MamaJuli

It’s crazy to think…

MamaJuli

(Me in 2003 with baby Juli)

That when I (and my husband) was going in to have my gastric bypass surgery, my kids were just little things or not even born yet. 

My daughter that's allowing me to share  (we have two doing this) — she was born in 2002 and I had surgery in 2004.  She was just a toddler, in fact, I weaned her literally the day I went in for surgery.  She went on vacation with the inlaws and allowed me to relax post op instead of worrying about picking up, putting down.  Her entire childhood has been living with me and dad with our respective altered guts.

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In the beginning, I thought that shaking things up would stop the genetic tornado we had going on with so much familial obesity, but I think our surgeries created a microscope of eating issues and only made it harder for the kids. 

Like the kids say:  we always have healthy food available, but we made a big deal about junk in the early years and I think that Really Caused A Problem with snacking, etc.  We didn't really mean to be the food police, but it happened.  I try not to NOW, but with another toddler that would eat nothing but Cheeto dust if allowed — we have to be a bit careful, but not.  Does that make any sense?!

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(Juli in September 2018, pre-program)

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14 Years.

I didn't make a 12 or 13 year update?  Really?  It might be the distracted distraction: 
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It occured to me that I don't have photos to share, partly because I have been sitting at the same. exact. weight. (within five or so pounds) for two-and-a-half years (*see distraction) and there's really nothing to update in that aspect.  
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I started "this journey" more than 15 years ago.
 
My highest weight was 320 pounds.  I have reached a low weight of 145 lbs, once.  I gained over 210 lbs. while pregnant in 2006 and 2015. 
 
I have spent the majority of the last 14 years at or about 170 lbs.  
 
All of this is in the history here on the blog.
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Self – last week
 
I would say that 170 is my eat-what-you-want and "don't do jack shit for cardio aside from chasing a hyperactive toddler/house cleaning and seizure" weight.
 
What do I eat?
 
Old-lady food.  I still loathe cooking.  I would not cook a thing, ever, if there weren't kids here.  I don't cook much anyway, since I was told "not to ever use a knife unattended" or "a stove," so, I just … do, but I don't.  If money were no object, I'd be all over home delivery.
 
Coffee with almond milk, tea, whole grain toast, probiotic cottage cheese, frozen meals, chicken salad.
 
I mix it up with a take out meal about once a week, usually a cold sandwich like roast beef and all the veggies or a BLT.  
 
I regret most meals eaten away from home, so I am careful about food choices if we go out.  I trust no one not to kill me.  I dump on the most random things, or have awful reactions later, so I stick with what Should Work.  
 
I'd say I take in 1500 or so calories most days. Today?  
  • Dave's Killer Bread + Light Butter
  • Two bites protein cookie, the rest donated to the kid
  • Frozen chicken a la king, tossed some of the chicken away
  • And it's nearing 5pm.  Typical.  I'll eat dinner at bedtime.
 
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Bob and I at his police graduation, 2017, his 14 years is next month
 
I have that excess 20- 25 lbs hanging around.  I know how to lose it. I don't do it. At least I have not in the last few years. With my last (POST WLS!) baby who is now eleven, I would get walking for miles, but I don't anticipate that happening anytime soon with my special-fall-on-the-ground-head-crack seizures that developed in the last few years (*see the timing correlation?) Well, at least I did it back then and did not realize I was falling down.
 
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Christmas Day, 2017 – Myself and all the "kids"
 
I have two cardio machines in the house. I'm not using them and my excuse is the youngest child that climbs on them with me. (YOU HAVE TO KNOW HIM.  HE IS THAT CHILD.)  Getting up before he does or climbing out of bed after he sleeps to exercise is … not tempting. I'm just not that into it, yet.  Clearly exercise is not a priority. 
 
I think that remaining upright — is?
*On that topic which some of you don't like to read, but it's a huge part of my life/day — I'm taking lots of medications, which need a little tinkering (again, usually once a year I'm in the hospital for a tune up) since I am obviously having lots of seizure activity.   I currently take ONFI, Topamax, Banzel, and as needed Lorazepam.  They are treating my various types of seizures.  I just tapered off of a huge amount of Keppra. I suspect these will change in the near future, because me.
 
People ask me if I blame my gastric bypass for this "condition" or it's increasing changes/etc.  No.  I was born with the brain malformation that causes seizures, and at this point in my life I believe I had seizure activity longer than anyone knew (maybe since I was very small, in the form of smaller seizures that no one noticed, I understand the symptoms now) — but the gastric bypass caused a trigger by changing my gut.  The science shows that the gut can affect the brain — and I feel that in some way the WLS lowered my seizure threshold by altering my gut, and making my malformation — "turn on" and show it's full power.  I feel that there's a cure in my lifetime, if it's fecal transplants, brain stimulators or who knows what else – because there are many of us out there with post WLS seizures
 
What do you want to know about "long term" post weight loss surgery life?  
 
Any questions, I am a too-open book.  Ask here or Facebook.  Just don't sell me anything unless you plan on sending it to me free.
 
 

From NYT – Why WLS Works When Diets Don’t

Don't shoot the messenger, I'm sharing this for my blog's historical reference because it's AMAZING INFORMATION — and even if you "don't agree," because it's not your experience, it's science!

Via New York Times - https://nyti.ms/2kBVirc

Bariatric surgery is probably the most effective intervention we have in health care,” says Laurie K. Twells, a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weight-loss surgery’s ability to reverse the often devastating effects of being extremely overweight on health and quality of life.

“I haven’t come across a patient yet who wouldn’t recommend it,” Dr. Twells said in an interview. “Most say they wish they’d done it 10 years sooner.” She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying — and failing — to lose weight and keep it off. And the reason is not a lack of willpower.

“These patients have lost hundreds of pounds over and over again,” Dr. Twells said. “The weight that it takes them one year to lose is typically back in two months,” often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate, an effect not seen after bariatric surgery, which permanently changes the contours of the digestive tract.

In reviewing studies that followed patients for five to 25 years after weight-loss surgery, Dr. Twells and colleagues found major long-lasting benefits to the patients’ health and quality of life. Matched with comparable patients who did not have surgery, those who did fared much better physically, emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety, among other factors that can compromise well-being.

Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar, blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type 2 diabetes, it nearly always puts the disease into remission and slows or prevents the life-threatening damage it can cause to the heart and blood vessels.

 

Even in the small percentage of patients who ultimately lose little weight after surgery, significant metabolic benefits persist, according to findings at the Cleveland Clinic. In a study of 31 obese diabetic patients who had not lost a lot of excess weight five to nine years after surgery, a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities, Dr. Stacy Brethauer and colleagues reported.

For the two most popular surgical techniques — the gastric bypass and the gastric sleeve — “the metabolic benefits are independent of weight loss,” Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However, the gastric band procedure, which is reversible, lacks these benefits unless patients achieve and maintain significant weight loss, he said.

Furthermore, as a study last year of 2,500 surgical patients at the Veterans Affairs Medical Center in Durham, N.C., found, those who underwent bariatric surgery had lower overall death rates up to 14 years later than comparable patients who did not have weight-loss surgery.

Experts in the field regard the reluctance of some medical insurers, including Medicaid programs in many states, to cover the cost of bariatric surgery as a penny-wise, pound-foolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical $30,000 price tag of bariatric surgery — sometimes even millions of dollars more.

 

Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially, the latest long-term research has shown otherwise. In a decade-long follow-up of 1,787 veterans who underwent gastric bypass, a mere 3.4 percent returned to within 5 percent of their initial weight 10 years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of 82 percent of gastric bypass patients, a task too challenging for most clinics.

The study, by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery, found that 10 years later, more than 70 percent of surgical patients lost more than 20 percent of their starting weight, and about 40 percent had lost more than 30 percent. Gastric bypass, an operation called Roux-en-Y, resulted in a somewhat greater weight loss at 10 years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band (Lap-Band) surgery, which “has fallen out of favor in the last two or three years,” Dr. Maciejewski said.

 

Bariatric surgery, regardless of the method used, is also much safer nowadays than it was even a decade ago, said Dr. Jon C. Gould, a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary on the V.A. study. However, he noted, the surgery is “vastly underutilized,” to the detriment of patients’ health and the nation’s health care costs.

“Less than 1 percent who would qualify for bariatric surgery are actually getting it,” Dr. Gould said. “Although the vast majority have health coverage, insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesity-related health conditions and are taking a slew of medications to control them.”

 

For example, he said, to be covered for bariatric surgery, Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure.

He cited a further deterrent to bariatric surgery: “a perception that it’s dangerous and doesn’t work,” beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions.

 

Given the well-documented safety and effectiveness of bariatric surgery, it is now increasingly being performed in people whose obesity is less severe — those with a body mass index (B.M.I.) of 35 or perhaps even less — but who have a metabolic disorder like Type 2 diabetes related to their weight.

In recent years, the profession has promoted what Dr. Gould calls “centers of excellence,” where 100 or more bariatric operations are usually done in a year. Practitioners at these centers “learn from experience, share their knowledge and push for quality improvements,” he said.

Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery, which have combined forces to promote quality control.

While experts agree that money would be better spent on prevention than treatment, Dr. Twells pointed out that “we have yet to find a way to prevent obesity, and people whose health is compromised by their weight deserve to be treated by the most effective method we have.”

 

Worth a read. New York Times article about a year in the life of bariatric surgery

Worth a read, and worth a watch.  This mimics a bit of my experience, my family's experiences, and brings up some (deeper) questions.  As someone who's had gastric bypass in 2004, I'm always intrigued at any new science that's discovered about the gut – brain connections.

"Nearly 200,000 Americans have bariatric surgery each year. Yet far more — an estimated 24 million — are heavy enough to qualify for the operation, and many of them are struggling with whether to have such a radical treatment, the only one that leads to profound and lasting weight loss for virtually everyone who has it. Most people believe that the operation simply forces people to eat less by making their stomachs smaller, but scientists have discovered that it actually causes profound changes in patients’ physiology, altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain."

Article – New York Times

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Forget #WLS – just exercise 4-6 hours a day says Dr. Huizenga

  • Exercising for four hours a day and following a strict diet can yield the same results as weight loss surgery, a leading doctor has claimed.
  • Dr Robert Huizenga, of UCLA, says his extreme diet and exercise plan should replace bariatric surgery as a treatment for obesity.
  • He says bariatric surgery is expensive and carries risks of death, muscle loss, bone thinning and mental health issues.
  • His 'Biggest Loser' weight loss plan, which was made famous by the hit TV show of the same name, helps people lose the same amount of weight and is cheaper than surgery, he claims

Dr. H says that "we" watch TV for four hours day, surely we have time to exercise that long, but FRANKLY, I DON'T WANT TO.  

I am LAZY.  

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Do you honestly think I would have even considered it at my former size at ALL?  NO freaking way.  I am in a normal body weight range right now and there is zero point zero chance of getting me to exercise aerobically four hours daily — at 320 lbs — I would have sooner had weight loss surgery — and I DID.   Eleven years ago.  LOL.  It worked.

<3, MM.

Patients With Psychiatric Illness Require Close Watch After Bariatric Surgery

A study conducted in Brazil and presented at a poster session at the 2014 annual meeting of the International Federation for the Surgery of Obesity and Metabolic Disorders looked at six cases in which patients committed suicide or attempted suicide after bariatric surgery. The study did not specify the form of weight loss surgery that each patient underwent.

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Ethicon Bariatric Surgery Comparison Tool Online – What can you lose?

I am easily distracted online by quizzes, gadgets, tools, and "Who Will You Be When You Grow Up?"  (Which said TEACHER, BTW, ME, The Kid Who Failed Half Her High School Classes…) quizzes, which is when I saw this - Online Tool Designed to Help Patients Evaluate Potential Bariatric Surgery Outcomes – thingamajig – I did it myself even though I am already ten years and two months post gastric bypass.

How cool is this?

Are you considering weight loss surgery?  Check this out.

LA Times –

A new tool nveiled at the annual meeting of the American Society for Metabolic and Bariatric Surgery may help patients with a body mass index over 30 — the threshold at which obesity is diagnosed — to navigate those complexities. Based on the accumulated experiences of 75,000 bariatric surgery patients, the Bariatric Surgery Comparison Tool details the expected outcomes of gastric banding surgery, gastric bypass surgery and sleeve gastrectomy, the three most common bariatric procedures.

I did it myself, based on my start weight – height – though I have lost an inch of height.  (Shut up.)

Start weight – 320, start height 5 ft 4.  I am close to 5 ft 3 now.

Are you considering weight loss surgery?  Check this out.

image from http://s3.amazonaws.com/hires.aviary.com/k/mr6i2hifk4wxt1dp/14060712/190a84c8-6aca-452b-953c-cec251332856.png

 

And now –

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And the tool gave me these results based on the potentials of experiences of 75,000 patients (… surveyed out of the most common WLS) 

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The stats for the gastric bypass are damn close to what my surgeon "quoted" me for my landing place after my procedure.  

I bottomed out lower than this, my very lowest was 147 lbs, but wouldn't you know I bounced exactly to 175 lbs and maintained around there for a good portion of the years after my RNY?  The gastric bypass got me there, everything after that was a lot more work.  (See the blog.  I was pregnant immediately after.  And, so on.  This was 2005, guys.)  

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The 24 month data is EXACTLY right!  I am ten years post op and 149 – 158 lbs!

I guess what I am saying is — that the data for this "tool" —  (and you know I loathe that word) is there, it is right on the money.

Some goobledegook from Ethicon - 

  • The tool (officially named the Ethicon Bariatric Surgery Comparison Tool) pools data from more than 75,000 U.S. people who have had bariatric surgery, and based on personally provided, anonymous information, shows what people of similar demographics have experienced after undergoing bariatric surgery. The tool shows data for gastric bypass, sleeve, and adjustable gastric band surgeries.

o   Ethicon understands that no two patients are identical.  For example, when considering bariatric surgery, obesity related conditions like diabetes, hypertension and cholesterol need to be taken into consideration – this tool helps do just that.

o   Based on patients who have had similar conditions to theirs, prospective patients using the tool are able to see what surgical outcome looked like for patients just like them and can use this as a discussion point with their doctor about  which treatment option might be most appropriate for them (i.e., gastric bypass, gastric sleeve or gastric band).

 Now is a promising time for people in need of support for obesity and illnesses associated with it (such as type 2 diabetes).  There are safe, effective ways for physicians to help patients better manage their conditions.  There’s a growing body of clinical evidence that shows that bariatric surgery not only helps with weight loss, but that it also can help with issues like type 2 diabetes.

Some things you should know about bariatric surgery and the tool

Bariatric surgery is used in severely obese adult patients for significant long-term weight loss. It may not be right for individuals with certain digestive tract conditions. All surgery presents risks. Weight, age, and medical history determine your specific risks. Individuals should ask their doctor if bariatric surgery is right for them.

The tool is provided for educational purposes only and is not intended to be a medical evaluation, examination, consultation, diagnosis or treatment. The tool provides potential results by procedure type including pounds lost and medication reduction over time based on personal information provided by the user of the tool. Patients should consult a physician or other health care provider to determine whether or not bariatric surgery is right for them and for guidance on expected outcomes benefits and risks.

The weight loss, medication, and diagnosis information provided by the tool is derived from statistical analysis of historical claims and clinical databases as well as research published in peer-reviewed journals. While predictive modeling techniques were used, the results cannot predict the specific outcomes for any individual. The information presented does not represent any statement, promise or guarantee by Ethicon Inc. concerning a patient’s eligibility, experience, or potential outcomes. Individual patient results may vary.

 I had gastric bypass in 4/2004 in Boston, MA with Dr. Michael Tarnoff

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Weight loss surgery: ‘not everyone lives happily ever after’ – Medical News Today

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Weight loss surgery: 'not everyone lives happily ever after' – Medical News Today.

http://www.medicalnewstoday.com/articles/272432.php

I realize this is a very small sample study, but I can't say I don't disagree with most of it after living this WLS-life for ten years and observing hundreds of people in it.

http://www.medicalnewstoday.com/articles/272432.php

All women had undergone gastric bypass surgery – one of the most common bariatric surgery procedures. It involves rerouting a part of the small intestine past the stomach in order to reduce food intake, promote satiety and suppress hunger.

The majority of the women were interviewed twice. The first time was 1 year after surgery, while the second interview took place 2.5-4 years following surgery.

Groven says although most previous research suggests that weight loss surgery leads to an increase in quality of life for the majority of patients, her findings suggest that not everyone lives happily ever after following bariatric procedures.

Positive outcomes after surgery 'can feel like grief'

There is no doubt that weight loss surgery puts the body through a series of radical changes.

Groven says that although the procedure leads to a slimmer body – which others perceive as a "sign of success" – the surgery can cause many smaller problems that other people are unable to see.

Groven explains:

"Becoming slimmer and lighter is mostly perceived of as positive. At the same time it is ambivalent, since people start to behave differently towards the women after they've had surgery.

People are friendlier than before, and this may feel extremely provoking. And people often ask very invasive questions concerning the woman's radical weight loss."

The interviews revealed that some of the women experienced a boost in self-esteem after surgery, were more outspoken, and found other people were more likely to listen to what they were saying – particularly in the workplace.

Groven notes that although these factors are clearly positive outcomes, this could also be seen as a "grief" because the women realize they had to undergo weight loss surgery before seeing these outcomes.

Many of the women also felt embarrassment after the surgery, particularly when it came to speaking about their weight loss. Some women told others they had been on a diet to lose the weight because they were ashamed to say they had undergone bariatric surgery.

Excess skin promotes a negative self-image

Groven found that many of the women had mixed feelings about their naked body after surgery, and many of these feelings come from the occurrence of loose skin – a common consequence of rapid weight loss.

"It is given little focus before the operation. Patients are often told that this is something that can be fixed afterwards. But it is not so easily fixed, and the women are not prepared for the challenge of having to live with the loose skin," explains Groven.

Although women can undergo surgery to remove excess skin, Groven notes that many women are not prepared to take the risks associated with this procedure, which include hematoma or seroma formation, infection and risks associated with future pregnancies.

Groven found that some of the women interviewed even spoke about their excess skin in third person, which she believes is a way of distancing themselves from it.

Health problems and bad food relationships after weight loss surgery

According to Groven, five of the women interviewed reported a lower quality of life after they underwent weight loss surgery, compared with their quality of life before.

She notes that this was down to the development of chronic stomach and intestine problems, and one woman became so ill that she had to endure another operation because of problems with her scar tissue after the gastric bypass procedure.

The five women also said they felt as if they had complete lack of energy following weight loss surgery.

Furthermore, Groven found that many of the women reported having a negative relationship with food after the procedure.

Some women were worried about eating too much or too little, or eating the wrong food at the wrong time. Because of these concerns, some women experienced tiredness, nausea, dizziness and even intense shaking.

Some of the women who had problems with overeating before weight loss surgery continued to overeat after surgery, even though this made them ill. Groven says some women commented that "the eating disorder is not gone."

Groven says that while previous research suggests that patients can avoid testing their eating limits after surgery by following dietary advice, the reality is much more complicated.

She adds:

"It is reasonable to ask, I think, whether the eating disorders that some of the women develop after surgery are diseases, or if they may be understood as normal changes as a result of the operation."

No regrets

Although many women reported negative thoughts and health issues after weight loss surgery, none of them said they regret undergoing the procedure.

"They say they would have done the same today and that they had no choice considering their life before surgery. Some said that the pains were a small price to pay," says Groven.

She adds that this suggests women are influenced by society's perception of the ideal female body, and that being obese is not within this scope.

"They are living with a body which is not accepted by society, and they are constantly judged from their size," she says.

"The message from the media and medical science is that they are likely to get cancer or diabetes unless they lose weight and the surrounding world regards their obesity as self-inflicted. Some have children and are afraid to die and leave them alone."

Groven concludes that although it is true that obesity can lead to health complications, such as diabetes and heart attack, little is known about the long-term effects of weight loss surgery and what complications may arise from this procedure.

With this in mind, Groven plans to conduct further research that will look at the effects of bariatric surgery 3-10 years after patients have undergone the procedure.

http://www.medicalnewstoday.com/articles/272432.php