Wednesday, May 18, 2016

Q&A - May 17, 2016 - Gastric Sleeve Edition

So since my last blog entry I've received numerous questions from readers who are interested in learning more about the gastric sleeve surgery and what it all entails. So let me answer some specific questions I have received as well as give some information.

Question:

"Can you go over the process of what you went through for the surgery?"

Answer:

Sure. Let me break it down in a simplified form.

1. I spent a great deal of time researching bariatric surgery to see if it was right for me and which one I should get.

2. Once I decided on the gastric sleeve surgery I tried getting it in my local area. However, since I did not have insurance the self-pay option was going to be around $20,000.00. For a while I contemplated saving it up and figured it would take me about 3 years or so to do it. However, as part of my research I was made aware that the surgery could be performed in Mexico for a fraction of the cost.

3. I researched the surgery in Mexico. I finally decided that going to Mexico would be my best option. I picked a website and surgeon. I began saving the $4,500 needed for the surgery and $800 more to have my gall bladder removed at the same time. I also had to pay for 2 first class flights to San Diego as well.

4. I saved up a total of about $8,000.00, just to be safe. I then booked the surgery and bought my plane tickets.

5. I arrived in San Diego and was met by a driver who then took me across the border. I spent the night at a very nice hotel in Tijuana and the had my surgery the next day.

6. My surgery was done as an out-patient in a clinic. I stayed in the clinic for two days. Day three after surgery I went home.

Question:

"Why did you have your gallbladder removed?"

Answer: 

A side-effect of losing a large amount of weight quickly is the development of gallstones. Gallstones are extremely painful. In the past surgeons in the U.S. automatically removed the gall bladder at the time of surgery. Today surgeons usually prescribe medication to prevent the formation of gallstones. Since I didn't want the extra charge of having to pay for a prescription, since the gallbladder is not necessary for survival, and since I had already been diagnosed with gallstones, I decided to just have mine removed at the time of surgery.

Question:

"Did you have to go on a special diet before surgery?"

Answer:

Yes. Most patients have to go on what is called a pre-op diet. A minority of surgeons do not require such. The normal pre-op diet is 2 weeks in length and consists of mostly liquids. It's purpose is to shrink the liver, as most obese people suffer from fatty liver disease, and to produce a safer surgery. During the surgery an enlarged liver can prove problematic and is easily damaged.

Question:

"How would you rank the pain of the surgery?"

Answer:

On as scale of 1 to 10, with 1 being the lowest and 10 being the highest, it was about 3. It was a breeze. It just felt like I was punched in the stomach. The most painful part was the removal of the drain but that pain only lasted a few seconds.

Question:

"How are you able to get in all of your required liquids and protein amounts?"

Answer:

Easy. You constantly sip all day. I carried a bottle of water with me everywhere I went and constantly sipped, talking a sip every few minutes. For protein, I drank protein shakes. You need about 60-80 grams of protein a day and 2 protein shakes give you 60 grams as well as also count for your liquid totals as well. Just so you know, eventually you will be able to drink as normal. I can down a whole bottle of water at one time now if I so chose. The sipping is only in effect in the first few months after surgery.

Question:

"What is your diet post surgery?"

Answer:

Immediately after surgery you will be on a week of clear liquids, followed by a week of full liquids, followed by a week of pureed food, followed by a week of soft foods, followed by normal food. When you get to normal food your emphasis should be on protein first and then non-starchy vegetables. It should be very low carbs.

Question:

"How much do you eat in one sitting?"

Answer:

About 2-3 ounces at first. With time you will begin eating more as the inflammation from the surgery goes away. I can eat about a cup of food now. Right after surgery I had saved some plastic pudding cups and washed them and used them for my food as they held pretty much the amount of food I was able to eat. You are able to eat more of food that breaks down easy and less of denser foods.

Question:

"What happens if you eat too much?"

Answer:

You throw up. However, it's not like how you threw up before surgery. Since your stomach is now so small it's more like baby throw up. It is painful though. Yes, I've thrown up numerous times. It takes time to learn when to stop eating. It's been a long time now since I overate so I haven't thrown up in a long time.

Question:

"How do you know when to stop eating?"

Answer:

You begin to feel a restriction in your stomach, your stomach getting full. It's subtle at first and with time you learn to stop there. You can continue past this and you will get a not-so-subtle feeling that is your last warning to stop eating. If you eat past this last signal then you develop pain and throw up.

Question:

"How do you distinguish between "head hunger" and "real hunger"?

Answer:

Head hunger comes from cues to eat from your environment and usually is geared toward a specific item. Real hunger stems from cues within your body and any food can satiate it.

Question:

"How often do you eat a day?"

Answer:

Three times plus an occasional snack. My doctor warned me against the notion that people have that they are supposed to eat multiple times a day as he believed this defeats the purpose of the surgery. Some people even go as far as eating every couple of hours. These people tend to lose considerably less weight in the long run, in my opinion.

Question:

"How much can I lose if I got the surgery?"

Answer:

It's up to you. The surgery is just a tool. If you rely on it alone to do all the work then you are not going to lose the amounts of weight that patients who use it correctly will. The average is 60% of excess weight but this figure includes all those patients who did not use the surgery correctly or who were not dedicated to the program and their goals.

Question: 

"I heard that most people who get the surgery will eventually regain the weight. Is that true?"

Answer:

Patients who are not dedicated can cheat the system. For example, if they don't follow the low carb diet and do not focus on protein first then they can gain weight. If they go back to eating junk they will gain weight. Additionally, there are what is called "slider foods", which are foods that break down really fast and do not produce the necessary restriction in the stomach. Examples of slider foods include: chips, crackers, pretzels, popcorn, nuts, ice cream, milkshakes, pudding, and alcohol. If you consume too many slider foods you will gain weight. There is one slider food that is actually good for you, salad. I can eat a ton of salad without feeling restriction. For example, I regularly get salads from Subway and I can now eat the entire bowl in one sitting.

Question:

"What do you do about holidays?"

Answer:

Easy. I allow myself to eat all the holiday foods I desire. However, keep in mind that a holiday is only one day. Problems arise when people confuse the holiday season with the actual holiday. If you are going to eat some candy on Halloween, then only do so on Halloween and not the entire month of October. The same for Christmas, Thanksgiving, and the rest of the holidays. I only allow myself to eat ice cream and cake on birthdays. The rest of the year I do not eat sweets.

Question:

"How do you handle eating out at restaurants?"

Answer:

You must come to accept that you are going to waste a lot of food. Most of us were raised to clean our plates but after surgery you simply aren't able to do that anymore. You will get sick to death of left-overs so eventually you will reach the point where you don't give a damn that you are wasting so much food. Your waiter/waitress will think there is something wrong and you will constantly be asked if there is something wrong with the food. It gets tiresome but I just smile and say the food is fantastic. I often go out to eat with my friend who likes to take my left-overs home with her for her or her mom to eat later so that helps as well. If you want you can also ask if you can order stuff on the children's menu but honestly you will get tired of doing that as well.

Question:

"Is it true that you can stretch out your new stomach?"

Answer:

No. The stomach does not regenerate or grow back. The stomach does stretch but when you remove 80% of it there is no way in hell it could ever go back to being what it was before. What does happen is that some patients abuse their bodies and purposefully overeat with time until they reach the point where they can tolerate more food without throwing up. However, this can be reversed by going on what is called a 5 day pouch test which resets the restriction.

Question:

"Does the surgery produce malnutrition?"

Answer:

No. In the gastric sleeve there is no re-routing of the intestines so there is no issue of malnutrition as there is in other types of surgery, such as the gastric bypass. You also don't need special vitamins either and there is no problems with absorbing medication.

Question:

"What can be done to prevent excess skin?"

Answer:

Nothing. You abused your body and stretched your skin out. A deflated balloon can never go back to being what it was before it was blown up. The same with skin. However, there is an answer. It's called plastic surgery.

Question:

"What are the major side-effects of the surgery?"

Answer:

1. Being cold all the time at first. For the first 8 months I was constantly cold. The summer of 2015 I wore sweaters and long sleeves shirts as well as used a personal heater to stay warm. Eventually this will pass.

2. Not being able to sit comfortably for long periods. My ass fell off and is now bony as hell. I can even feel my tailbone when I sit down. So I have no padding.

3. Hair shedding. The stress of losing weight causes your hair to shed. You will not go bald but your hair will thin out. When your weight stabilizes it will grow back. Despite what people claim there is nothing you can do to stop it.

4. Excess skin. As noted above, it can't be prevented. Genetics and how heavy you were determine how much you will have. You don't have to live with it the rest of your life and can have plastic surgery to remove it.

5. BM changes. For the first three months I had constant diarrhea. This was followed by months of constipation. No biggie. I just took laxatives. Eventually things will settle down to normal. Be prepared for accidents just in case.

6. Your farts will be horrible. Since you are consuming mostly protein your farts will smell like you have the grim reaper up your butt. They are terrible! You will be so embarrassed. Also, for some reason they will be very loud. I guess the fat muffled the sound but I am still shocked by how loud mine are now.

7. Gallstones. Losing a large amount of weight quickly can cause gallstones. They are painful. To avoid them you can have your gallbladder removed as you do not need it to survive or you can take prescription medicine to prevent them from forming.

8. Body Dismorphia. Most people who lose a great deal of weight suffer temporarily from the inability to properly perceive their new body. When they look in the mirror they still see the same old fat person. I too suffer from this and I'm told that eventually your brain will begin to process the new information and you will eventually get over it.

Question:

"How bad are the scars from the surgery?"

Answer:

Not bad at all. The incisions are less than an inch, 5 in total. I have to hunt hard to find them.

Question:

"I'm a vegetarian and was wondering if the surgery would be right for me?"

Answer:

I've encountered a few vegetarians who were successful with the surgery. However, vegans are another issue. I've known only 2 who had the surgery and they were both failures as they were unable to consume the necessary protein and ate far too much carbs.

Question:

"Did you require someone to help take care of you when you got home and how soon can you go back to work?"

Answer:

No. I could shower and use the restroom as normal immediately after surgery. No catheters were used. You likely can return to work after a few day to a week as long as there is no heavy lifting.





No comments:

Post a Comment