of 2012. My BMI was 38 or 39, I'd had a sleep study which showed sleep apnea, but I never followed through and got a CPAP and my blood pressure was high, but not high enough to warrant medication - only watching.

We (a surgeon from the NJ Bariatrics practice and I) discussed the lap-band. I know it works for some people, but I can tell you, I'm not one of them. It's reversible - something that reminded me of every weight loss I ever had. I had mentioned the sleeve a year earlier but the practice was a little hesitant because they hadn't seen a 5-yr track record, my insurance didn't recognize the procedure as a viable alternative, etc, etc.. Anyway, I asked about the VSG again and then he turned me over to the nurse who is the business administrator for the practice.

Our conversation was the most important one I ever had until that time. We got into detail about the requirements for a VSG, how to get the approvals through the insurance company and what I would need to do on my side. 

First and foremost, I'd need to get to a 40 BMI or 38 with two proven comorbidities. Then, I'd need a 90-day supervised diet with regular visits to one of their nutritionists, I'd need to have a psych eval and consent from my GP. I needed to NOT GAIN WEIGHT once the ball was started so I had a decision to make. No matter how much better it seemed, I couldn't permit myself to intentionally gain weight so that I could qualify for a surgery, So, I put on all of the clothes I had, my jacket and stuffed the pockets with change from my car, my cell phone and a couple magazines from the waiting room - 300lbs. It wasn't 40, but it was close enough that I'd just have to work with the sleep center to get the results confirming my apnea and the BP thing, well, I could handle that. So I was off to the races, my 90-day clock started ticking right then.

I'm 40 years old. At 20 years old I was in college on an Air Force scholarship, fit to fight and 188lbs. I trained to be a pilot and an officer. I graduated college, got married just 6 weeks after and from a fitness perspective I have really gone downhill since. In 20 years, I gained more than 100 lbs, 10 inches around my waist and began losing my hair. My blood pressure was up and down and I developed pretty bad apnea accompanied by (marriage threatening) snoring.

I have been on no less than 10 name-brand diets and a couple of different fasts, the most recent being Medifast from mid 2010 to early 2011. I had good success ~60lb weight loss on carb control and the medifast and in 2007, I went to Canyon Ranch after sustaining a very severe traumatic injury to my hand and again, through diet and exercise, lost about 60lbs.

Every time I gained the weight back and every time, it was a little bit faster.

I am a little bit taller than 6'1", my maximum recorded weight was 300 and I imagine I never pushed much higher than 301 or 302. The way I carried my weight was very deceptive and accordingly, when I discussed my problems with weight control, the response was invariably - "you're not that fat", "just go to the gym", "you don't need a surgery" or something right along those lines.

I was the CEO of a public company, so for a good stretch, we had whatever we wanted. We have a large and lovely home, a boat, several beautiful cars, we vacation around the world and we have an 11-year old who wants for nothing. However, I never have had really nice clothes because other than business suits, they really don't offer much in the way of stylish casual wear for 300 pounders with wierd proportions. Jeans look unflattering on a 46 inch waist and the inseam on pants is never quite right, so to compound the fact that pants are either a little snug or a little loose, they are also too short or long as well. Shirts come in a million sizes, certainly including 3X, 4X and more, but they look horrible when they are tucked in and look something like a tent when they're not. And... I'd love to know why people think that fat men like sweatpants and button down shirts in colors and patterns inspired by the circus. Anyway, enough on clothing.

The worst thing was that I missed out on too many things to speak about. I never went to the beach with my wife despite living on the Atlantic and travelling to exciting vacation destinations. Why? Because that would involve taking my shirt off. I missed visiting water parks with my daughter, swimming with the dolphins, heck, I won't even go in the pool at my in-laws house because I'm so ashamed of what I look like. I'm 40, going on 14. Embarrassed of who I allowed myself to become. On top of it all, when it's 95 degrees and all of the normal people are relaxing in the pool, I'm sitting outside eating or drinking, making it even worse.

I made the decision in 2009 to sit down and talk to a surgeon about a gastric bypass. Thanks to the wonderful world of insurance, a lack of proven co-morbidities and my 90-day supervised diet where I lost 60lbs, Twice in a row, I didn't qualify.

It seemed like I was destined to just keep getting fatter and less happy. Face it, it's the first thing we see in the morning, the last thing we see before we go to bed and all you think about all day long - the joy and pain of food and sheer humiliation of hating yourself.