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The Years (By)Pass

Posted on 2008.08.17 at 18:38
Current Mood: pensivepensive
Current Music: The Weight - The Band
We’re coming up soon on the 6th anniversary of a friend of mine undergoing gastric bypass surgery, and it’s time to look back what has happened and what we’ve learned.

Some of you know her; for the rest, I’ll omit mention of her name out of respect for her privacy. She’d struggled with her weight almost all of her life. She’d been on every imaginable diet and should probably write a book about them.

A pivotal moment, I think, was when she realized she was approaching 50 years of age. She further realized that people her size did not tend to live to a ripe old age – and God help them if they did, because the back goes, the knees go, and one becomes a bedridden invalid. Since neither that option nor the prospect of dying young appealed to her, she began to consider options she had long ruled out as too invasive, or too risky, or too life-altering. When she realized that she was already living out a death sentence imposed by her weight, she realized that the equation had changed. The final piece fell into place in the aftermath of the 9/11 attacks. She realized that in a roughly comparable situation, she would have died rather than be carried out of the building. This, then, is the epitome of what I would call a personal choice.

There are now many different types of weight reduction surgery on the market. Some are more invasive than others; some are reversible while others are not. Each option carries its own unique set of risks, rewards, and other assorted specifications. She attended various meetings and seminars around town advocating these various procedures, and I accompanied her to many of them. In the end, she settled on the most radical of the options.

On the day of the surgery, I spent many long hours at the hospital awaiting word of her status. When she was finally ensconced in her room and had regained consciousness, I was her first visitor. Her first words when she saw me were, “Well, that happened.” It’s a quote from a very good though little-seen movie called State and Main, spoken by Alec Baldwin’s character immediately after an auto accident.

Prior to the surgery, her weight was well over 400 pounds, but that number began to plummet immediately. You have to understand – after this surgery, you have no choice but to lose weight. Your stomach is now teeny-tiny. If you eat more than a mouthful, you’ll throw up. In fact, almost everyone who has this surgery becomes quite familiar with throwing up. In that respect, the body is working the same way it always did – if you eat too much, you throw up, only now, the tolerance is much much lower. On top of that, most patients have no appetite in those first weeks/months, in spite of their low food intake. My friend had to remind herself to eat in order to keep her strength up. She would wake up in the morning and think, “Oh God, I have to eat again!” It was no longer something she craved, or even looked forward to. And the pounds rolled off.

So the first part of the post-surgery process is pretty straightforward because you have no options. You have drains attached to various parts of your body that have to be emptied (and measured) multiple times a day. You’re exhausted because your body is in serious healing mode. And you’re pretty much homebound by your overall condition.

I should mention this as well – when one undergoes this procedure, there are two major surgical options. You can either have a long incision down your torso, or they may do it laparoscopically, which means that it is done with a series of small incisions. A small rod camera called a laparoscope is then inserted through the incision and the surgery is carried out using a video screen. The upside to laparoscopic surgery is that there is far less of an issue with scarring, and there can be a significant reduction in both pain and healing time. The downside is that, according to some reports, there is a higher risk of complications. In the case of gastric bypass surgery, the size of the patient often makes laparoscopic surgery impossible. Even though my friend did not investigate that option, it probably was not a choice that was open to her. She opted for the one long incision approach since, as she put it, “I’m not doing this so I can look good in a bikini!” She looked at the pain angle as something one endures, and then it goes away.

So almost 6 years down the road, where do we stand? Well, the vast bulk of that excess weight has gone away and has never come back. At present, she probably weighs about 50 pounds more than she’d like, but considering where she’s come from, that’s a pretty good number. The most important thing this surgery has given her is her life. I’m not talking about number of years; I’m talking about the ability to do things; to have an active lifestyle. A while back, I heard her say that she’s living her life in a different order than most people – she’s already been through old age, and now she’s getting to live her youth. She’s been able to work steadily, which had always been a challenge, and she’s now able to run around town all day being active without finding herself laid up in bed for two days afterward.

So could you call me a great believer and booster of gastric bypass surgery? Well… not exactly. To put it that simply would be to ignore the seamy underside of the weight loss surgery business and the rampant ignorance and foolishness that surround it.

At those meetings and seminars I mentioned earlier, I listened to various doctors as they stood there and tried to put the very best spin they could on the surgery they were offering. Coupled with my observations of the printed and online literature available, it became apparent that a lot of doctors and companies are out there first and foremost to sell surgery. If you then look at the many patients who do little or no research, even with their own permanent well-being at stake, you begin to see than many people are undergoing these procedures who should not be doing so at all, or who should be doing so only after they have examined other options and educated themselves.

The vital, oft-ignored facts are these: this is life-altering surgery; you’ll never eat the same way again. Also, it is entirely possible to screw it up. This surgery gives you a window of unavoidable weight loss. The precise timing varies from person to person, but a typical window would be about a year and a half, during which the pounds will come off regardless of your attitude. After that, IT IS POSSIBLE to gain it all back, and many people have done just that. Your capacity for food intake will begin to return. It will probably never get back to what it was, but it will come back enough for you to start putting the pounds back on. So you get a free pass for a year and a half, during which you need to continue working, to re-educate yourself on your relationship with food.

I would like it if doctors giving seminars on gastric bypass surgery were to say the following: “This surgery is a last resort. If you’re contemplating this, you need to either be in a dire, life-threatening situation with no time for second chances, or you need to have already tried the other options, like dieting, counseling, or testing for other medical issues. If you’ve passed those criteria, you still should not pursue this until you have educated yourself on all the implications. If you have done all of these things, you may stay for the rest of my presentation. The rest of you should leave now. Also, this surgery needs to be done for the right reasons. If you’re doing it to please your mate, or to fit into next season’s fashions, think again. But if you’re here first and foremost for your own health and well-being, have a seat.”

To be fair, I think there are probably people who should investigate these surgical options but who have not educated themselves properly. Or perhaps they view this surgery as a sign of weakness; that it would be like wearing a badge saying, “I couldn’t muster the will to keep my mouth closed so I cheated and got the surgery.” Such an attitude is, I think, comparable to the attitude many people have towards counseling – “That’s something other people get, but I could never live down being seen as that sort of person.” But I think such individuals are exceptions; the far greater problem, I think, is the people being sold on it who need to follow other options first.

One of the less invasive options I want to single out is the lap band, or more technically, the adjustable gastric band. It’s a silicone-filled band that is placed around the top of the stomach, creating a small pouch that functions much like the pouch created in a full gastric bypass procedure. It has the advantage of being a much simpler operation, along with the added advantage of being completely reversible. The band itself can also be adjusted after placement, to make it larger or smaller as needed.

My friend took a good hard look at that option before settling on the more radical surgery. Her ultimate decision was based on her assessment of her own personal psychology. She felt that the lap band approach gave her more of an option to fail; an option she did not want. I cannot judge that choice; I can only report that her choice has worked out marvelously for her, and from what I read, the lap band option has also changed the lives of a lot of people for the better. My wish is not for a specific choice, but only for an informed choice.

Postscript — I did something with this post I’d never done before. Because so much of it involved reporting and speculating on my friend’s thoughts and opinions, I asked her to read a first draft of it. Many of her comments and corrections were incorporated into the posted version.


Hand built by robots.
onceupon at 2008-08-17 23:58 (UTC) (Link)
The gastric bypass industry has vastly changed even in the 6 years since your friends surgery. It's pushed on people who weigh as little as 200 pounds. I have fended off brochures from more than one doctor and, even though my grandmother's eyelashes fell out due to malnutrition and complications when she had the surgery in the 80s, she has suggested it as well. If doctors were presenting it as a last resort, I'd have a lot less issue with the industry but it's presented as a magical cure. And I think that is totally scary.

I wish your friend continued health and wellness!
charlesofcamden at 2008-08-18 00:18 (UTC) (Link)
That's some depressing news. I just want to shake some of these doctors. I hope we don't reach a point where all of these unnecessary surgeries and unscrupulous doctors create a backlash that prevents and discourages people from getting these procedures who really need them.
Hand built by robots.
onceupon at 2008-08-18 00:36 (UTC) (Link)
What I would like to see is an alternative to these surgeries. Right now, there are NO OPTIONS. I don't think gastric bypass is a good thing. I can't support it, though I have friends who have had it and I support their personal choices because I am all about body autonomy. But I'd much rather live in a world where someone who felt like it was their only option had some other resources.
charlesofcamden at 2008-08-18 01:03 (UTC) (Link)
I suppose it's a matter of perspective. For my friend, she thinks back to when she was fat in the 1970s and sees that as a time when there were truly no options. By comparison, gastric bypass is an option that, in her view, has saved her life and enhanced it far beyond what it could have been had she been born in an earlier generation. In my view, gastric bypass is like any tool -- it's a wonderful thing that makes the world a better place if it's used wisely. By analogy, a hammer may be used to build a house, or it may be used irresponsibly to commit mayhem. What we have right now is a lot of doctors swinging the hammer of gastric bypass very irresponsibly, threatening to give a bad name to something that ought to be regarded as a wonderful, and less common, procedure.
Hand built by robots.
onceupon at 2008-08-18 01:05 (UTC) (Link)
My point is that sometimes a hammer is useful but having a variety of hammers is even better. Because if your job calls for a tack hammer and all you have is a 70lb sledge....
Hand built by robots.
onceupon at 2008-08-18 01:06 (UTC) (Link)
Plus, I admit, I don't think gastric bypass even approaches wonderful. I think the impact it had on your friend's life is wonderful but the surgery itself? Not so much.
meryddian at 2008-08-18 01:17 (UTC) (Link)
Yes, I know I'm overweight. I've kept 50 lbs. off from my peak weight, but I still have a long way to go.

I *would* consider lapband surgery, but I know from knowing a couple people who've had the lapband, it doesn't seem to have as dramatic an effect as GBP. I've kind of made myself a little goalpoint in my life path... ie. if I cannot get to X# weight on my own by _date_ then I will strongly re-evaluate the lifeband thing.

I was rather appalled that both times I went in to see my throat/ear/nose specialist, that he brought up gastric bypass as a means to lose weight. Losing weight helps slim the neck and helps you breathe easier, and while I clearly have a secondary chin and some excess weight on the neck, my neck is NOT so huge that it clearly inhibits things ie. when I am sleeping.

So I got mad and kind of exploded at him, and said, "Look, I know some folks who've done GBP. I know what it entails. I also know I'd probably end up killing myself between either not taking all my suppliments properly, or doing something stupid and end up bursting my stomach open." The tales I've heard from people who've gone through it frighten me considerably; the side effects/risk factors me downright terrify me. And I don't think one should go through terrifying surgery unless, as you point out, it's an absolute-last-resort. I don't feel I'm there yet, or will be; and it bothers me that a doctor is so willing to almost casually suggest it. I carry my weight predominantly in my hips, butt and lower stomach; I'd hate to think what he'd have recommended if I were more an "apple" -- take me out back and put me down?
charlesofcamden at 2008-08-18 01:45 (UTC) (Link)
One thing I've learned - though I wish I'd learned it a little sooner - is that I do not have the right or the wisdom to say who should pursue this option, any more than I would presume to tell anyone how to pray. I wish a few more doctors, including yours, could learn similar humility.
(Anonymous) at 2008-08-26 13:54 (UTC) (Link)

The fight against fat!

I've always battled the bulge. As time goes on it does get harder and as I slide into my fifties it seems that I am loosing the battle. I have steadily gained 10-15 pounds every year. I don't eat more so it doesn't seem fair. My metabolism is slowing down. I have thought about surgery...not a good option for me. I do not heal quickly. I am trying to step up my metabolism with exercise. I joined a gym. I love to dance and play laser tag, so I try to do those things that I love as much as possible. I have lost 16 lbs since April. Not much but I am trying to change my life....I am like your friend and looking into the future I do not want to be an invalid when I am elderly. If I keep gaining I will top 300 by retirement and that is not how I want to retire. She is very lucky to have such a supportive fiend in you. My husband is trying....but it is hard to understand when you never really have had a weight problem. It sounds like CC really has her head screwed on right and this is going to last her lifetime. I'm so happy for her! Now me!
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