(units should be kg/m^2)
16 December 2010
Suddenly, I'm one week away from undergoing a vertical sleeve gastrectomy. It is almost too much to digest that this truly is the beginning of the end of my 15-year battle of the bulge?
Suddenly, I'm one week away from undergoing a vertical sleeve gastrectomy. It is almost too much to digest that this truly is the beginning of the end of my 15-year battle of the bulge?
The
long-and-short of my story is that I was a chubby kid, athletic
high-schooler, super-athletic collegiate (squash team) and, league
player in my twenties and early thirties. A back injury (herniated disc)
whilst training for a tournament spelt the end of competitive squash
and any form of athletic activity. A job for a bachelor that involves
numerous lunch meetings and after-hours cocktail functions is a recipe
for disastrously rapid weight-gain. The trouble with athletes who
suddenly quit working out is that they retain their appetites and eat
with the same care-free abandon as they did when they were burning it up
in the gym. Thus began my long addiction to food. A 10-year
marriage-to-date to a wonderful wife and excellent cook fuelled the
addiction. Despite sporadic forays into the gym and some tennis, I went
from 85 kg (187 lbs) in my playing heyday to my current 160 kg (351
lbs). I've gained the equivalent in weight of another entire adult human
being.
Interspersed
in this 15-year saga were numerous efforts to lose the weight, the
likes of which are all too familiar: cabbage soup, Exchange, Atkins,
X-Diet, etc. There was one time that I managed to stick to a so-called
'detox' eating programme that caused me to lose weight possibly at the
same rate as many bariatric post-ops. I actually fought through the back
pain and starting playing squash again. It was tremendously gratifying
to fit into my college clothing once more. The diet itself, though, was
tantamount to starvation and led to my becoming incredibly sad. Although
not diagnosed as such, I came about as close as I can imagine to being
chemically depressed. It makes sense, I suppose, that if you deprive
yourself of fat and not take supplements, plus cut out salt and sugar
without electrolyte replacement, you're not going to absorb fat-soluble
vitamins which has to affect one's sense of well-being.
Short-lived
was my renewed thinness because at the end of the two-month crash diet,
my resolve came crashing down too. So pleased was I with reaching my
goal that I celebrated with a hearty double cheeseburger from the
world's greatest supplier of lard disguised as food and have been
supersizing ever since.
Five
years ago when my doctor noticed the increase in my blood sugar levels
and expressed alarm at my increasing size, I took notice but was sure I
had the strength of mind to return to my athletic ways. I didn't count
on the severity of my backache nor the added damage that must have been
caused to my back lugging all this weight around over the years. When he
asked his assistant to find out who did bariatric surgery in Canada, I
really froze in my tracks. A failed business contract, the commencement
of accounting studies towards a different career and a home relocation
found me in the offices of a new personal care provider. I discussed my
weight with my new doctor and told him what the previous one had
suggested. This time, I assured him, I wanted it too.
That
was two years ago. The wheels of the Canadian public healthcare system
grind slowly. It took about a year to first see one of only three
bariatric surgeons serving our entire province. At the time, the
wait-list to have surgery here for free was around 3 years. I had two
visits with the surgeon spaced six months apart. In that time, the only
hospital where bariatric surgery is performed in our province announced a
60% cut in the budget for the procedure. This further clogged the
bottleneck and increased the wait-time for surgery to 5 years.
I
couldn't afford to self-pay abroad so explored a not-so-well-published
option of out-of-country-funding by our provincial health insurance for
elective surgery. When I was approved, it felt like I had won the
lottery (indeed I may have in terms of longevity). In fact, the first
time I knew the outcome of my application was when I checked my
voice-mail one evening early in November. There was a cheerful message
from Virginia Mason Medical Center in Seattle regarding a referral.
There was no mistaking then that funding had been approved.
Until
a few weeks ago, I was working nights as a security guard whilst
studying accounting through night classes. I kept playing phone tag with
the administrator of the bariatric office until we eventually connected
and set the ball in motion. Since her first voice-mail on Nov 5, I have
been scheduled for surgery on Dec 23 and am seeing my new, American
surgeon for the first time this coming Monday. The pace of things South
of the 49th parallel is at lightning speed by comparison.
I
had two final exams to distract me these past weeks but can now fully
concentrate on preparing for surgery. I'm an irreligious, sceptical
46-year-old so there's some irony in getting a gift of sorts (we
actually pay a sizable premium for health insurance so it's a right
rather than privilege) when the rest of the Western world is exchanging
trinkets and electronic gadgets in State-mandated spending sprees. I'm
deliberately trivializing the arbitrary commercialization of the Winter
solstice against what in my case will amount to better health and
possibly, longer life.
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19 December 2010
19 December 2010
With
not a little trepidation, I pointed the car South and put pedal to the
metal. It must have been the fatigue after a late night at Mark and
Stacey's party rather than a hangover--I was careful not to overdo the
Jägermeister and spiked punch--that made me want to get this journey
over with. Testing a new pair of progressive lens glasses from behind
the wheel for the first time, I made a beeline to Dave's house in
Tacoma where I would be spending the night. Everything seemed a little
clearer on the drive down.
I
have known Dave since I first started playing squash at the YMCA in the
centre of Tacoma, WA. In 1990, I was wrapping up the penultimate year
of my economics degree and Dave was a high-risk options broker. A
substitute for one of two older brothers that I never had, Dave was a
mentor and friend. In fact, it was on a trip that Dave sponsored to a
squash tournament in Vancouver that sparked my love for the city that my
wife and I now make our home.
Cut
back to a year earlier when I met fellow ex-South African, Claude where
we played squash at the same club in Los Angeles. Claude had had his
full of LA and when he heard that I was heading to the Pacific Northwest
to complete my studies, he and his wife, Lynelle contemplated selling
up and following suite. After a few visits to me in Tacoma, both were
sold on the idea and moved. From being an only son with two sisters, I
was privileged to now have two brothers in the same town.
Needless
to say, over the years, both these guys have watched anxiously as my
weight practically doubled after my return to South Africa and
subsequent emigration to Canada. They were always classy enough not to
chide me but often asked how my squash was, as if to prod and propel me
back onto the courts.
Dave's
wife, Rasha had prepared a magnificent prawn dinner with pasta which we
washed down with red wine followed by sliced kiwi fruit and pumpkin
pie. Over several rounds of backgammon, we dissected and analysed the
American economy. It was indeed a last supper of sorts. Having solved
the problems of the world, we all turned in for the night. The next
morning would be quite eventful for me. Dave had pancakes on the stove
and heaps of bacon sizzling in a pan. The last breakfast, he said. With a
mouthful of pork, I told him this felt like taking a drink before
meeting one's parole officer.
When
Dr. Jeffrey Hunter walked into the room with a beaming smile and firm
handshake, I knew immediately that my surgery next Thursday would be in
safe hands. During the 20-minute drive from Dave's house to the
hospital, I didn't once doubt my decision to pursue the surgical path to
wellness. This surgeon and his staff reinforced it. Everything at my
first visit to the man who will next week be removing the greater
curvature of my stomach, representing 85% of it's current size, went
swimmingly. My visit included a lengthy stint with the nutritionist who
walked me through the diet plan that will be the mantra that I chant
over the next several weeks.
With
my sights set firmly on protein shakes and lean cuts of meat with heaps
of spinach leaves, I made tracks to Claude's in the hamlet of
Woodinville a few kilometers Northeast of Seattle. Claude owns a house
with a veritable park for a backyard complete with flowing stream all
nestled amongst giant douglas firs. I love going there. With the clock
ticking to get back to Canada to fetch Shamin at work, Claude and I
barely had time to do a deep analysis of what Obama and the Democrats
are doing to fix the problems of America before we spirited ourselves
off to a Mexican restaurant. The last lunch, Claude called it. Faced
with a two-hour drive, I declined any liquid nourishment and stuck to a
black bean soup plus a quarter of Claude's chicken enchilada.
Not
only had my brothers treated me to some pretty amazing meals, but
Shamin had ideas of her own when I fetched her. We made tracks to our
favourite sushi spot in our hometown of White Rock and indulged as only
convicts facing the gallows can, with the maki 18-piece combo, miso
soup, agadashi tofu and mugs of green tea. Shamin said that this was our
last supper.
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6 January 2011
It's 11h30 and two weeks to the hour that I was being wheeled into surgery. What Shamin expected to be a 45-minute routine procedure like a visit to the dentist, an impression I had created, turned out to be a 2-hr major operation that resulted in yanking out 80% of my stomach. Mostly the upper curvature, the stretchy part of the stomach, was removed leaving me with a pouch about 4-6 oz in volume, the size of a small banana or 2/3 of a cup. This new pouch does not stretch.
I chose this particular version of bariatric surgery to avoid some of the malabsorptive issues related to Roux n Y (a.k.a. RnY or gastric bypass), the current gold standard of WLS, and to be able to take anti-inflammatories as and when I become lighter on my feet and engage in more sport.
The sleeve gastrectomy went quite well and there were no complications. My first night post-surgery though, was rough. I was in a lot of pain from the surgery and kept burping which caused quite a bit of discomfort. The staff at Virginia Mason Medical Center in Seattle is absolutely top-drawer and took excellent care of me.
The next day, the barium drink during the x-ray in order to check for leaks and make sure that fluid was passing through the stomach via. the pyloric valve into the small intestine, ranks amongst the most vile stuff I've ever drunk. It was all I could do to keep from throwing up. Isn't it remarkable how attuned you become to everyone's expressions when you're a patient? Why is the nurse frowning at my chart and how come the doctor is gesturing so animatedly? When the surgeon and the radiation team relaxed as the barium made it's way successfully through my tract, I also breathed a sigh of relief. Later, one of the nurses explained to me that they medicate the stomach to near-lifelessness in order to operate on it, then it becomes of paramount importance to revive it as soon as possible the next day. So they're constantly listening through the stethoscope for signs of activity. You'll never see from polite company or one's wife quite the kind of elation when you tell them that you've farted than erupts from the nursing staff when you inform them after bariatric surgery that you've passed gas. In fact, after your first bowel movement if indeed you have one, they're ready to hand you a trophy and send you home. Two days after surgery on the 2010th birthday of our lord Jesus, I was desperate for a shower. After I accidentally yanked out my glucose supply line, they deemed me fit to be discharged.
Shamin helped me get my things back to the hotel room. No sooner did we set them down than we were in the car heading to Kirkland for lunch. Shamin drove. On the menu was medium rare sirloin, baked potato, crumbed shrimp and salad, with cheescake and chocolate for dessert. I pigged out on soup broth and sugar-free jelly. Wine flowed liberally so two days after surgery, high on oxycodon, it fell to me to drive back to the hotel. In fact, the next day, I took the wheel to blaze a trail out of Seattle and made it half-way back to Canada before succumbing to fatigue.
Things went a little pear-shaped the next morning, my first back in Canada. I chewed on my gummy bear multivitamin, followed by some flavoured water with a crushed metformin. Later, a bit of cream of wheat fortified with whey protein isolate seemed to be competing for limited space. In the middle of a Skype chat with my sister in South Africa, the cream of wheat wanted out and I hurled for the first time. How on earth am I going to get in 70 - 100 g of protein with this little stomach volume?
The summary of my food intake is protein and more protein, very, very little carbohydrates and almost no fats and sugars. I'm also on a cocktail of multivitamins, iron, B12 and calcium supplements to compensate for the limitations of the new diet. Modern multivitamins and supplements are chewable and tasty so, incorporated as snacks, you don't even feel like being medicated.
Combating dehydration is now a way of life. I have to walk around with a bottle of water and sip constantly between meals. As it is early days yet and I'm only now graduating to pureed foods, I have to space out my spoonfuls in order to avoid an extreme sensation of fullness and subsequent pain. Recently, I was able to finish a whole cup of veggie soup over two hours whilst watching a movie.
It now takes about 4-or-5 teaspoons of food to achieve a feeling of fullnes whereupon I start to belch. Any more hurts like hell. One more bite is like trying to stuff one more marble into an already full jar. There’s no give whatsoever. The greater curvature of the stomach is where your stretchy material resides. Mine has been removed and sealed shut with three lines of staples. My very compact stomach pouch has a valve on both it's entrance from the oesophagus and exit into the small intestine, respectively. Therefore, it is a closed container under pressure, implying no more fizzy drinks that could release carbon dioxide and cause immense discomfort. Adios beer, hello wine, vodka and whiskey on the rocks.
I’m currently paying lip service to six meals a day; I can barely manage one, and two protein shakes. Yesterday morning, I bravely scrambled a single egg with a tiny amount of spinach and a sliver of cheese. I got through half of it, then ate the rest several hours later. Interspersed between meals, I’m supposed to sip about 2 litres of water. What a bloody joke! I’m averaging about a litre. The only things I’m making sure I consume are the multivitamins, iron supplement and chewable calcium sweets. They’re like dessert. Oh, I do get to enjoy as much sugar-free jelly that I can handle and I never seem to tire of it.
Within a few weeks, there will be little external sign that I had any surgery. As the whole affair was done laparoscopically, I’m left with 5 little scars on my belly that is already mostly healed. Once fully-healed, I'm heading to the swimming pool to start exercising. I hate walking at the best of times.
Oh yes, the million dollar question; I first met the surgeon on 13 Dec and went on a pre-op diet for 10 days. I lost 10 lbs (4.5 kg) in that time. In the 24 days since, I have shed a total of 36 lbs (16.3 kg). I have been told by my dietician that it is not unrealistic to expect to shed around 75% of my excess weight over the next six months. When I started out, I was 351 lbs (160 kg). I'm now 315 lbs (143 kg). The next milestone is to break the 300 lb mark, a weight I haven't been in over a decade.
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13 January 2011
If there's one thing that I've discovered post-op, it is precisely that old habits can die easily and very, very quickly at that. There is nothing quite as drastic as once being able to virtually inhale a three-egg omelette with cheese, green pepper, mushroom and bacon and, sausage and hash browns on the side, followed by a cup of coffee, to hoping-upon-hope that the single boiled egg you're just about to tackle for breakfast won't fill you after just three bites. Such is the drastic nature of this procedure.
The sense of fullness isn't the same satisfactory one as before. Rather, it takes you by surprise. One minute you're savouring the taste of just your third spoonful, then you feel a slight burp and know you ought to stop right there-and-then. But being a man, you bravely go for the fourth and the pain hits from nowhere. The tightness in your stomach is indescribable. It feels like your chest is going to explode and you wonder why-oh-why you were ever so greedy as to dare to eat a whole fourth spoonful. This surgery is like having an electric shock device around your ankle when you're on parole. Any deviance in the eating department and you're very quickly zapped into line.
All went well the first two weeks post-op with a little heartburn to contend with. These past few days, I thought I was going to meet an untimely demise from acid reflux. How embarrassing is that? Even in my drinking heyday, I had never felt anything quite like this. Back in the day, you puked, you rinsed, you slept (not necessarily in that order) then got up, nursed the hangover and picked up where you left off. This time, the reflux was a whole new kettle of fish. Anything short of standing bolt upright had acid gurgling at the back of my throat. Sleep was almost impossible. Yesterday, I finally collected from the pharmacist in capsule form a potent antacid which has proven to be the elixir for which I had been waiting. Last night for the first time in days, I got a full night's sleep and am feeling very refreshed finally.
The surgery is doing its work. I have shed 17 kg in 30 days. The last three days, there's been a slight lull from my average loss of a pound-a-day. It might be because I have been struggling to get in the dietitian's requirement of 70 - 100 g of protein per day. A single egg has just 8 g of protein. Given the minimal volume of my stomach of around 130 ml, it would be impossible to meet the protein requirement from food consumption, the equivalent of 9 - 12 eggs. The solution to the dilemma is whey protein isolate shakes that body builders use. I mix it with something called enriched milk (skim milk fortified with powdered milk for the extra protein) and knock them back in 15 g slugs. Even that requires about 5 drinks a day. As tasty as vanilla and chocolate flavour is, after a while you just want to gag. Interspersed in all this protein intake is a requirement to rehydrate constantly. Water, jelly, electrolyte drinks and more water, 2 litres minimum of the stuff per day, is what is required. There just isn't enough room for it all.
To combat the potential for malnutrition, for the rest of my life I have to take a multivitamin and iron supplement with breakfast, then three doses of calcium supplements the rest of the day. They're all in chewable form so it feels like snacking on sweets for dessert. Also, once-a-month, I have to get a vitamin B-12 injection.
On the plus side, I've kicked the type II diabetes that required two metformin pills a day. Which would one rather have, is the big question. There's no telling what the consequences of diabetes is, ranging anywhere from gangrene and the amputation of a foot to a stroke from high blood pressure. Yikes! By far, the nuances of bariatric surgery are a nuisance I'd rather have.
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13 February 2011
It has been so long ago that I was last under 300 lbs, I have kind of forgotten which era of my life that was. There is a selection of still-new clothing in my closet that is too tight for me so I obviously bought them when I was thinner than I am now. I have to try to recall when I bought--and almost immediately outgrew--them. Did I buy them in Canada at my favourite fashion store, Walmart, or in South Africa at my similarly popular source of bulk thread, Makro? If memory serves me right, I don't think I ever felt this 'trim' since arriving in Canada in 2004, and I certainly had one hell of a paunch during my wedding in 2000, so we may well be looking at the late 90's.
I would be lying if I didn't admit that my latest stall was getting the psychological better of me. I mean, here I am post-major-surgical-procedure to lose weight, barely able to imbibe half-a-cup of food per meal that fills me for hours, and getting nowhere near the required amount of protein, only to hover tantalizingly above 300 lbs for the last few weeks. Like everyone, I went dramatically from 351 lbs pre-op to around 305 lbs. The expectation that this kind of rate would be sustainable is rich to say the least, yet it becomes a pipe-dream for the morbidly obese. Luckily, I didn't go into the kind of depression that resulted in starvation to achieve this milestone. I stuck with the programme, sucked down protein shakes to make up the deficit, ate the soy sausages and even relished the chocolate-coated protein bars that 10 years ago would have made me gag.
My exercise regimen has included some very basic exercises because I still feel a little too weak to go for lengthy walks, let alone jog or play squash. I timed my exercise routine. It took me exactly 13 minutes (12h00 to 12h13) to do 20 reps each of the following:
- squats (feet shoulder-width apart, only squatted as far as was comfortable)
- crunches (lying on back, hands clasped behind head, tried bringing up head to knees, could barely get my head off the ground)
- leg lifts (lying on back, palms face down under buttocks, just lift feet off ground)
- cheat pushups (on my knees instead of the traditional way)
- left bicep curl (using a shopping bag filled with our new duvet as a weight)
- right bicep curl (ditto)
- left tricep extension (ditto)
- right tricep extension (ditto)
- bench press (lay on bed and pushed the 'weight' towards the ceiling)
- shoulder press (shopping bag as weight, standing legs slightly apart, raised 'weight' to ceiling)
- left side bends (standing feet slightly apart, hands clasped behind head, lean twice to the left, then back upright, will use make-shift weight in future)
- right side bends
Which brings me to the topic of constipation. What is up with that? I guess the minimal food intake is as much to blame as the lack of hydration. I have struggled to drink the suggested amount of water and am hoping that the protein shakes count as both nutrition and fluids. No doubt, the body tries to absorb as much of whatever little it is now getting and often tempers the metabolism in anticipation of famine rather than feast. So, as much as toilet humour provides endless hours of mirth in slapstick comedy, it is a serious topic when it comes to diet and weight-loss. Not having a bowel movement for two-to-three days is discomforting to say the least. The medical team knows about this and is ready to prescribe suitable 'stool softeners'. Instead, I've re-discovered prune juice.
"What does all this have to do with the scale," one wonders? Well, when you're desperate to reach certain weight milestones, like lose 50 lbs or 100 lbs, or achieve a specific weight, 300 lbs in my case, you start to become very particular about what exactly it is that you're weighing. In my mind, any food or liquid in my intestine is not part of my body weight, hence has to be expunged before the weigh-in. How ridiculous is it that I was careful not to swallow any water whilst brushing my teeth in the morning? Sometimes, the mind concocts ideas that descend rapidly from the sublime to ridiculous.
To cut to the chase, after yet another morning leaving the toilet tissue undisturbed, I stepped trepidly onto the scale and weighed in at 298.4 lbs. The sensation was overwhelming. For all intents and purposes at 05h30 on a Sunday morning, I ought still to have been in bed. But an early night and a full bladder resulted in an early morning and my usual interlude with the scale. My wife was still fast asleep so it took enormous restraint to squelch my desire to yelp.
With an enormous weight off my shoulders, no pun intended, I have a spring in my step today. At last it feels like the programme is on track again. I have regained all of the confidence in the surgical procedure that I had going into it. The overwehlming evidence of its effectiveness just from the experiences of its alumni should have been convincing enough. However, it still requires one's own adventure with it to fully come to terms with its benefits. I look forward now to tackling the next 100 lbs.
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Tuesday, 22 March 2011
I love numbers because, unless manipulated by accountants and politicians, they tend not to lie (a bold statement from a would-be-accountant)
When I first started exploring bariatric surgery as a solution to my morbid obesity, one of its wilder claims that attracted me to it was that a person could lose 75% of his excess weight within 6 months. At the time, I was 351 lb (160 kg) and felt that I needed to get down to 220 lb (100 kg). In total, that would imply a loss of 131 lb (60 kg). 3/4 of that is 98 lb (45 kg). Could I really lose 45 kg in 6 months, in other words, 7.5 kg per month? It seemed too good to be true. A 45 kg loss in weight would put me at 115 kg, a weight at which I once used to play a half-way decent game of league-level squash. As I read more about the effectiveness of the surgery, I became giddy in anticipation of becoming a veritable gazelle within just six months.
At the 3 month mark since my vertical sleeve gastrectomy, I weigh 280.4 lb (127.5 kg). I have lost a whopping 71 lb (32 kg). This implies a rate of loss of just over 22 lb (10 kg) per month. If this is sustainable for another three months, I'm on track to blitz right past the projected 6-month, 45 kg loss. It even tickles a tantalizing fantasy of shedding the entire 60 kg within 6 months. Reality dictates otherwise, however, because the initial rate of loss post-op is staggeringly high versus what it's become, hence a much larger drop in weight immediately post-op. Still, a gander at my weight graph in the health tracker shows a fairly straight line with a constant slope.
With some hesitation, I'm tempted to adjust downward my overall weight-loss expectation to around 187 lb (85 kg). Before my op, I asked the surgeon whether this was feasible and he said it certainly was. At the time I didn't believe him but now I'm not so sure.
I remember very well when I was last 85 kg. It was in 1991 when I was at my fittest ever and about to play in the B Divison at the US Open Squash Tournament in Portland, OR. In the second round, I lost a 5-game marathon to the top-seed and shed 8 lbs of water weight for my effort. Back then, I was a fairly well-oiled machine and knew intimately the effects of food on my body. A diet on a student budget, comprising instant noodles with broccoli, tuna, pinto beans and chicken kept me in trim. Toasted sandwiches with hotdogs, cheese and mayo inevitably translated into an upward tick of the scale.
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Sunday, 27 March 2011
More on the numbers, this time regarding my recent lab tests. In summary, they're all good and a reversal of where they've been the past decade. I've moved into the normal range in just about all the important categories.
Even going back 10 years to my mid-30's, my blood sugar levels--as measured by Hemoglobin A1C and Fasting Glucose--were always a couple of points above normal though nothing worth calling out the cavalry for. Even the Urine Albumin or ACR (Albumin/Creatinine Ratio) which is a gage of the level of functioning of the kidneys, was just above normal. When my personal care physician (PCP) a.k.a. family doctor diagnosed me with Type II Diabetes, it was almost tongue-in-cheek. He said that each measure, on its own, was not worth a diagnosis of diabetes but, together, ooh, aah, maybe, why not?
"Diabetes! Take a couple of Metformin daily and see me again in three months." At the time, it sounded more like he was obliged for ethical and liability reasons to come to a conclusion of diabetes rather than any concrete proof of the disease.
Thus began three-monthly visits to the labs to test these two variables, as well as an annual visit to the optometrist to photograph the back of my eye. This was to see if excess blood sugar was causing the rupture of capillaries back there. The eyesight of diabetics deteriorates for this reason rather than from the normal decline around middle-age from retinal mal-function.
Another ominous feature of my blood was elevated pressure and high levels of cholesterol, especially the abnormally high ratio of total cholesterol to bad (LDL) cholesterol. Neither was ever high-enough to warrant medication but required a change in diet that favoured fish and chicken over red meat and, an increase in leafy greens. My dietary approach was to ignore the advice.
The PCP was vindicated in his diagnosis of diabetes. While the ocular capillaries were always intact, the blood sugar levels were not. I initially avoided the Metformin like the plague and it showed in the tests. As soon as I started taking them, the numbers came down though never into the normal range. It was plainly obvious that my body was not processing sugars normally. In fact, the endocrinologist to which my first bariatric surgeon had referred me emphatically increased my Metformin dosage from two- to three-a-day. There must have been something more compelling in the numbers that he saw leaving me feeling a little disingenuous for doubting my PCP.
It's a coincidence that my three-monthly lab date was just before my VSG. It meant that I had fresh numbers for comparison and could attribute any changes in my digits directly to both the surgery and post-op dietary changes. Prior to those pre-op labs, I had been on a high-protein, leafy-green diet to shed some weight, get my body into ketosis mode and, reduce the size of the liver and rid it of fats and sugars. Despite that, my numbers were still off the charts.
A tabular summary of the results are:
Normal Early Immediately Post-op
Range Dec '10 Pre-op Mar 2011
Glucose 3.6-5.5 mmol/l 7 (high) 6.4 (high) 5.3 (normal)
A1C 4.8-6.2% 6.8 (high) 6.6 (high) 6.0 (normal)
ACR < 2.0 2.1 (high) 0.8 (normal)
Chol. 2.0-5.2 mmol/l 4.6 (normal)
LDL 1.5-3.4 mmol/l 3.3 (normal)
HDL >0.9 mmol/l 0.9 (low)
Chol/HDL <5.0 5.1 (high)
Triglyc. <2.3 mmol/l 0.9 (normal)
BP 120/80 120/80 (normal)
I'm reasonably pleased with the results though everything could come down a notch, especially the cholesterol level.
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Tuesday, 24 May 2011
Almost 21 weeks since surgery, I find myself still picking from the hors d'oeuvres or soup section of the menu while my short, slightly-built wife has her pick of the entrees. It's an ironic reversal that is actually working quite well for our appetites and budget. For the wait staff, however, it's enormously confusing. The order taker has to first scowl at me for declining anything to drink, not even water, then frown harder at my minimal order. I don't always feel that it's necessary for me to explain why I cannot drink 30 minutes before a meal. There is usually a progression from amusement to bewilderment as the paltriness of the order registers. "Are you sure that would be all?" I get asked whilst being physically sized up against my order. As he turns to leave, you can almost read the, "What a cheapskate!" facial expression. Initially it might be understandable that I'm too cheap to order a beer or glass of wine. But for such a big fellow to cut costs with just the cup (not even the main-course-sized alternative) of clam chowder while the lady chooses the lamb shank with potatoes and gravy is just wrong. It doesn't end there. If a different person actually brings the meal to the table from the kitchen, there is the almost mandatory politically correct query about which meal is for whom. To avoid any question of ridicule as it's obvious that the mountainous lamb shank is for the big chap and the lady is watching her figure, I find the main course heading my way. At least the order taker had time to digest the information; this poor character shakes his head almost as if we the customer got our own order wrong.
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Thursday, 26 May 2011
The converse of the non-surgical victory (NSV), something with which bariatric post-ops become quite familiar even only a few months post-op, has to be the non-surgical disappointment (NSD). In the wake of the breakneck speed at which we lose weight, start fitting into old clothes, get compliments from people and become more active, we run the danger of expecting too much too soon. Coupled with a stall at the 22-week mark, I experienced my first NSD when my scuba wetsuit proved two inches too tight. If you know these infernal things, the zipper is at the back, like those embarrassing surgical gowns. I guess if it had been wet which is when it is more stretchy, I might have been able to squeeze it shut until my blood stopped flowing. So rather than pass out, I go it the heck off and resolved to be patient a few more weeks.
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Thursday, 23 June 2011
Today is a weight-loss surgery (WLS) milestone for me. Exactly 6 months ago to the hour, I was in my ward at the Virginia Mason Medical Center in Seattle, WA recovering from my vertical sleeve gastrectomy earlier that morning. The six-month post-op period is significant in the WLS context because it is considered the 'honeymoon' period during which the most rapid rate of loss occurs, as much as 75% of the total weight needed to be reduced. Of the 70 kg (154 lb) that I needed to shed at surgery, I have kissed 49% away so my experience has been closer to average. I'm half-way there with the rest expected to take another year to come off. As a matter of fact, I reached my current weight about a month ago so my honeymoon may have ended prematurely. I seem to have entered the dreaded post honeymoon stall that is experienced by many WLS recipients.
This is not the end of the loss because my caloric intake is still miniscule. It may be the body's response to what is essentially starvation (in relative terms, of course) in which it hangs on to whatever it is fed. That's all well-and-good and I'm not panicking. I continue to get full on tiny portions. I have pushed the envelope on a few occasions with one bite too many, and paid the price in the form of extreme pain and discomfort. It's a vast change in psyche compared to the heyday of binging with a stretchable stomach. That was when I could eat through any sensation of fullness whereas now I'm alert to any signal of fullness. Around three bites into a meal, I start to notice a slight churning in my stomach accompanied often by a tiny belch. Of course, this sensation is commonplace to anyone who hasn't had surgery. It is only unusual in my case because it occurs so much earlier. At that point, most normal people would be exlaiming that they have left just enough place for dessert. I, on the other hand am good for just one more bite which, if I reserved for dessert, would be depriving myself of a crucial opportunity to ingest protein. Most of this description in any event is pertinent to meals of dense protein comprising fish, chicken, red meat or soya. A small bag of popcorn goes a longer way in which I have to allocate an entire segment of about 3 hours to indulge.
Cynics may be critical of the fear-driven disincentive to eat and they would be right. You should not be averse to food and certainly not terrified of getting full. That kind of mentality coupled with societal pressure to conform aesthetically spawns a whole range of eating disorders that include bulimia and anorexia. Overweight people such as I are often like petulant children who want our cake and want to eat it. The surgery is just the wooden spoon of discipline. So wish me luck as I tackle the next 50% over 12 months.
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Sunday, 26 June 2011
The irony of getting a question in a letter from someone named Ruth was enough to send me into paroxysms of laughter. She's not Dr. Ruth, just my friend's daughter whom I've known since the mid-80's. She wrote: "Wow, Neeven, you look so great! You must feel really good too! How has your weight loss changed your life? Ruth". To this I replied simply (yeah, right!),
"Dear Ruth
Thanks so much for the compliment. Indeed I feel good courtesy of numerous changes to my life, both psychological and physical. The most important of these has been a more optimistic outlook despite bleak circumstances. Just being able to leap out of bed with ten times more energy rather than dragging myself from under the covers is testimony to that. My mobility is vastly improved. I am walking everywhere now, back on the tennis courts with a vengeance and, after a few more lost pounds, even contemplating a squash membership. I played tennis this morning against a chap who 24 years ago used to play competitively. He tired after the first set while I was still good to go. It was a big boost to my confidence that my fitness has improved so much. I was chasing balls that I used to let fly past and taking the extra steps to better position myself without the fear of exhaustion. It is easier to get in-and-out of cars. I no longer have to shuffle in the aisles between restaurant tables and risk knocking over some poor diner’s beverage. I can see my shoelaces again and even bend down to tie them without needing a respirator afterward. From opting for the stairs, to sharing a bench with someone, to stepping aside in an elevator to allow one more person in, I’m considerably more self-confident.
It’s taking some getting used to the attention I’m receiving from friends who are noticing the difference. Those who have been with me from the beginning have continued to be tremendously encouraging and supportive. Others who see me after a very long interval struggle with the awkwardness of commenting on my physique. They want to gush at how ‘good’ I now look but suddenly hesitate at the implied suggestion that I used to be a slob. Yesterday, at Shamin’s company’s annual Summer picnic, most of her colleagues had last seen me mere weeks before I had the surgery, squeezed into my suit and wolfing down chow at the Christmas function. This time, many targeted me for conversation to inquire how I felt, what I was eating and whether I had struggled. I’ve never been coy about talking about the surgery (and neither is Shamin at work, it appears) so I was flattered that they wanted to chat and heap praise on me. I soaked it all up Stephen Colbert style, like a seasoned celebrity.
I made the mistake of not logging my body-dimensions pre-op but I guess my loosening clothing is measure-enough of what used to be. I say that tenuously because a lot of what is now too big for me, was actually once very tight for me. I used to bulge out of my jeans so my girth must have been a lot larger than the diameter of the trousers. Near the end, I couldn’t button my suit coat and the ski jacket that I wore during my Dec. ’09 visit to New York shows evidence of strain on more than a few seams. From shirt collars that used to choke me, to button holes that protested, to belts that didn’t even fit but now need new holes, there’s no shortage of evidence of my shrinkage in my wardrobe. Heck, even my feet slip into my shoes more comfortably.
By far the biggest compliment I get is from Shamin who is highly critical of my aversion to saving cash in lieu of splurging on a few pants, shirts and jackets that actually fit. I sometimes catch her giggling at how much of a clown I look in jeans with a crotch that hangs too low, or a favorite sweater that now reveals my clavicle. My logic is that I’m just a few inches from fitting into four brand new trousers that I outgrew the instant I bought them years ago. The reality is that as good as it has been, I’m only half-way down this journey with another 80 lb of loss still to navigate. I’m going to get much smaller (how many guys actually say that with gusto?). It will now fall off slower but fall it will, so I’m biding my time before incurring the expense. We’re saving in other ways. I select from the appetizer section of restaurant menus and my share of the consumption of household groceries is negligible. That is partially offset by the introduction of pricey protein shakes, protein bars and a cocktail of nutritional supplements to the grocery list though there’s a net saving against breakfast cereal, candy, soda and potato chips.
My life was worsened for the sudden development of GERD post-op which persists intermittently but guaranteed to flare up by my favorite, curries. We used to prepare it spicily-enough to remove paint from a ship’s hull, whereas I can barely handle black pepper on my 4 oz steak now. I have become partial to fat-free, white-sauced foods rather than their tomato-based alternatives and, in general, just a whole lot more finicky about meals. I approach every meal with a certain trepidation. This selective eating is a two-edged sword that deprives me of the tastes I once savored, but further promotes my weight-loss.
Now do you regret asking a simple question?
Your friend
Neeven"
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Wednesday, 17 August 2011
Stalls are the bane of those of us who underwent drastic surgery to overcome what was a losing battle of the bulge. It's tough enough reaching the conclusion that the surgical option, which is tantamount to draconian discipline, is the final option. Then when the weight doesn't continue to drop at a fantastic rate, forget that you're now a fraction of your pre-op size but you begin to second-guess the wisdom of having gone under the knife.
When I dropped an incredible 41 kg (91 lb) in a little over 5 months to get to 118 kg, I grinned until my dimples made a reappearance. I relished just being able to reach my shoelaces, let alone tying them without getting an abdominal cramp. Yet by the 7-month mark, I was oscillating between 119 kg and 122 kg terrified that I had figured out how to eat 'around' my gastric restriction. Adding a few carbs, ice cream and a little grazing can easily outwit the smallest stomach. Well, stomachs don't think, brains do. Clearly, an element of discipline is required. A small stomach is only a tool.
Perhaps it is a character flaw when no half-measures govern behaviour. In obese people, it is counterproductive and deadly. You eat too much, drink too much, abandon exercise, drive to places within walking distance and then yo-yo diet to a point of sheer malnutrition. A compulsive disorder can, however be a useful trait. Nobody faults workaholics who get rich or, as I've discovered, gym rats who get in shape.
They say you should never overdo anything. When it comes to exercise, I say challenge the myth. What's the downside? Getting too fit? Becoming too muscular? That's like saying studying too hard will make you too smart. When did that become a problem for society? Yes you can tear a hamstring from running one step too many, but you're more likely to have a pulmonary embolism from one more French fry than one more situp.
That was the thinking that percolated in my mind during my two months of stalled weightloss, and which propelled me to my next obsession--the gym. I always knew I wanted to train again. After all, back in the early 90's, I didn't rank in the top-10 of A-level Seattle squash players just by watching Jahangir Khan on TV (besides, watching squash on TV is only slightly more exciting than watching paint dry). There's a certain release of endorphins when you're exercising that overcomes pain and gives you the same high as morphine. No surprise there because endorphins are actually endogenous morphine, meaning morphine created within the body. Runner's high is not a myth. Just like a morphine addict, runners develop a resistance to their own endorphins and have to run harder and farther to release enough to get the same high. I wanted that sensation again, a near-ecstasy when the muscles are sapped, the brain is focused and the lungs are screaming for air.
At long last, the scale jumped down in familiar fashion this morning. One day I was 119 kg (262 lb) and today, 116.7 kg (256.8 lb). Alarmingly, that's just 1.7 kg away from where I promised myself I would get back on a squash court. Promises are made to be broken and this is one I will consciously break. I still feel too heavy to be jerking my aching knees in every direction. Tennis isn't nearly as brutal on the joints so I'll stick to that for now. By far the contributor to the new low on the scale is the gym and pool effort. I haven't changed much as far as the diet goes. Six days-a-week in the gym can't go unnoticed and it's manifesting itself in the only measure I know, the bathroom scale.
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Saturday, 20 August 2011
I made yesterday my day off from the gym because circumstances dictated. My exercise schedule required me to do cardiovascular work which I usually accomplish in the pool. The call centre company where I have just started training gave those of us without technical issues the day off. It was an opportunity to play tennis in the morning in the tranquil setting of Vancouver's Queen Elizabeth Park, one of my favourite destinations in this town. After playing dreadfully, I decided to drag myself to the pool but was intercepted by my friend, Ron Francis' welcome invitation to pop by. An afternoon in the hottub ensued that included imbibing liberally of four Guinness. In the wake of a KFC dinner with Shamin, any ambitions of swimming were shot prompting me to write-off Friday instead of today, Saturday as my exercise leisure day.
I was expecting the liquid carb load and decadent dinner to conspire to thwart my best efforts of the week earlier. That was not the case at all. Five solid days of exercise (I'm not counting yesterday's tennis as exercise given how badly I played) easily overcame one day of decadence culminating in another dip on the scale. Hooray for a further one pound loss bringing me to my new low since surgery of 255.8 lb (116.3 kg). The total loss for the week was 6.2 lb (2.8 kg).
The notion of decadence post-bariatric surgery has a different meaning entirely. Four Guinness, a small piece of deep-fried battered chicken thigh and two forks of French fries used to be a snack, the precursor to decadence whereas now it is decadence personified. In my case, it resulted in a very uncomfortable evening on the couch, hiccuping badly with reverse peristalsis threatening ominously in the background. Whether or not abstinence would have yielded a better weight-loss number for the week is of little relevance. Life must be enjoyed warts-and-all. On occasion, a little indulgence brings out a smile and a sense of relaxation even if accompanied by a few hiccups, no pun intended. In the grand scheme of things, life is good. Today we're going to work on my backhand, hit the pool, then Shakespeare in the park in Langley.
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Wednesday, 14 September 2011
At the half-way mark in my 12-week Body-for-Life exercise regimen, it suddenly occurs to me that, for better-or-worse, the topics of my conversation with everyone has changed. When I was learning to fly, aviation was always up for discussion. In my scuba days, drinking was all we talked about (and occasionally sharks and shipwrecks; you see, I belonged to a drinking club with a diving problem). Since bariatric surgery, it has become inevitable that people ask after my health. It is typical, topical and quite simply a decent thing to do. The transformation in my appearance has also drawn attention from a few people who hadn't seen me since before the op. One of my neighbours whom I bumped into wasn't too sure but no sooner did her dog growl at me than she recognized who I was and we immediately got on with our old favourite topic of...you guessed it, discrediting our building manager and the condo strata committee. In the middle of lamenting our unkempt garden and unsightly litter, she suddenly changed gears with, "Have you lost a lot of weight, I mean, a lot?" It was a spontaneous comment which she instantly realised might be discourteous--you could see the machinery turning-- then relaxed because it is always a compliment to recognise weightloss but an insult to draw attention otherwise. Oh yes, we fat people are touchy; we're sensitive to the point of tears but fiercely defensive about our right to gorge ourself to death.
I dare say I'm culpable and invite the discussion. There are very few people who don't like talking about their successes. That is balanced by equally many who fixate on their failures ad-nauseum as if that would fix them. Have you ever met an adult who craves attention like a child? They tug at your pants looking for an excuse to complain. We're all looking for empathy, I guess. In my case, I couch my self-absoption as philanthropy whilst simultaneously soaking it in. Some good does rub off as I think I've inspired more than a few people with my story, have dispensed advice tirelessly following my experience and even proactively engaged a few people to do something about their health. I never advocate a surgical solution for my obese friends, but those who recognise the need for it and ask me for advice get it in abundance.
Nowadays, my typical topic of discussion with most people is fitness and weightloss. I welcome it and relish when my friends tell me of their achievements. An online scrabble buddy who lives in Thailand and whom I have only chatted with on Skype tells me of his 15 kg loss from running. That is like music to my ears. Another here in Surrey, a recent mom mentions a pants that fits again. You go, girl! My old South African friend now in Australia regales me with tale of his re-discovered squash prowess. It hearkens back to an era when we both played hard but lived decadently. I beam for him. But there's a dark side too. I cringe when my good friend with a string of maladies won't do the obvious thing because, by his own admission, it will forever curtail his submission to the temptations of good (bad?) food and drink.
Of late, I have begun declining invitations to social outings that only involve food consumption. I'll go to them if they don't interfere with my first priority, my ability to train that day. I'm not inflexible and will happily go to the gym late at night if necessary, but then the outing earlier must not be a pub outing that requires alcohol consumption. I'm also starting to become a tad insufferable. If I can't make a social event for whatever reason, like a perfectly normal schedule conflict, I'm quick to propose an alternative that includes a fitness component, like a walk or tennis game. As those alternatives meet resistance because of the fitness component, I'm starting to seek new companionship. Luckily for me, my wife has started hitting the gym too which has given us a whole new topic for discussion.
Another positive spin-off from my time in the gym is befriending new people with a similar interest in longevity. I've discovered that not every gym rat comes from a long line of athletic genes. In fact, many were insecure, tired of being too fat, too scrawny, too ill and too bullied. When I'm in the weightroom, I'm the only geek in there with a folder in which I log my effort level after each set of reps. Of course, there are always one-or-two with a trainer who is doing exactly the same thing for them. I use my notes to prepare for my next session; add 5 more lbs to the second set of 10 because the effort level was a 5 when it should have been a 6. Drop 10 lbs from that last set of 6; overly ambitious admirably but compromising posture and not exercising the relevant muscle; who are you kidding? Curiously, nobody snickers, not even the heavy-necklaced drug dealers-cum-cage-fighters. The other morning, I got to the gym really early, just after 06h00 and discovered that that is when the local teachers work out. There are two schools adjacent the public recreation centre. How convenient. One fellow commented very positively about my following a structured programme. Between sets, we exchanged ideas. Another chap that I met in the sauna is making a long overdue return to the gym. He hasn't hit the weightroom or pool yet but is biding his time before he makes his move. He warmed not only to the dry heat but also to my story and now can't wait to start training again. Guess what? He has three businesses and is looking to change his accountant. At last I'm networking with the fit set.
Anyway, I told you all of that to tell you this...
When my aforementioned buddy from Thailand told me that he had lost 15 kg, he made the fatal mistake of asking how I'm doing. That is never a one-line-answer question for me. I told him:
"I'm sticking to my fitness programme despite a stall in weightloss, all the time consoling myself that the inertia of the scale is proportional to my muscle gain. The absence of noticeable definition on my frame is because any improvement has been masked by loose, flabby skin. That said, even if I lift a cup to my mouth or try to stand up from the couch, I feel myself tensing chest and arm, and leg muscles, respectively that I swear weren't there 6 weeks ago. My wife, gave me a most-welcome, backhanded compliment the other day. I was showing her my new-and-improved bicep and she said, "Oh my gawd, if it's only been 5 weeks and that has happened, you're going to look like that freak Arnold." I had to grin. Of course, she doesn't appreciate the number of years of training and the volume of pills and hypodermic needles that went into those guys' torsos.
"I'm content to be pushing myself to a level about two notches shy of maximum output in order to avoid injury, alternating weight training with laps in the pool six days a week. I also alternate upper and lower body workouts so, over three weight training sessions in any given week I'll have two days working one half and one day the other, then it'll switch around the next week. That affords ample time for the exercised muscles to recuperate while my body overall still benefits from daily exercise.
"I continue to shrink which is gratifying when the scale doesn't flatter me. I'm down to the last of my suits and the last of three 'newish' slacks that I had outgrown no sooner had I bought them years ago. The 6-month honeymoon period post-op of massive weightloss from doing nothing is a distant--albeit, cherished--memory. From now on it's down to hard work like anybody else, sticking to a high-protein diet and just being grateful for a small, non-stretchable stomach that won't accommodate what my eyes perceive it can."
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Saturday, 17 September 2011
Some Fun With The Interpretation of BMI And The Curious Milestones We set
The holy grail of weightloss surgery is reaching goal weight. It is the veritable chalise from which the half-brother of James enjoyed his last swig. The chalise is far shinier if said goal weight is also within the BMI [mass (m) in kilograms divided by the square of height (h) in metres] range that is regarded as normal, namely 20-to-24.9 kilograms per square metre. If you had to translate this into physics terms, it would be the amount of mass your body is applying to a square area (A) the length of whose sides is your height (h).
The area of this square whose sides are equal to your height is
A = h x h
Everyone's body mass index is given by
BMI = m/(h x h)
= m/A
The gravitational force (F), measured in Newtons, of planet Earth on any given body with mass (m) is the product of the mass (m) of that body and the gravitational constant (g), i.e.
F = mg
[g is a constant acceleration of 9.81 m/s-sq whose absolute size is not really relevant to the outcome of the discussion here but I'll include it just to preserve integrity.]
If I divided both sides of this equation by the area of a square (A) the length of whose sides are my height, I would have
F/A = mg/A
I can re-write this as
F/A = (m/A) x g
= 9.81 x (m/A) ... [remember we said g = 9.81]
Earlier, we saw that BMI = m/A so, in reality
F/A = 9.81 x BMI
Now F/A is a well-known physics formula for pressure (P) measured in Pascals (Pa), or, Newtons per square meter. Many of us can relate to the concept of pressure as pounds per square inch, PSI in your car tires.
Since
P = F/A
then
P = 9.81 x BMI
We can re-write this as
BMI = (1/9.81) x P...roughly 1/10 th of P.
What does all this mumbo-jumbo translate into? Well, quite simply, for each and every one of us, our body mass index
is nothing other than about one-tenth of the amount of pressure that our body is exerting on the surface of the earth if our mass was spread out evenly over an area that is defined by our heights. If you doubt me, get your kid to show his physics teacher this write-up.
In a weird way, BMI is almost a measure of fairness. It is as if each of us is allocated a quota of 200 - 249 Pa of pressure to apply to the surface of the earth. If we take one-tenth of that to make the math easy and rename it the body mass index, we get to 20-to-24.9 as the yardstick of fairness. However, if you're muscular, well done, you may apply more pressure. If you're fatter, you're putting too much pressure on earth. If you're taller, it's not your fault so you are allocated more area therefore you can carry more weight, but your overall allocation is the same as everyone else's. Dwarf bodybuilders have it the best.
In the grand scheme of things, whatever difference does it make if my BMI is 45 or 70? Either way I'm sickly obese and need surgery to help me lose weight. I'm sure someone somewhere has done a comparison of this strange pressure measurement that we all know fondly as BMI to various health issues and correlated it to all sorts of maladies like diabetes, hypertension, etc. In my humble opinion, BMI is merely a guideline, a point of departure which should be used in conjunction with other measures of health, like body-fat content, exercising pulse rate and resting blood pressure to determine fitness.
Someone my height of 1.78 m would have to weigh between 63.4 kg and 78.9 kg (139.4 lb - 173.6 lb) to be considered of normal weight by the current BMI yardstick. To put that into personal historical perspective, I weighed 64 kg at 18 in my final year of high school when I couldn't have been much shorter than I am now. Back then, I was Sportsman Of The Year, had decent body definition with very little fat, easily ran 6 km to warm up before 2 hrs of tennis, opened the bowling for my cricket team and could bench more than my body weight. The point is, I was neither scrawny nor unhealthy. In subsequent years as I became a man, I carried 10 more kilograms without appearing particularly overweight, probably looking more muscular if anything. In fact, by 1991 when I was 27 and probably the fittest I've ever been, I weighed 85 kg (187 lb) when I lost an epic 90-minute encounter at the US Squash Nationals in Portland, OR. At the start of the game, my BMI was 26.8 yet nobody in his right mind would have labelled me overweight. As a matter of fact, I shed 3.6 kg (8 lb) of water weight in that game which reduced my post-match BMI to 25.7, just a notch into the 'overweight' category. As you can see, BMI is not a stone-etched guideline, if you'll excuse another metaphor from Hebrew mythology. Nor is it the last word about fitness. A healthy and fit bodybuilder would have a BMI that is way off the charts, whilst a wheezing chain-smoker could have a BMI in the normal range.
Another popular WLS milestone, the loss of 100 lbs, is particularly meaningless given how arbitrary it is. It is probably the Shroud of Turin of WLS, dubious at best. 100 lb is the same as 45.5 kg so what's so special about that? If, like me, you prefer metric units of measure, there's nothing especially magical about the number 45.5. Further, if you were 500 lb at surgery, 100 lb lost is just scratching the surface compared to someone who started at say, 295 lb. At the end of the day, 100 lb lost is only worth jumping about like a Wheel-of-Fortune winner over if you swear allegiance to lbs as your unit of measure. Far more meaningful is the percentage of the mass still needed to be lost to get to goal. For the record, I was 351 lb pre-op and just weighed in at 250 lb at the 37-week mark. I'll be watching my mailbox for my 100 lb prize. However, before I start patting myself on the back, the fact remains that 8 months later, after all this starvation and hypotension and constipation and stalls, I'm only 2/3 of the way to goal. The sobering reality is that my work is still cut out for me.
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Thursday, 20 October 2011
So here we are, the night before the last day of the 11th week of my 12-week Body-For-Life effort. A week after my 47th birthday, on 30 July 2011, I weighed in at 267.4 lb which was particularly frustrating because it represented a 7-lb gain over two weeks. So much for the removal of 80% of my stomach to lost weight. It might explain the gap between my late-June and mid-August postings; I was going through a rough time controlling my weight. At the beginning of August, I bought a one-year membership of my city's recreation centre which includes used of the gym and pool near our condo and any other city-owned facility. At the beginning of August, on the advice of my bodybuilder buddy, Avzal whose advice I sought for a way to train, I embarked upon Bill Phillips' Body-For-Life weight-training and cardio-vascular fitness regimen.This morning was a cardio session and I hit the stationary recumbent bike and the pool particularly hard. When I got back home and weighed myself, I was in for a shock: 242.2 lb (110 kg), my lowest weight since surgery. Not only does this represent a loss of 109 lb (49.5 kg) since surgery, but also a not-insignificant dip of 25.2 lb (11.5 kg) since I started training 11 weeks ago.
It bears mentioning that this is probably the first time in my life that I've trained so hard, 6-days-a-week, without incurring any injury. Back in the squash days, by now I would have torn a ligament, pulled a muscle or twisted an ankle which would have stuck me on the couch for days with a bag of potato chips and a declining willpower to return to the gym. This time, however, alternating sessions between weight training and cardio, especially riding the bike and swimming rather than running, went a long way towards keeping me injury-free. Even the weight training alternates upper and lower body workouts so there's plenty of time between sessions to rest weary muscles and allow them to recuperate.
Friday will be a hectic day of activity starting with an upper body weight workout, squash in the afternoon and, table tennis at night. As I no longer have any excuse to avoid playing squash because I am light-enough to not do any injury to myself, and at the coaxing of my friend, Daniel, I will be picking up a racquet tomorrow afternoon for the first time in about 3 years and hitting balls with my friend, Natalie.
Next week will be significant because it will be the very first time in my entire athletic life that I followed to completion on my own a strict training programme. The last time I did that was in the late 80's under the tutelage of squash coach Bob Callaghan at Princeton.
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Wednesday, 2 November 2011
Robert Burns himself could not have articulated how my perfectly laid plans to complete 12 consecutive weeks of training could get scuppered. I felt the start of a head cold on day two of my final week of this first chapter of my bodybuilding fantasy, soldiered on to a particularly good effort of upper body training last Wednesday but, was simply wiped out come Thursday. I came crashing down with the whole kit and kaboodle of either allergies or cold. Between coughing, sniffling and sneezing and, blocked sinuses and headaches, it made no sense to aggravate matters in the gym whilst also spreading my germs to anyone other than Shamin. A week later, poor thing is still seeing the tail-end of her malady as I bounce back.
Feeling a little refreshed tonight after work, I thought I'd test the waters with a light, late-night lower body session. It went surprisingly well. A week off may have been just the elixir I needed. I was a little intrepid heading there tonight--almost like meeting a former girlfriend--and planned on scaling things back a notch, going a little lighter on the weights. I found that entirely unnecessary. If anything, I felt stronger and could have gone heavier. Erring on the side of caution, I just picked up where I left off exactly a week ago Wednesday.
Come Friday, fully thirteen weeks would have elapsed since I picked up my first dumbbell. On current form, I'm on track to wrap up the Bill Phillips Body-For-Life challenge this Friday. Needless to say, considering last week's hiccup, I had better not get overly enthusiastic and just take it a-day-at-a-time. But finish it I will, if not this week then next or the next.
What follows in the weeks to come will probably be a continuation of this style of training. Barring the interruption caused by illness, the programme could not have gone more smoothly nor yielded better results. I've shed a further 20+ lb and added muscle to a few places where previously there was either fat or just loose skin. If ever I get around to subjecting myself to surgery to remove excess skin, I know that at least the area of my biceps and triceps won't need any trimming.
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Saturday, 17 December 2011
With a week to go to the anniversary of my bariatric procedure, I have been reflecting quite a lot on what the past 52 weeks have meant to me. They will undoubtedly go down with many favourite cliches. "Got my life back," and, "Given a second chance," come to mind. Suffice it to say that there is no substitute for even improved health, let alone good health. A body that is malady-free after grand weightloss is quite simply a bonus.
52 weeks ago, exactly seven days before a 23 Dec surgery last year, I was becoming increasingly anxious. It was the third day of a 10-day pre-op diet comprising protein shakes for breakfast and lunch, unlimited greens from lunchtime onward, and a piece of protein and sliver of carbohydrate for dinner. The diet had two purposes: one, to reduce the amount of fat in the liver which would induce a state of ketosis (in which the body seeks fat and protein stores for energy rather than glucose) and, two, to reduce the size of the liver in order to increase the amount of space available for the surgeon to do his work, thereby minimizing the risk of damage to the liver. I was just beginning to cope with the diet as the hunger pangs began to subside. The sensation was not new to me; I had been in similarly happy states of weightloss from countless diets before. This time, it was euphoria mixed with dread and a dose of anxiety. The euphoria was the usual glee that accompanies shedding a few pounds. Also, I was still in joyful disbelief at my good fortune for winning approval of funding for the surgery. At the same time, however, I was harsh on myself for letting myself deteriorate into a preventable condition of obesity that now required surgery to correct. As often as it flashed through my mind that I could do this without medical intervention, the counterarguments flooded my thinking of how many times I had failed at dieting and what enormous secondary benefits followed WLS. High blood pressure, Type II diabetes and sleep apnea are not conditions to be trifled with so their eradication after surgery was very appealing. Finally, who isn't terrified of dying during surgery? Even the statistics of stunning rates of success and almost negligible deaths on the operating table weren't enough to console my fears.
In the week to come I would conquer many psychological lapses. Right up to the point of being wheeled into surgery, I remember thinking that it wasn't too late, that I could cancel the whole show, hop off, go home and just lose the weight by myself. By far the hardest thing to let go of was an ego-driven resistance to submitting to a surgical solution to a mental condition. The reason that I ate and ate more was not because I was hungry but because I was greedy. My stomach could stretch without limit to accommodate my appetite so it had to be cut out. The VSG was the perfect solution: an irreversible procedure resulting in a small pouch that could never stretch. Well, it was either that or a lobotomy for I was surely losing my mind from the distress of not being able to control my eating. I used to have this irrational fear of being separated from food. I dared not take even an hour-long bus ride without carrying a snack for the road. What if the bus broke down on the freeway and it would be more than a few hours before my next meal? What if I was maimed in an accident in Winter and was too injured to eat. I might as well eat the chocolate bar at the start of the journey. I feared hunger more than being attacked by hooligans on the bus or freezing in the snow. With the ample availability of cheap food in North America, the fear of hunger is irrational indeed.
As my post-op year progressed, so did my relationship with food. It was an education in restraint, patience and reassurance. Old habits die hard. Even post-op, food is of paramount importance in one's thinking. Both you and the doctors want you to eat. You want to eat because you're conditioned to want to eat. Then you learn restraint in a most painful way, when you overeat and discover the constraint of your pouch. It only takes a few instances of that gut-wrenching pain when you feel that you cannot breathe from having eaten one bite too many, that you quickly learn to confine your meals to very small portions. The surgeon on the other hand wants you to eat to avoid your body cannibalising itself. Very early in the weightloss experience, you become accustomed to a weekly dip in the scale that seems almost magical. A fair bit of that is fat, a lot of it is water, and a hefty chunk of it is muscle. To counter the latter two, the medical staff wants you to sip copious amounts of water all day and eat good protein, the very eggs, chicken and beef that you once thought was the sole cause of your weightgain. And you start to drink more water. Eventually, the weightloss slows down to a crawl and even reverses, much to your surprise. You wonder how it is possible for your clothing to continue to get loose yet you don't seem to be bothering the scale too much. The education in patience comes from realising that muscle weighs more than fat yet occupies less space. Eventually, some semblance of stomach capacity returns, you can eat a bite more and even drink an entire glass of water. It sometimes leads to panic that you may have stretched your pouch. It's reassuring, however, when you continue to shed pounds and go out to eat only to find that unless you order from the appetiser menu, you're taking the bulk of your food back home with you.
Such has been my year. The literature that convinces you to consider surgery sometimes promises loss of as much as 75% of excess weight within 6 months. Just before surgery, I weighed about 330 lb. I needed to lose at least 130 lb. At the 6-mth mark, I weighed 263 lb, so had lost 67 lb or, 52% of excess. A year on, I'm 245lb so have lost 85 lb or, 65% of what I needed to. To put things in slightly different perspective, I weighed around 350 lb when I met my surgeon, needed to lose 150 lb and have since shed 105 lb or, 70% of my excess. Although my personal experience has been far below the expectation created by the literature, I could not possibly be happier with where I currently am. I train hard in the gym 6 days a week. I am confident in my skin and my clothes, step out without looking like a miserable slob and am fit beyond my wildest expectation.
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Friday, 18 May 2012
As much as the final decision to have surgery to disrupt food addiction rests with an obese person, for many there is a circle comprising family and friends that is involved in the discussion. In this chatter, several questions are raised and answered. For example, the answer may be conclusive that the battle against weight gain has been lost and only a drastic, surgical solution is required. There may not be consensus in one's circle about that and even the patient may have doubts, but by the time you're in the operating room and about to undergo voluntarily this restructuring of your digestive system, you've pretty much come to terms with your decision. In the two weeks post-op, as you're sucking down protein shakes for your very survival and battling GERD, you may question your decision, wondering what on earth you did to yourself. As the months roll on and the incisions heal, the GERD resolves and, most-importantly the weight falls miraculously off, you may wonder why you left it this long to get your life back.
Some pre-op questions are left unanswered and indeed are impossible to answer. Will all this weight really come off? What will life be like when it happens? How long will it take?
All the while, there is the circle to which the weight-loss surgery (WLS) recipient feels he owes answers and explanations. In the case where the cost of the surgery was picked up by someone in that circle, there is almost a guilt-driven obsession to vindicate the decision to have WLS. Understandably. But what of the others, like those who are genuinely concerned? What of the cynics, the cheerleaders, the jealous, the curious observers and the followers, all of whom might be looking for inspiration and answers their own questions, or waiting for you to fail? In the furthest recesses of your mind you can't help but feel that you owe everyone a steady update on your progress.
My immediate circle comprises my wife and she was the only person to whom I felt I owed answers. Because we live far away from our relatives, our larger circle in the Pacific Northwest of America is a group of close friends who have been nothing short of supportive. Beyond that, family and friends interact with us through the odd visit but consistently electronically and through social media. The encouragement that I have found through them has been astonishing. If the naysayers exist, they have remained refreshingly quiet. A few of my fellow WLS alumni have not been as fortunate and have endured jealousy and criticism quite unbecoming of civilized society. I hope that it makes them stronger, and that they realise that they control who remains in their circles. Life is tough enough as it is so they should surround themselves with people who make it bearable.
Along my journey that has been almost two years in the making since my first discussion with a surgeon, but 17 months since surgery, I have shared honestly my experience with my extended circle. Most of it has been positive as expected. I also wrote of the pitfalls and frustrations. Despite noble pretensions of wanting to be a role model and inspiration, a latent vanity exists. It may be a defense mechanism against a failed career (I was high school valedictorian, have an Ivy League pedigree, but now work part-time hours for minimum wage in an exploitative call centre whose employment practices are nothing short of a glorified sweat shop), an effort to show that I'm still good at something--writing, if nothing else. In the end, there's a niggling need to explain, justify and vindicate myself to everyone for a decision that was mine to make in the first place.
Hot on the heels of that morbid declaration, I find a positive. Somewhere, somehow, after a lull in motivation mostly influenced by our dreadful Winter, I have started earnestly in the gym again. My initial 13-week program last August produced fantastic results during which I gained muscle mass but lost an overall 22 lb (10 kg), then nothing. During an especially refreshing 9-night vacation in Miami, I threw caution to the wind, ate junk food, wolfed down chocolate and slurped decadent ice cream. I gained 10 lb.
At the start of this week, I found as expected that I would not be as strong as I was last year. Funny that even in Miami during an upper body weight session at the hotel, I was able to lift heavier than I could this past week. It's amazing how quickly the body loses its fitness and strength. Then again, I'm just happy that, since my WLS, I have progressed to the point where just a few sessions in the gym can bring me back to the point where I can set goals again. I saw out my sixth session this week with a bike ride this morning. It was a roller-coaster week at the beginning of which I was nowhere near my maximum training weights from last year, then ended with a lower body session where I could have lifted heavier than ever. I restrained myself to avoid injury but am eying setting some new levels next week. Even as I contemplate that, I'm making longer term plans. Come August and in time for our next onslaught of wet weather, when my membership expires at my current gym which has a swimming pool, I'm thinking of joining one across the road from me which has squash courts. I'll drop in at the pool now-and-again when my knees get shot from the squash and I want that unique cardio lung-burn from swimming.
I and as i am sure others are so very proud of you. What an amazing story, from an amazing guy. Congrats again.
ReplyDeleteVery glad to hear about the type2 diabetes. That's a big plus. Good luck to you with the continuing effects of the operation. You have done SO well. Congratulations.
ReplyDeleteNeeven, as much as I have come to loathe the infernal protein shakes it may be the best way for you to max out your daily protein requirements. Also, I have been taking sublingual B-12 pills once a week. I know we have had different procedures but I hope this helps.
ReplyDeleteThanks so much for sharing that, I'm in line to have it done in 3-9 months.
ReplyDeleteGood luck, Eoghan, thanks for reading my story. Feel free to ask any questions.
ReplyDeleteWow, so amazing. Where did you get the paperwork to do an out of province?
ReplyDeleteThanks, Cathleen. I got the form and guidelines from the BC Ministry of Health website: https://www.health.gov.bc.ca/exforms/practitioner.html
ReplyDeleteAs you scroll down, in the right column, there is a link to "Out of Country Health Services Funding Application." Be sure to also study the guidelines.
I'm given to understand that the wait times for surgery in BC are quite long once again, but also that the surgeons are reluctant to sign the forms. Good luck.