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

My first exposure to weight loss surgery was through my second cousin. Wanda had an old-fashioned long-limb Bilroth procedure in the 1980's. I believe she was in her 30s at the time, and she was clearly motivated by humiliation and fear of not being able to get people to care for her while she was obese. She had her surgery, lost some weight, and over time I heard she gained some of it back. And one day years later, she developed a very sudden gastrointestinal bleeding episode, and did not live long enough for exploratory surgery. The exact relationship of her death and the weight loss procedure, if any, has never been known. During the mid-1990's I was a physician assistant working for the Navy at Bremerton, WA. I began to see several primary care patients who had had WLS, and indulged my curiosity, picking their brains about the techniques, the surgeons, the complications, the catastrophes, and (yes!) the successes. Frankly the surgical techniques in use in that location and time were just not successful enough for me. I wanted a procedure that would work right the first time, give me the results I wanted, without complications. And the word in the internal medicine circles was SO negative. Endocrinologists, rheumatologists, orthopedists, cardiologists, everyone seemed to hate the very notion of surgery for weight loss. Thankfully, over time, and nay-sayers are being shushed by good research and a growing following among surgeons. The word is getting out: WLS works, provided one does the right surgery for the right patient, and provides the right care afterwards. Now I am a die-hard advocate,and can't wait to help my patients who need the procedure find a way to get it.

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

I have been very lucky to have Athem BC/BS Federal Employees Plan, and I will hand it to them, they didn't question one thing, didn't require any pesky "medically-supervised dieting", approved surgery the first time approval was sought. The only little glitch, they take forever to pay and I had to make a bunch of phone calls to get them to pay.

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

The office staff was fine, many of Pomp's staff have had a WLS themselves, and they are a great source of information. Dr Pomp is impressive, personable, caring, answers questions directly, and truly wants the best procedure and outcome for every patient.

What made you finally decide to have the surgery?

As stated else where, I knew I would have a weight loss surgery as soon as I identified the right surgeon and procedure, and this was easier than expected.

How did you decide which proceedure to have?

Through a frank talk with my surgeon, I decided that the risks associated with duodenal switch were not appropriate for someone with a BMI below 60 (mine was 53 the day of the consult, 57 was a lifetime high). So we went for the RNY gastric bypass, and things have been just great overall.

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

I felt very confident about the surgery going in, my fibromyalgia was painful and fatigue disabling as a pre-op, so I looked forward to surgery day as the "beginning of the end" of my misery. One of my big motivations for seeking WLS was my profound fear of being disabled and unable to care for myself. When I was morbidly obese, stiff, sore and exhausted all the time the only future I could envision was one of laying around, unable to earn a living and unable to care for myself. My mother was a critical care nurse who became disabled in her 40s, and I really believed I was headed that way unless I could change my body. As the surgery approached I realized that having the procedure could itself be the thing that disabled me, and in quiet moments I pondered this, a little afraid I would not make it to the goal.

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

Most of my friends were very supportive, and have continued to be such while I am losing weight. My father touched my heart when I told him over the phone one day that surgery was only a few weeks away. He had watched me struggle with my weight through adolescence and adulthood, but never had an ugly thing to say about my body (in stark contrast to my mother, who never shut up about my terrible body and what a terrible person I was for being fat). When the I gave him my surgery date, he replied, "You could always decide not to do this." He was afraid, and afraid to say so. Through my post-op period, he has been his supportive and kind with his remarks, and this has meant a great deal to me.

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

Since I work in a large hospital folks around me were quite supportive, and in fact I was approached by some co-workers who had already had or planned to have WLS, and now when I meet one of them in passing, we cheer each other on. It's like an elite club, a group of us winning big by losing big. On a humorous note, one day I had a doctor's appointment and my boss and I miscommunicated about which day I was to be off. On the day of the appointment I was expected at work but did not show, and after a few hours my boss was so worried (knowing I was a few weeks out from surgery) he actually called the cops to go to my house and see if I was OK. Of course I was at my appointment and oblivious to this, so arrived at work to find everyone very emotional ("Thank GOD you're OK!"). So I am blessed with caring folks around me at work.

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

Mt Sinai in NYC was a very good place to have this procedure, as they care for several thousand WLS patients every year. I literally owe my life to the med-surg nurses who found me not breathing a few hours after surgery and initiated a Code Blue. They and the residents who answered the code did their job so well, I was extubated within a couple of hours (as opposed to spending the night like that). I am able to tell this story because of these heroes.

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

As stated in the above section, I evidently have some sleep apnea, and under the influence of dilaudid I fell asleep on my back, a position in which I cannot lay because I can't breathe like that. Between the sedation and laying in the wrong position, I must have quit breathing. But the staff at Mt Sinai in NYC was great, and I have done well.

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

All I remember feeling was "FINALLY!!!" I found my patience with my fibromyalgia and fatigue was nil, I got frustrated and became emotional thinking of all the things I wanted to get done in life, around the house, at work. And just could not wait to get the surgery done and begin living. Unfortunately as a post-op the fibromyalgia and chronic fatigue have remained problematic, but working with physical therapists and a massage therapist is helping a great deal.

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

Initially I had trouble with post-op pain. First of all I have fibromyalgia, a condition in which one's pain response is altered, and I believe being subjected to a Code Blue was more traumatic than most of us ever think. So it was tough to control the pain. Before surgery, get your life organized for the post-op period. You may need to change the room you sleep in for the first few days-to-weeks. Go shopping and stock up on the foods, supplements and drinks you will be using. I did not do a very good job of preparing and found myself in the grocery store, incisions HURTING, belly empty and hungry, head spinning from being so hungry, and having to shop and make decisions was hard. GET ORGANIZED BEFORE YOU GO TO THE HOSPITAL. One thing I did right: I made sure I would have people I trusted around me 24 hrs a day for the first 2 weeks, and this turned out to be important. There will be personal issues of hygeine, cooking and eating, laundry, and daily self-care, and you will want to be cared for by people who don't mind seeing you at your worst. In my case I am not married, have no significant other, and a difficult relationship with my parents. I chose to stay at the home of my friends in another state, about 2 hours from the hospital. They were very kind to let me take up space while they renovated their house. The importance of having reliable, continuous personal support in the early post-op period cannot be underestimated.

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

From southern Ohio to NYC is about a 13-hr drive or 2 hr plane trip. I do not advise travel on planes for the immediate post-op period due to risk of blood clots at high altitudes. Again, get your dominoes lined up before the day of surgery. I had friends who could transport me to the hospital and back if need be. As far as aftercare goes, the surgeon knew I am a medical professional and basically left it up to me whether to travel back to NYC for the post-op visits. It turns out I have had no problems requiring his assistance, but he was clear that he wanted to know if there was anything he could do for me. I try to return the favor by keeping him informed of lab results via the ole fax machine.

Please describe in detail what things you could and couldn't eat in the weeks and months following surgery. What foods have been off limits? Please explain how your dietary tolerance changed week-by-week, and then month-by-month since surgery.

I had more trouble than I anticipated in the first few weeks. First, I had GERD and esophagitis before the surgery. Afterwards my esophageal pain was completely gone, but I had nausea and vomiting anytime I ate something with more texture than cottage cheese. My surgeon is fairly liberal with post-op diets, seems to prefer letting folks find their own way through the big world of food, and I was allowed solids as puree or blended on post-op day 3. I discovered quickly that grease ran right through me; meat and chicken were too chewy; starchy or doughy foods would just lay in my new stomach until I threw them up. Eventually I learned that just because I had no esophageal pain, I could not assume my GERD/esophagitis was gone. Thinking my problems with GERD were over I had stopped my prilosec after the surgery (RNY gastric bypass is THE procedure of choice for curing GERD). I finally learned that if I take my prilosec every day I can tolerate reasonable amounts of pretty much any thing I want. I have only a few times actually dumped, and as long as I get my protein I will not be hungry. If I had it to do over I would eat only soft foods for the first month, meaning cottage cheese, tofu, scrambled eggs, oatmeal and other things that must be eaten with a spoon. It was tough to find a protein supplement I could live with, as my tolerance for volume was so limited. Most of the less expensive protein drinks must be consumed at the rate of a quart or more per day to achieve adequate protein intake, and I just could not hold all the volume. Tired all the commonly-known brands for protein, and these days drink Boost Glucose Control, 2-4 per day. I feel the best when I get 40-50 grams of protein every day. I have slowly been able to tolerate up to a whole slice of bread, 4-5 crackers, have experimented with pizza, all my old favorites, in small quantities. I get hungry 3-4 times per day, try to eat protein first and other things afterwards. I am finding I crave fatty foods less, must limit sweets to small amounts (3-4 bites is a big serving of chocolate these days). And after several months, I can finally tolerate salads again, and this is something I have actually craved. The bulky fiber was impossible to handle initially, but this has resolved.

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

The days right after surgery were tough. At this point, surgery is done and you will have incisions which might be painful. You may feel tired and need to lay around a lot. It may be tough to sleep as you wish when you must accomodate those incisions. Go easy, remember, you still weighed nearly what you weighed pre-op, as your body begins to shrink it will feel different, you will need GENTLE activity to get used to this. I took 4 weeks off my job, since it is not very physically demanding, and would advise anyone who is more active to take even longer off work. However, I was able to climb stairs right away, felt like driving a car again within about a week. I was able to sleep normally within 2-3 weeks. After that the improvements have been steady and continuous. With sleeping better my fatigue has backed off, and now I find it is actually exciting to think of the future, setting goals is fun because I know I will have the energy to meet them. Prior to the bypass, I just couldn't be bothered to think about the future, as the only future I could see was full of pain and disability. My fibromyalgia has continued to hurt and actually in some ways I have more pain because I feel like doing more activity. So I am using physical therapy and massage to ease the transition back to a real life.

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

I was always a vitamin-freak. Those of us with fibromyalgia learn eventually that prescription meds are not very helpful for this condition, and over the years I have learned to manage most of this condition with supplements. I have been questioned by some folks regarding my reliance on supplements, and all I can say is life is better with supplements. It takes years of making small changes gradually, and lots of self-education, to learn to cope with these chronic illnesses. So here is my list, as of Apr 2008: Calcium CITRATE + magnesium powder, drinkable MultiVitamin, CHEWABLE with extra vit A-D-E-K glucosamine-chondroitin-MSM fish oils extra multi-vit if needed (Nature's Plus brand) Biotin B12, CHEWABLE, twice every day Iron, carbonyl form, CHEWABLE Calcium citrate, CHEWABLE, with D3, K, magnesium,etc. SAM-e Every few months I re-evaluate the program, drop things that aren't helping, maybe add something new.

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

Fragile, weak hair that fell out. Nails very soft and slow-growing. Drastic skin changes, went from normal acne-prone to painfully dry pale and eczema-prone. Fatigue can be crushing. Vomiting after a bad meal choice is NOT the worst thing that can happen; having a chewy item STUCK is the worst! Physical resilience dropped, takes 3-4 days to recuperate after one very active day. Menstrual periods changed character several times. As the big weight loss began my breasts were suddenly full of lumps I had never before noticed, can be disconcerting. It was stressful to be very hungry and not have access to the right foods at the right times; advance preparation for feeding oneself in every environement becomes crucial. Weight loss is good; yards of hanging flesh is depressing; save money for plastic surgery, if you don't need any plastic work you can always spend/save the money elsewhere.

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

Absolutely the worst thing is waiting as you approach the big day. I have written about my pain and fatigue, and frankly there aren't words for the misery and frustration. In my experience there is no substitute for a knowledgable, compassionate nutritionist, as well other trained experts!!

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

I lived several hundred miles from my surgeon, so I got busy looking for others with obesity and WLS issues locally. As stated in other sections, many folks at my job were kind about approaching with their own stories, and 6 years later I still get the occasional e-mail from someone on the WLS network looking for "I have a friend with a question" kind of support. It has been difficult to keep a real WLS support group up and running in this community, so we rely on other types of interactions, small groups, e-mail conversations, etc.

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

My roux-en-Y was a laparascopic procedure and the scars have all but disappeared completely, no hernias, I couldn't be luckier!

Please describe any plateau experiences you have had since surgery.

It seems my entire experience has been a series of plateaus and gentle, downhill work. Kind of like cross-country skiing, instead of falling off a diving board into a sea of skinnies, LOL!!! I have had problems with keeping my albumin levels, iron levels, B12/folate levels adequate and have paid the expected prices for these. Among other symptoms, these deficiences feel bad and can plateau me. Peripheral edema that existed prior to surgery continues to create higher weight and some physical discomfort, so my diuretic is still needed. Without the Dyazide I slowly regain and this can be discouraging. When one's intake is volume-limited, it matters more what type of calorie is consumed. Carbs just don't help anybody, they should only be eaten to keep the diet livable, and they should be complex carbs.

Do you notice people treating you any differently now?

Yes, indeed. It is amazing what a difference several pounds can make. I am now treated like a mature female, a professional, and a customer who deserves appropriate service. While I weighed 340+ lbs it was impossible to get anyone to take me seriously, which was most frustrating trying to get care for my own patients.