I Am Okay; I Can Make Healthy Choices

I threw up my hands in disgust over this weight loss business months ago, but I had started before that. College was so busy that I had little time to devote to my health. After I joined my local hospital’s physician-monitored weight loss program I started gaining weight. Knowing full well that I needed to see someone about why I ate, I attempted to schedule with the program’s psychologist. She was only available two hours during lunch on some days and I was a full time student, still am. The more I saw the dietician, who simply kept telling me not to eat so much, the more I ate. Join a weight loss center and gain weight.

Screw that! This summer my noontime schedule opened up. So I signed back up, making my first schedule with the psychologist. I am feeling much better and this go around is going better. I’m still gaining weight in the program, but I am making better choices. I’ve gained some muscle from walking 5 days a week, but I am unconcerned. I know that sounds weird, but I am making better food choices, making some progress, so I am keeping focused on that and not on what others do.

The work I am doing is easy and mostly common sense. It’s not easy in the sense that I just eat salads and don’t feel hungry, but it is not difficult to understand. I am taking baby steps, teeny tiny baby steps. I could wonder about what I am actually paying her for as she gives me mantras to say and things to think about. It seems silly at times, but the thing that I recognize, is that I keep an open mind and I am finding that her simple exercise actually work. So I let the silly feelings go and do what she asks me to do.

Mantra 1: I’m okay
Mantra 2: I can make healthy choices.

Before I ever go into a place to eat, or anytime I f eel hunger pangs, I recite these simple phrases to myself. I am okay. When I feel anxious or irritated or upset, which can happen if I get hungry, then I remind myself that I am okay. I will eat when I need to. Everything is okay.

Simple though it may be, it works and I am feeling like I am gaining some control over my eating. I still feel hungry, but I try to mantra’s and they sometimes work. Yesterday I had a salad and soup for lunch. It was good and I enjoyed it. Baby steps, my friends.

This week I am supposed to think about the difference between real hunger and psychological hunger. This is real chore for me as I struggle to differentiate between the two. They feel the same. I am allowing myself to feel hungry then reflecting on that hunger. Is it real or psychological? Am I really hungry? Is this what real hunger feels like?

Making progress.

It’s Been Too Long

It has been a while since I have posted on this site. I’m not sure why that is. I could say that it is because I am busy. I am. I could say that it’s because I am too mad to say anything, but that is what blogs are for. In the long run, it doesn’t really matter, except that have some kind of the duty to the very few readers of this blog.

I’ve applied for bariatric surgery – the lap band. Lo and behold my insurance will not approve. I have to go through a physician-monitored weight loss program first. That is reasonable, but my insurance has a one year requirement. I think that is to discourage folks from going through the process.

I’ve applied for the weight loss program and my insurance won’t approve it either. They had to have special documentation from my physician first. I guess the whole fat and diabetic thing just wasn’t good enough. Fine. My doc was Johnny on the Spot with her end of the paperwork. The insurance company is dragging its feet on this too.

I called today and got approval for six of the 12 month required by the insurance company. Now I am ready to go through the New Images program (physician-monitored weight loss program). Good for me. I had hoped to be able to get the surgery in December. Looks like it will be closer to next December before I can get it. Such is life.

In other news, I bought two packages of Fig Newtons (whole wheat) while my wife was out of town last week. I ate one package and left one. Pretty good for me. The extra package has disappeared. The wife hid them. She reports that she will ration them out to me one serving at a time. Better than nothing.

24 Fig Newtons and 8 Biscuits Later

I mailed my bariatric surgery packet out yesterday. It was quite a bit of information to put down. They asked for all types of information, especially the number of diets I’ve been on in the past, weight lost, weight gained, and a two-day food diary. Now it’s just a matter of time before the surgeon’s office calls and schedules my first appointment.

Filling out the paper work isn’t so much fun, but it was a good exercise. I learned that there is another food that I just can’t have around the house, even if they are the whole wheat variety: Fig Newtons. I was fooling myself, thinking that because I was buying the whole wheat kind, that they were healthy. Healthier – maybe – but still not something that I need to eat. In that two-day period where I had to record my food intake, I had 24 of the little devils and seeing how they have sugar, I can not imagine that my doctor would approve. The nutritionist and behavior therapist at the bariatic clinic will not care for the fact that I also ate four biscuits for breakfast. I do not do well when I am home alone for Spring Break. It’s better not to have some things around during those times. I told my wife that my days of Fig Newtons are done and asked her to be sure and not buy them when she goes to the store. I won’t either. I will not tell you what else I ate, but I will say that it could have been much better.

The Results of the Bariatric Surgery Seminar

It has begun. I am on the road toward bariatric surgery, which will assist me in reducing or eliminating many of the complications that I have incurred as a result of my weight: diabetes, sleep apnea, high blood pressure, and cholesterol. I’m tired of watching my body and health deteriorate because of my life-long problems with food. Despite the fact that I have tried to lose weight since I was a child, those attempts have resulted in short-term weight loss and long-term weight gain every time. I feel hungry and I shamefully feel powerless against the pangs to gorge.

On Saturday the surgeon held a bariatric surgery seminar, which is the first step in the process. He presented the information on both the gastric bypass surgery (called Roux-en-Y) and the lap band surgery. Both, according to Christopher Edwards, M.D. are good surgeries with excellent results. The lap band, however, is quickly becoming the surgery of choice because of the lower rate of complications and the ability to adjust the restriction of food. I am going to summarize my understanding of the information presented at the seminar to give a better understanding of why I am choosing one procedure over the other.

ROUX-EN-Y VERSUS LAP BAND

ROUX-EN-Y (Gastric Bypass)
Weight Loss: Slightly Higher and faster
Complications: More
Risks: Higher
Procedure: Laparoscopic but more invasive
Hospital Stay: Day or Two
Deficiency: Calcium, B12 and Protein
Adjustable/Reversible: No
Dumping: Yes
Pros: Higher weight gain and more long-term studies.
Cons: There are more complications, side effects and it is not reversible or adjustable. With gastric bypass, you can stretch out the egg-sized pouch and then you taken in more calories than you should. This is common after several years so the patient must be diligent in sticking to the strict dietary requirements or the weight may come back.

LAP BAND
Weight Loss: Slightly Less (55-62 percent) and slower
Complications: Less
Risks: Lower
Procedure: Laparoscopic and less invasive
Hospital Stay: Outpatient
Deficiency: Protein. Must take a multi-vitamin
Adjustable/Reversible: Yes
Dumping: No
Pros: It is reversible and adjustable. The surgery is less invasive and there are fewer side effects and complications. The egg-shaped pouch tends not to get stretched because with lap band, when you eat too much, then your body tends to vomit it back up rather than overstretching the pouch. Your stomach and intestines are not surgically altered for life.
Cons: There is slightly less weight loss associated with the band. Too much vomiting can cause band slippage requiring a surgical procedure.



DIETARY REQUIREMENTS
Calories Per Day (up to six months): 600 calories per day
Calories Per day (6 months-life): 1,000-1,500 calories per day
There are strict dietary requirements in the weeks and months after the surgery. I don’t know those details, but I will be presenting them when I find out. I do know that the diet consists of higher intakes of protein.

HOW DOES LAP BAND WORK?

A silicone band is placed around the top of the stomach, creating two stomach pouches. The pouch at the top is about the size of an egg and the opening into the larger pouch is about the size of a dime. When the person eats, the food sits in the pouch. This does two things. First, it fills the pouch and then the pouch sends signals to the brain that the stomach is completely full. Patients report that they feel full. The second thing this does is allows the food to sit in the small pouch and trickle into the larger portion of the stomach. By doing so, a person’s feelings of being full last longer. The rest of the body digests and works as it always has. There is no poor absorption of vitamins and nutrients (as with gastric bypass). There is just a restriction of food.

The band itself, when around the stomach, does not restrict food. The lap band has a cord attached to a port. The port is located under the skin on your left side. The surgeon sticks a needle into the skin and port and fills it with saline. This blows up a balloon on the inside of the band and causes the restriction. This can be adjusted as needed throughout the patient’s life.



IF YOU STILL EAT LESS, WHY DON’T YOU JUST DIET AND EXERCISE?
That is a good question and one that I have asked myself. Why do I need surgery? Why don’t I just hire a personal trainer and eat more healthy foods and smaller amounts. That is the natural way. I can’t argue with that logic. I can just tell you that I have tried that with no long-term success. My hunger eventually overtakes me and I am right back where I was, or worse, I end up heavier.

The way the lap band works is to trick your body into feeling full on only a small amount of food. True, a person will lose some weight by eating less, but as the question above states, it is more than that. The surgery does not fix a sedentary lifestyle nor does it replace proper nutrition and exercise. The surgery is not it. The entire process requires a change of thought and attitude – of lifestyle – in order to achieve real success. That is the hard part and it involves will power and determination just like a typical diet. The difference is that the person feels full after lap band surgery and does not have to deal with always feeling hungry.



ISSUES RESOLVED WITH BARIATRIC SURGERY
The following numbers from my surgeon’s presentation, are the numbers of people who report they no longer have issues with the condition.

• Type 2 Diabetes: 95%
• Hypertension: 92%
• Cardiac Function: 95%
• Sleep Apnea: 75%
• Stress Incontinence: 87%
• GERD 98%
• Cholesterol 97%

PSYCHOLOGICAL SIDE EFFECTS FROM BARIATRIC SURGERY
(This piece of information has come from Internet sources and from the presentation)
Bariatric surgery is not all good. There are issues that come up after these procedures. Psychological factors arise that people do not realize or are not ready for. Cases of divorce and suicide have occurred as a result of the surgery. Divorce can happen for several reasons. The patient may lose weight and start getting attention from interested parties that they are not used to. This can lead to adultery. If both spouses are overweight and only one gets the surgery, then there can be jealousy on the part of the one who is not losing weight. If a marriage was rocky to begin with, then the weight loss will not fix the martial problems and can increase them.

There have also been cases where people have been unable to deal with their new body. Their friends and family may treat them differently, they may get divorced and they may feel all alone, leading them to suicide. These issues cannot be dismissed out of hand, but must be considered carefully.

The surgeon stressed that family supports are the most important factor in this process. The surgery, he said, is very easy. The hard part comes afterwards and a person must be in a supportive family unit in order to see success and be healthy and happy afterwards. In my case, my wife and I have a remarkable, loving and trusting relationship. We are not cheaters, either one, and neither of us are jealous. I don’t think these will be issues for us, but they are things to consider.


FAMILY SUPPORT
Besides my wife and daughter, my parents are supportive of this decision. My friends and I have only talked briefly, but I think they too will be supportive. There is a difference between support and concern. My wife and parents are especially concerned about the surgery and the after affects. They are scared that I will die, have complications, or that everything will change. I know my wife is struggling (I write this with her permission) with the fact that I will be a new person. I will have a new body, a new degree, and a new job. She is scared that she will be with a completely new guy. She also worried that the new me will not like the old her. She is also slightly overweight and she worries that I will not be attracted to her any longer. It is a fair concern and I would expect anyone to be fearful. Change is very scary. My role in all of this is to reassure her that my physical change does not affect my emotional connection with her. She is my soul mate and I love her very much. She loves me fat or skinny and I love her fat or skinny.

My family will need outside support and they will need support from me. I will have to remember that this is a hard process for them as well and that I am not the only one struggling. And this will be a struggle. The surgeon made no bones about the fact that this is hard. The surgery does not make this easy. A quick Google search will tell you that. The surgery is the easy part. It is after the surgery that the work begins.



THE LAP BAND CHOICE
I am choosing the lap band for several reasons. The sense of feeling full on an amount the size of an egg is probably the most appealing to me. The fact that it is less invasive, adjustable and reversible appeals to me. Not that I want it reversed. I don’t. Let’s say a patient with the lap band, God forbid, gets cancer. The person will need to be able to get more nutrients during chemotherapy. During an office visit, the surgeon takes out saline so you can intake more food. It takes all of five minutes in the office. Same thing for a woman who has a lap band and then gets pregnant. The surgery is done under general anesthesia but it is outpatient surgery. Most people go home that day.



NOW WHAT?
There is a strict procedure and requirements to follow in order to be considered for bariatric surgery. Because of my weight and other issues I am eligible for the surgery. Now I must go through the process, which is as follows:

1. Attend the bariatric surgery seminar
2. Fill out the paperwork
3. Office visit with the surgeon
4. Office visit with the nurse coordinator
5. Nutritional evaluation
6. Behavioral therapy evaluation
7. Psychological evaluation
8. Rehab exercise evaluation
9. Submit request to the insurance company
10. Schedule surgery

DISCLAIMER
I am not a member of any medical field – not a doctor, nurse or anything else. The information presented here should not be used to for any kind of medical decision. It is presented here strictly to help my family and friends understand my decision and help give them an idea of what is going on, why I choose the lap band over the Roux-En-Y, and to help them make sense of what is going on with me. Always consult a physician and don’t quote me.

Insulin Makes for One Hungry Jack

My doctor warned me that moving to insulin might make me hungrier. That is an unfortunate side effect. That is just so crazy. Most folks on insulin are overweight to begin with. Not all diabetics are fat, mind you, but many are. So you don’t lose weight and your diabetes progresses to the point that you have to supplement your oral medications with insulin or you have to go to insulin altogether. It makes you feel very hungry so you eat more, gain weight and require more insulin. It is insanity I tell you. Insanity.

So not only do I have problems with overeating, but now I have a medication that makes me hungrier. What the Hell am I supposed to do about that? Well, I’ve already talked about what I am planning on doing, but it sucks that the meds I need to take make me more unhealthy.

And He's Off …

The wheels are turning toward the weight loss surgery. I called the surgeon today, as promised, and registered for the bariatric surgery informational seminar. It’s this week, which is faster than I anticipated. It works out well though. We were planning on going out of town this weekend to see my parents. My sister et al from Tulsa were coming to the parental nest this weekend and we were going to join them. Still will, but we will be a bit later than expected. It will give us time to talk with my family about this.

Fortunately for me, my family – wife, mother, father, sister, and brother-in-law – are supportive of me seriously considering this option. Not pushing and not pulling, they are encouraging me to seek out as much information as possible and find routes that will help me lose weight in a positive. They aren’t too keen on burying me within the next 10 years. Me neither as far as that goes. My family has reservations too. They are nervous about the surgery and the side effects or complications that can arise. Me too. I think my wife is probably the most nervous and the most supportive all at one time. I think she will need her own set of support, as this will affect her just as much as it affects me. She will, after all, have to life with me after all of this is over. She needs all the good thoughts, positive energy and prayers that she can get to put up with me.

After my Saturday educational seminar, I can go to my parents’ home and talk with everyone about what I have learned. I think I’ve pretty much made my mind up already. I say “pretty much” but in my head I know this is what I want – have – to do. So it’s merely a procedural thing for me to go to the seminar. I am ready to make the plunge.

Damn Those Girl Scouts!

My daughter joined Girl Scouts this year and she is excited to get her first badge for selling cookies. She had to sell 50 boxes to get the badge and she met her goal, which is very exciting for her. It’s just murder for me though. BIG men and Girl Scout cookies don’t go well together. My wife was smart and hid them from me. I get one serving per day, which works out to four Think Mints (which are the best), two Lemonades, or two Peanut Butter Patties (both of which are quality cookies).

Everywhere I go I have reminders of Girl Scout cookies: church, home, my daughter’s school – they are everywhere, permeating my brain and begging me to eat them. Truth be told I shouldn’t be eating any of them, but I can justify one serving per day. If I had my druthers, I would not have any in the house at all. It’s just easier that way, but I have to support my daughter. Supporting her does not equate into my eating cookies, but I just can’t stay out of them. So we compromise with one serving per day. Since I don’t know where they are, then it works out okay. I have managed not to search the house for them.

And what of the hypocrisy of this post in conjunction with the preceding one? All I can say is that I am a messed up dude and I need some serious help and soon.

It's Time To Get Off The Pot

Come Monday I am going to initiate the bariatric surgery process. My diabetes is increasingly progressing and because of that my doctor started me on a one-daily insulin shot. That didn’t come as a shock exactly, but it was a powerful shot to the emotions. To move from oral medications to the dreaded I-word, the shot … insulin … is a big deal. It just sends a reality signal that diabetes is a progressive diagnosis and something must be done.

My friend Paul, who does not know about my insulin yet, called me this weekend right after I got my new prescription. He wants us to start a drastic workout regimen where we train for and run in a half marathon by November. I am 320 pounds and have never ran. I hate running, actually. So this is a big change. He used to run, but is now a BIG guy like me. This whole running business is not necessarily a bad idea in theory, but I’m not sure that running is the thing that we should be doing. It’s hard on the body -- the knees, the back – and as heavy as he and I both are, I just don’t see that as a viable option.

I hurt my ribs about a year ago in Karate and they haven’t healed back yet. Diabetics heal slower than other people. Running will surely aggravate that problem much more. I’m just now getting those pesky ribs to quit hurting as much as they used to and I don’t need any setbacks. Paul is pushing me pretty hard to get on board with this running scheme, his word not mine. Maybe in time, but right now it does not seem like such a good idea. I can’t even walk the treadmill right now with my ribs the way they are. I don’t really know how I can start running.

With the introduction of insulin injections, I have come to realize that my methods, such as they are, are not working. I can’t see the light and I don’t know what else to do. Tomorrow I am calling the surgery clinic and starting the application process. I sign up to attend the informational seminar and learn more about bariatric surgery: gastric bypass and the lap band. My cousin just had gastric bypass. She felt it a better route than the lap band. I am leaning the other way right now. The lap band is less invasive and is also reversible, making it a much more appealing alternative for me.

I’m pretty serious about this now. I am convinced that I need a radical intervention in my life and bariatric surgery seems the only way out. I have been considering this for a long time – maybe a year or so. I have gone back and forth about the surgery, wondering if I needed something this drastic. My mind is made now. I know what I need. I just need to go through the process and find a way to pay for it, be that insurance or private pay. I have decided to go through with this even if my insurance doesn’t pay for it. It’s got to be done and I am ready to make the move.