Tuesday, February 15, 2011

FAQ about Gastric Bypass


So, my family members began bombarding me with questions about gastric bypass a few days ago. I guess they had a million questions, but wanted to wait until I had recovered a bit before asking them. Like my buddy Colin, they are still in a state of shock that I actually went through with it. Since most friends, relatives and significant others will have questions like this, I thought it might be interesting to compile these questions into a FAQ document, just like the kind you see with software websites.

1. I took a look at the animated explanation of the surgery. How could you allow them to do that to you?

The first time I saw the animated presentation explaining the surgery I was flat-cold horrified. I said things like:
  1. You actually did that to someone?
  2. And it was legal?
  3. They gave you a license to do that to people?
  4. And you want to do that to me?

2. Weren’t you afraid of dying on the table?

Gastric Bypass is a bit risky. The surgeon makes serious alterations to your internal organs. 1 out of every 1,000 patients dies as a result of the surgery. Since something like 220,000 people has gastric bypass last year, this stat would indicate that something like 220 people died last year after having the surgery. The stat may seem minor, but for those who died, mortality was 100%. You don’t want to become a statistic like that.

I researched the question quite a bit. Some of these folks died as a result of malpractice. I minimized that risk by getting one of the best surgeons in the business, and staying in a first-rate hospital. Most died because their medical conditions were far worse than mine. Most who died were not only 100 pounds overweight, they had advanced diabetes with advancing heart disease. I had none of these conditions. I was about 100 pounds overweight, and that is all.

Before putting me under, the Anesthesiologist asked me his standard list of 21 questions: Asthma, diabetes, heart condition, medicinal allergies, cancer, blood pressure, seizures, epilepsy, narcolepsy, etc. In all cases, the answer was no. He turned to me and said, “Well, except for your weight, you seem to be in excellent health. You should ride through this pretty easily.”

After the fact, I almost agree with that statement. I wouldn’t exactly call it easy…

3. Do you feel weak and woosey?

Occasionally I feel weak and woosey. Interestingly enough, going to the gym and walking a mile on the treadmill fixes the situation by kicking my system up a notch. I do feel a little bit deprived at this point, but there is nothing that can be done about it. The system needs time to mend itself.

4. Do you feel deprived of food?

Sometimes. Ultimately, I know this too shall pass. My system just needs some time to heal from the change that just happened. I need to take this vacation from food. Everything is going to be alright.
5. Do you dream about food?

Nope. However, my culinary imagination has been running hot lately. I am scheming a Spanish sofrito Mac and Cheese with Chorizo and a Kashmire Saffron released by lemon juice... just for instance. I have some other big ideas as well... regarding Gumbo and Chili.

I really, really, really want to make a batch of Chili Con Carne in my pressure cooker.

6. What about the big weight regain we see people experience after surgery?

When considering weight re-gain after surgery, you have to know what type of surgery was done in the first place. There have been at least four different types of bariatric surgery approved by the FDA at different times. They are not equal in effect. The four types are:
  1. Duodenal Switch
  2. Rouex en Y
  3. Lap-Band
  4. Sleeve Gastrectomy
Duodenal Switch was incredibly effective, but it was considered too aggressive and created nutritional problems later on in life. It is no longer approved by the FDA. However, this did bring the famous radio D.J. Big Boy down from 505 pounds to 225 pounds pretty well permanently. I said 'pretty' because it was only about 11 years ago that he had the surgery. He has not gained his weight back.

Lap-Band doesn't work. 50% of all cases fail to make their ideal target weights. Most people gain the weight back. Many have the band removed, which puts them in precisely the predicament they were in before. It was a bad idea that is ineffective. It is still FDA approved, however, I think they are going to be taken off the approved list soon. This is the so-called 'safe' out-patient bariatric surgery. The problem is that it doesn't do much of anything. That's why I discarded this option.

Sleeve Gastrectomy cuts the stomach down quite a bit, but not as much as Rouex en Y, and there is no change to the intestines. People lose weight on this one, but it may or may not be permanent. They've only been doing this for about 4 years now so it is hard to tell if it is lasting. I would suspect the results will be mediocre in the long term. That's why I discarded this option.

Rouex en Y is the gold-standard for bariatric surgery. They've been doing it for about 15 years now. 98% of patients hit their ideal target weight. 15 years later, 85% of that excess weight is still gone. Only about 15% has come back. This is attributed to normal weight gain due to aging and a slowing metabolism.

7. So why does the Rouex en Y work?

It's drastic and draconian. A morbidly obese individual typically has a stomach 4 liters in size, or just over 1 gallon. They cut that back to 2 ounces. That is a reduction from 135.2 down to 2. It will expand, and mine has already expanded to something like 5 or 6 ounces, but it will never reach it's original size. They say it tops out close to 1 quart to 1 liter or about 32-33.8 ounces. This is still only 25% of the original size.

Beyond that, they bypassed the first three feet of your upper intestines. This is the region of the system most responsible for processing and absorbing heavy fats. This means you no longer absorb fat well. Only about 20% of all consumed fat calories can be absorbed by your system, for the rest of your life.

Any nutritionist will tell you that it is difficult to gain weight when 80% of all of your fat calories are always and automatically removed from your diet, whether you consume large quantities of fat or not. Fat calories are usually the prime mover in weight gain. Fat contains 11 calories per gram Protein and Carbohydrates are just about 4 calories per gram.

It sounds crazy, it sounds dangerous, but the truth is that it works. The insurance firms are approving this surgery at an amazing rate because the medical facts show that this conquers the problem permanently and has amazing side effects.

8. Have you had any complications?


9. What was the worst part of the surgery experience for you.

Having the fucking drainage grenade hanging out of my left side during the 3 days in the hospital. The thing probably saved my life, as it does for all pateints, but it bothered the fuck out of me. This despite the Dilaudid. The drainage grenate is a little rubber-plastic grenade looking thing attached to a plastic tube that weaves it's way through your gut. The tube has small holes in it. They squeeze the grenade till it collapses so that it applies a mild suction on the tube. This drains loose blood and fluid in your gut.

The removal moment was shocking, and laid me on my ass for a good 15 minutes. The nurse simply jerked the 12 inches out of my gut like a rooster pulling up a worm. The cut where the tube was inserted is still the angriest looking wound on my belly.

10. Have you had any bad food experiances yet?

Yep. I ordered a 24 ounce 800 Pound Gorilla (perfect contradiction) from Robek's Juices, and it did not sit well. The 800 Pound Gorilla is a high protein drink composed primarily of soy milk, yogurt, and peanut butter. It is blended super-smooth, so I thought it would be fine.

I consumed only a 4 or 5 ounces before I had to stop. I felt like I had a 14 pound bowling ball stuck in my gut, jamming its way down. That was some true discomfort. The mass was not the problem. I had cosumed 8-10 ounce servings of protein drinks before. I thought the trigger was the peanut butter. Peanut butter does contain some rather complex proteins fibers and fats.

The funny thing is that stored the rest of the drink in my refrigerator. Last night, more than 24 hours later, I drank some more. This time it went down fine. This is hard to understand. Would 24 hours of healing be sufficient to make this difference? Maybe, maybe not...

10. When do you transition to solid food?

I'm scheduled to make my first jump to semi-solid food either Friday (2/18) or Saturday (2/19), give or take. At that time, I will be able to try yogurt, cottage cheese, eggs, and over-cooked chicken soup. I have a pressure cooker. Believe me, I can over-cook if I want too.

From there, it will be another two weeks before they will allow me to try anything more substantial, like a sandwich, or an Italian dinner. This means I will be celebrating Lock-Out Day, March 4th 2011, but returning to solid food.

11. What do you plan to eat on 3/4/2011?

I really want to make a Chili Con Carne right now. I may do a Bolognese just because I love it so much, and it doesn't contain any capsaicin, which the active 'hot' chemical in spicy foods.