Every Pizza is a Personal Pizza...if you work hard and believe in yourself

Too soon? (At least from a guy who had bariatric surgery just 15 months ago?)

The other day amongst some friends, the conversation floated to the subject of ice cream. We chatted about our favorite flavors and cafes. One person remarked how they could eat this certain brand every day if it were available. Everyone chuckled and nodded affably, myself included.

I have quite a long history with ice cream. I love the stuff. And I happen to be quite a discriminating consumer; at this point I literally won’t waste the calories, money, or time on low-quality product. Part of...

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How to Lose 70 Pounds, (part 3)

My first (you read that correctly) surgery in early December was not only the first in the process of treating my obesity, it was also my first ever. As I indicated in previous posts, fears around anesthesia, not waking up, losing control, etc., formed the basis for the majority of the anxiety I felt heading into the surgery theater the first time. In the back of my mind, I couldn't shake the thought that the (albeit brave) decision of going through with my plan might also be my last! I usually do my best to avoid wearing my anxiety on my sleeve at home - Paige and I both feed off each other and the picture ends up not being pretty. I'm sure the weeks leading up to December 1 were about as stressful for her as they were for me.

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How to Lose 70 Pounds, (part 2)

When I finally made my decision that bariatric surgery was a good decision for me, I immediately felt anxious. I believed it would be a great tool for me in getting back on track with my health. But there were so many unknowns.
Is this the right decision after all?
Who should I tell about it?
I thought about the hypothetical reactions my church members, colleagues, and friends. What would they think about the idea?
What if I end up regretting it years down the road?
Is major surgery worth the risk when there are alternate safer treatments available?

My mind hummed with potentialities.

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To Sleeve (or Not to Sleeve) Series - #12, The Process: An Update

(This is part of a series I posted on my other (formerly anonymous) blog, tobypass.wordpress.com. An index of all posts in this series is located at the bottom of this article.)

 

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I’ve alluded several times to the fact that I had my initial consult with my surgeon last week and that as of now, I have several assignments to work on before any operation will take place. I haven’t discussed much the nature of our conversation and what I’ve decided with regards to surgery — nor have I outlined the process between now and then.

First of all, I was very impressed with the surgeon. He seemed competent, empathetic, kind, and ‘present’ with me. He spent what I considered to be a great deal of time with me — probably pushing 40 minutes — happily answering all of my questions (I came with notes stored up on my phone). He told me about he and his group’s complication rates, death rates, and history with procedures. He described their recovery floors and the process that patients go through for surgery. He carefully gave examples and outlined answers to my questions. One of the things I most appreciated was how he sensed my anxiety about going forward with surgery. As I’ve described, while I’m not unwilling to do it, I just want to be SURE that it’s right for me — and have NO regrets. He sensed this and responded without me really having to dive into it in detail.

At one point near the end, he actually offered that I could begin the process — the march toward surgery — and if, say, in 6 months I decide that I’ve lost a lot of weight and been successful with lifestyle change and want to put surgery off — they’ll celebrate that it’ll be all good. This made me feel a great deal of relief and freedom: as though this group is more interested in helping people than processing them like cattle for a payday. I trusted him more when he suggested it.

My secret was that I had planned on asking him if this very thing was a possibility — before even entering my appointment that day. He himself bringing it up felt like a boon.

As I’ve described thus far, I’m trying to make some serious changes in my life and in the back of my mind, I want to make a valiant effort at real change before I go through with surgery. Maybe I need the tool. Maybe I don’t. But I really want to give it half of a chance without. First. And that’s my current plan.

My insurance requires a 4 month process of supervised medical dieting. So over that period, I’m going to be visiting the clinic about once per month and seeing their dietician, weighing in, and working through a list of pre-op items. As I’ve outlined in previous posts, I’m already tracking my meals, staying within a certain caloric intake, using protein shakes in the morning, weighing and measuring portion sizes, and generally being more conscious of my nutrition. According to the dietician this last visit, I really don’t have to make any changes yet. Just to keep going.

And believe it or not — just this bit of paying attention has yielded me a reduction of about 12lbs over the past month. That’s legit!! I feel good.

The pre-op items for me (beyond permanent lifestyle changes) include getting an EKG, a full blood panel, sending off my CPAP data, and obtaining a psychological evaluation. Each of these items are in process already.

Now — all this leads me to think about dates. The surgeon and I tentatively talked about December as a possibility — that was, at the time, about 6 months away — well past the 4 month insurance requirement and yet a long enough window for me to feel like I have given myself a fighting shot at real life change. In my mind, I picture the scenario going something like this: If, come November or so, I’m down in the realm of 250 and feel fantastic, and have a super positive attitude about continuing the process of losing weight, I’ll most likely choose to delay surgery — for a year — if not indefinitely. If I’m down in the 280s, have stagnated, and feel positive but also a little discouraged, I’ll go forward with it in the knowledge that I’ve already lived these exact steps many times in my life before.

So that’s it. Hoops to jump through on the way to December. Or maybe not…

 

 

To Sleeve (or Not to Sleeve) Series - #10, Isn't Having Surgery too Extreme?

(This is part of a series I posted on my other (formerly anonymous) blog, tobypass.wordpress.com. An index of all posts in this series is located at the bottom of this article.)

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In other words, “shouldn’t I be able to do this on my own? — without the extra tool WLS provides?”

At it’s root, I think my question comes from my ego. I don’t want to have to NEED the help. Not for this. I mean, I’m an accomplished man in so many other areas of my life. I was senior class president in high school and finished at the top of my class, I completed a double major magna cum laude in undergrad and had a job offer several months before graduation, and I earned my Master’s degree (summa-cum-laude) while working full time. I’m married to an amazing woman, I’m father to two wonderful sons, and I have the privilege of working as a pastor in the largest church in my denomination for 1000 miles. I’m in the middle of writing a book, I’ve traveled internationally to speak, and I’ve done a ton of personal/psychological/spiritual work in my life. I’m emotionally intelligent, extremely competent in terms of household, automobile, electronics, and carpentry maintenance. And to top it off, I’m an excellent cook (I do all of it in our home). The list goes on and on. (I’m humble too btw. HA!)

So why can’t I muster up the self-control to put the fork down?
Why do I need to get my stomach cut open in order to accomplish this one thing?
When I’m so proficient in so many other areas of life, why is it that I can’t figure out this singular area?

I had a the first consult with my (potential) surgeon last week (Dr. Mathew Rawlins of the Rockwood Clinic in Spokane, Washington) and I actually posed to him these very questions. Surprisingly to me, he’d heard this line of thinking before. Many times.

In fact, he told me that he’d had a physician not long ago who had gone through the process of having bariatric surgery who had expressed the exact same sense of exasperation. As a doctor, this person knew well the sweetness of success in life — and yet at the same time this person was also morbidly overweight.

Dr. Rawlins told me the same thing he told that physician — he talked about how I need to give myself a break. About how our culture and state of food works against our biology. About how there’s so so so much more than willpower or self control that contributes to getting a person into the health situation I’m in. And about how there’s so much more that gets people out. He talked about how the stigma we’ve created around weight is unhealthy and damaging to people; making the problem worse even. And then he finished by saying that he has many patients who end up putting surgery on hold for a while — or permanently. Some are successful in changing their lives and losing significant weight without surgery. Many are not. And he says that he cheers them on no matter what.

All of this was incredibly encouraging and humanizing to me.

I feel the stigma regarding my weight that sifts through in this American culture. Although internet comments can’t be regarded as mainstream thought, I do think they give an idea of many people’s unfiltered feelings. Read through the comments section of any mainstream article about bariatric surgery and you’ll read countless negative tomes about the shame of cutting oneself (as opposed to what is assumed as buckling down and getting one’s eating under control — as if that hasn’t been done dozens of times only to fail again). (See This Atlantic ArticleThis one from Mercola, and this one from CBS). It’s hard not to internalize that.

For now — I see surgery as a tool. Just like the scale I have on my counter and that crazy protein powder concoction in my pantry. Those are tools for me to lose weight. The app in my phone? A tool. My bicycle I ride for exercise? A tool.

If I end up going through with having surgery, I will simply be adding yet another tool to my belt. It certainly won’t be taking the easy way out. It will be more thoroughly equipping myself for the task at hand. And that’s something I know a whole lot about!!

To Sleeve (or Not to Sleeve) Series - #8, Pros & Cons of: Surgery vs. Permanent Lifestyle Change Alone

(This is part of a series I posted on my other (formerly anonymous) blog, tobypass.wordpress.com. An index of all posts in this series is located at the bottom of this article.)

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If you’ve been following me along over the past couple weeks — you know I just started this blog as a bit of a chronicle and journal of my walk through this part of my life. You also know that I have yet to fully decide, “YES – I’m going to do bariatric surgery!”

I did go to an information session put on by a regional bariatric group a couple weeks ago. And since then I’ve actually spoken to those people on the phone and am scheduled for an initial consult with a dietician and doctor in the middle of June (2015). Of course I’m not the only one at this point who has the option of opting me out — they certainly can disqualify me for a hundred different potential reasons for all I know. But I also know that I can decide to stop the process at any point along the way. I don’t imagine doing that; yet it’s comforting to know that I can.

In this post, I want to explore a little bit some of the pros and cons of surgery vs. no-surgery. Primarily just to help me get my mind straight about everything. Do the risks outweigh the potential rewards? Is the cost (in terms of permanent lifestyle change and social implications) too high for what I’ll get back? Are there intangibles with either that I can only get by pursuing a given path?

So I worked up this little chart — I’m a nerd, I know. And my hope was to compare and visualize the weightiness of each decision path. You’ll see some question marks throughout and that’s because I’m not sure how much to weight some of these items — or if even some of them are true. In any case, this is how it fell for now…

Now — The real question mark in all of this is whether or not I’ll stick to the changed lifestyle if I do the surgery — or If I’d be able to be successful at permanently reducing my weight without surgery (hasn’t happened yet in over 15 years of dieting)… In the end, it comes down to likelihoods — and according to my past path, it seems most likely that trying to do this without surgery is a far more difficult path also one that is more likely to end in little to no success… It also seems that according to the research, surgery is the best option for most people this overweight — yielding the best long term results of any currently known therapy.

If I were to make a chart with those things a little more solidified, the graph would look a little differently… The weight would fall much more firmly on the side of surgery.

However, if I were to beat the odds — really be able to keep my weight off with diet and lifestyle change alone, that would seem like the better option (other than the speed factor) — because I’d avoid all the risks of surgery and permanent body change while still reaping the benefits of lower weight and fewer comorbidiites. This scenario is the less likely one – clearly – but still possible.

The real wildcards then become clear to me…

First — time — surgery is far more likely to yield me into a successful situation within a couple short years than is lifestyle change, which is and will be a very long slog with many more downs than ups arguably. Because I have two little sons who’s childhood is in play here — time IS of the essence. And that isn’t overstating things at all…

The second wildcard isn’t a big deal but it is something. I write in the chart above about how surgery is this definitive, risky, permanent step — it’ll be putting me on a path irrevocably — an adventure of a kind. Sure. There might be dangers. Sure. There might be problems down the road. But it’s doing something about my situation. It’s doing something big. It’s arguably doing the BEST possible thing (according to my family doctor – and now my wife). It kind of has the feel of joining frodo on his quest to return the ring to mordor in the lord of the rings tale (ok 2 nerd references in one post — enough) — I like that. It feels good. It stokes my inner masculine adventurer. Even if there are negative things that come out of it…

I’m not sure if I’m any further along in the process of deciding than I was when I began this blog a couple weeks ago — but I feel as though the stars might be aligning for me to go forward with it.

The rubber will begin to meet the road after my consult in a couple weeks I’d suppose.

Cheers!

To Sleeve (or Not to Sleeve) Series - #5, Waiting and Deciding and Thinking and Preparing

(This is part of a series I posted on my other (formerly anonymous) blog, tobypass.wordpress.com)

In my opening post, I tried to make it clear that I haven’t yet decided how I should proceed with dealing with my weight. My doctor suggested I explore the option of bariatric surgery and while surprised, I decided to at least take a look. Thus far, I have been additionally and continually surprised with how interested I actually am with this option.

I had never considered it viable.

I had never even thought of it as something people do. It had always been something in my mind that was a last ditch, ‘half-baked’, easy-way-out strategy that rarely worked and had untold side effects. It was only something for those over 500lbs and were in danger of dropping dead within the decade because of their weight.

After my doctor suggested it, I first went online and read several scholarly articles. To my surprise I found ones like this one which coalesces over 150 studies on the outcomes of bariatric surgery. It concludes: “Our study suggests that bariatric surgery has substantial and sustained effects on weight and significantly ameliorates obesity-attributable comorbidities in the majority of bariatric surgery patients.”  Taking into account over 150,000 patients, the authors of this study estimated that the average person sustained a 16 point drop in BMI after 5 years of surgery.
This journal article stated it even more strongly: “Bariatric surgery is the only
effective treatment of morbid obesity resulting in a long-term sustained weight loss, a
decrease in comorbidity, and an improvement in the quality of life.”

This isn’t a message I have ever heard from media or friends or family.

In fact, this concept (that not only is bariatric surgery a viable option for me right now at a BMI of 41 with elevated liver enzymes, high blood pressure and sleep apnea — but actually a very good option) is startling to me. I’m still absorbing it.

—-

I guess this is in part why I feel as though I’m waiting.

I attended the Bariatric Clinic Information Session. I got the information. I learned a ton. (i’ll write more on that soon). The doctor there essentially said what I read in those journal articles. I was shocked.

But I still can’t hardly believe it.

I had an appointment with my GP this week and we talked in detail about some of the pros and cons of the procedure for me. I reiterated my feelings about the above. My reactions and feelings. I told him about some of my fears and worries. The long term impacts or consequences.

He more or less said that he thinks the benefits of doing the surgery will outweigh the negatives. That if I had diabetes (my A1C right now is around 5.4 — so pretty healthy really), he’d say it’s a no brainer. But even with elevated liver enzymes, apnea, bp — and mobility issues — it’s worth it. And that trying to continue with the diet thing is a doable trial. Just not a terribly realistic comparison to getting the surgery because of the change in anatomy/hunger/hormones.

—-

So this is where I’m at right now.

I’m beginning to follow the pre-surgery diet instructions the clinic gave.

1. No fluid 1/2 hour before or after meals (I’ve been mildly successful at this this week)…this will be a challenging habit to change. Doable though.

2. No caffeine. (I’ve been unsuccessful at this).

3. Quit calories by mouth (pretty successful at this — although I don’t usually drink a lot of calories).

4. Keeping a food journal (CHECK!!)

5. Slow eating times — chew slowly — take time (CHECK)

6. Exercise (3 out of 4 days so far this week so that’s pretty good)

I also called my insurance company and got the skinny (ha!) on what they cover and don’t — (I’m in luck) — and whether or not the Rockwood clinic is in network (again – in luck!).

SO that leaves me to wait until consults and pre-workups begin. We’ll see how things unfold.

I still want to do a pretty exhaustive survey of pros and cons — as well as look at long term risks of getting this surgery — what is known and what is not. At this point however, I must say that I am leaning toward moving forward with it.

To Sleeve (or not to sleeve) Series - #3, The Bariatric Surgery Clinic “Information Session” Experience

(This is part of a series I posted on my other (formerly anonymous) blog, tobypass.wordpress.com)

One of the first ‘official’ things one has to do in checking out the possibility of having bariatric surgery, is attending a lecture on the subject by a physician or surgery group.

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Just a few weeks ago, I attended just such an information session. It was organized by a clinic out of Spokane, but which services a good chunk of the Eastern Washington region (Rockwood Bariatrics). I chose this group because it was recommended by my primary care physician (and also my father, who himself is a physician).

In talking with a few people I know personally who have undergone the procedure and related lifestyle change, it became clear that going through with it via a comprehensive clinic such as Rockwood in Spokane is the wisest choice. Rockwood Bariatrics (and others like it) provide psychological, dietary, group, and ongoing medical support before and after the procedure.  For this group, bariatric surgery is all they do — all day long — every day. They have a special OR dedicated to bariatric surgery, they have a special bariatric ICU and bariatric recovery units — all who do this work every day. Their entire work is dedicated to these few weight loss surgeries.

In my estimation — if I were to go forward with bariatric surgery, it’s a no brainer to do it with a clinic like this instead of a general surgeon who might be confident but certainly not as experienced — and completely absent the social supports.

Now — apparently, one does not simply walk into one of these specialist bariatric surgeon’s offices for a consult… In fact, the 3hour information session, beyond being informational and helpful, is a requirement to be seen. Period. (Luckily, it was free, and held in a nice hotel board room on the river.) But only after a person fills out paperwork, hands over insurance, and chit chats with the nurses, etc., is he/she blessed with a introductory consultation with a surgeon.

On one level, this seems like a lot of red tape before having a simple conversation. On the other hand, I don’t really blame the doctor for trying to weed out the field a bit. For certain people, a simple surgery to make it so you lose all your excess weight might be really tempting — a cheap, dirty and easy fix! The reality of what the surgeon explained in his lectures, is that an entire permanent lifestyle change is absolutely essential for long term change to take root. Without adequate education before and after, the surgery doesn’t have much of a prayer for success. My impression (an entirely subjective and probably prejudicial take) at the meeting I attended was that the majority of the attendees were in a lower/poor income class, poor education status, and poorly informed regarding basic matters of health. If my observation had any truth to it, it further justifies the reason for additional education ahead of time — as those who could be the most vulnerable might also be ones misguided into surgery.

The meeting was held in a hotel conference/ball room and there were perhaps 25 people present. Tables were set up with 2-3 chairs at each (and only on on one side) so attendees could point toward the front and take notes at the same time. Water was provided. It was nice. I could tell the group went to some expense to create this information session — [and clearly it is also a recruitment tool for their business].

In any case – this is what happened.

First – one of the doctors in the group (in this case Doctor Mathew Rawlins) got up front and gave a presentation for a little over an hour. He talked about obesity, obesity related illness, and surgery as the “only known long term successful treatment to the disease of obesity”.

[An aside — I found his description of the problem as a disease to be quite helpful and non-shaming. Kudos.]

Anyways, he had a powerpoint slideshow that documented the success rates of patients who have undertaken bariatric surgery, its history, and its safety. I’ll probably write more detailed posts about these options later but more or less, he outlined three different procedures that seem to be commonly done today (any one of which are referred to as ‘weight loss surgery’):

  1. Gastric Bypass — the oldest procedure, originally developed to treat other medical problems back in the 50’s or 60’s; and with a well documented history of success for weight loss and associated comorbidities (albeit with some complications/downsides).
  2. Gastric Banding – (pictured) — a newer procedure where a piece of hardware restricts food entering the stomach.
  3. Gastric Sleeve or Gastrectomy – the newest procedure (Dr. Rawlins says he’s been doing it since 2007 and that it’s been around since maybe 2004?) – in which a significant portion of the stomach is actually removed.

For each of these, he outlined risks, complications, benefits, and documented outcomes. It became clear rather quickly that he does not at all favor gastric banding as a procedure because (according to his experience), people have a difficult time getting the right balance with it’s size. If the band is too tight, people can’t really eat and end up vomitting or having reflux. If it’s too loose, people don’t get much positive weight loss effects. To get it just right is difficult tedious. To make matters worse, so he said, sometimes the stomach can actually get pulled up through the ring and become necrotic…this apparently is an emergency  and must be fixed immediately. Anyways, he pretty much discouraged that one very thoroughly. I couldn’t help but think to myself that that one (while also less successful statistically in terms of weight loss) is also much cheaper and less invasive than the other two. Conflict of interest? Probably not. But I couldn’t help but think it.

Regardless, he spent a lot of time detailing exactly how the procedures for the other two were done and how they compare in terms of risk and outcome. His conclusion is that really, it comes down to personal preference and comfortability of the individual patient. He doesn’t think there’s much difference. They’re both good solid solutions.

Second – The clinic had a video of their dietician giving a lecture. This was less than impressive because it wasn’t a live person but what can you do? She talked about what the new diet would look like for a person who has gone through this surgery — she talked about what the workup and preparation looks like for a person who is getting ready for this surgery. Even though it was a video – it was crystal clear that if a total lifestyle change isn’t made, the surgery won’t work.
This isn’t a quick fix.

They aren’t just removing a bunch of fat and doing all the hard work that I didn’t want to do. (and of course, I’ve worked incredibly hard over the years managing my weight) — But this procedure is more like a ‘kick in the ass’ or a ‘boost’ on the road to recovery. And for most people, it works. They get to where they want to be. And it costs them something.

I’ll write more about what a post-surgery diet might look like but suffice it to say — it appears quite a bit different from how I’ve been living and eating — which is largely by guestimation and desire. A great deal of care will need to go into ensuring proper nutrition, proper balance, enough protein, the right foods. They said that the volume in a sitting will be reduced to about 1/2cup — and that about 6x per day. Because volume will be so much smaller, what a bariatric surgery patient does eat must be packed with quality. He/she could fill up on a 1/2cup of mashed potatoes but that isn’t very nutrient rich. This will take planning and care. Which my diet has little of now.

And this realization is kind of dawning on me in general — in order for me to achieve a healthy weight, I’m going to have to pay attention to what I eat. There’s no getting around it. I’ve sleepwalked through my diet for my whole life — simply eating out of emotion and desire. And this is where it’s got me. I can’t imagine that I will be able to go back to a place where I’m totally unconscious. One way or another, I will need to pay attention. I need to learn how. This is whether I have surgery or not.

Anyways, the third, thing that happened was a short discussion about insurance and next steps. Apparently this clinic has case managers that lead patients through the entire process — and it’s quite a process!!

It begins with an examination of insurance coverage (mine covers it as far as my conversations with my company) psychological evaluation, doctor consult, dietician meetings, lab tests and any other required testing, a pre-op diet to shrink the liver (this is both required and essential apparently), and the list goes on and on and on. As I alluded, this clinic also has quite an extensive post-operative system of group meetings and support that conceivably goes on for the rest of life.

SO where I’m at in the process right now is waiting to talk with a case manager about exploring it further…As well as waiting to speak once again with my primary care doc about what I’ve discovered since we last met.