Gastric Bypass Surgery and Obesity: My Story

By Jonathan Sauer

Introduction

I played football and ran track in high school and lifted weights for several years at a very high level while in high school. I was one hundred seventy-five pounds when I left high school and I was in superb physical condition. Here’s an example. At one point, for the hell of it, I decided to see how many sit-ups I could do. I did sit-ups on an incline board at a pretty steep angle. I did three hundred sit-ups and quit, just because I was bored. Still plenty in the tank!

Like many others, however, when I stopped all the exercise and met the stress of college (two hours commuting, increased academic work load and homework, part-time jobs to help pay for it all), I gained a lot of weight fairly quickly: about fifty pounds in one year. Isn’t it ironic that so many of us with weight problems end up working at fast food restaurants? That was my experience through college. Subsequently, for many years, I averaged two hundred and forty- eight pounds. Then, my “average” weight went to two hundred sixty-five pounds as I got older and then to something in the two hundred eighties after that. My highest weight was a couple of pounds short of three hundred, which is a lot of weight for someone who is slightly under five feet eight inches tall. Like many others, I thought I was “big-boned” and I knew how to look in a mirror only for certain angles and views (if I were to look at one at all).

I was often a pretty good dieter. I lost a great deal of weight several times: in 1986-7, in 1999 and in 2008-2009. Still, as those with this problem know, you don’t generally ever lose it all (although I did so in 1987) and it almost always comes back “with interest”. As those of us who have had serious weight to lose know, our bodies fight sustained dieting and weight loss on a whole variety of fronts - mental, emotional and physical. With my better diets, I would lose sixty or seventy pounds. Some were “fad-type” diets and some were good diets. I remember that when I did the Dr. Stillman diet - all protein - I would get tremendous urges for Three Musketeer bars, something I wouldn’t ordinarily eat when I wasn’t calorie-restricted. I had one diet where the focus was eating a ‘Healthy Choice’ type frozen dinner for dinner with lots of raisins and carrots. Still, after six or seven months on any diet, I would get tired: tired of the diet and physically tired from living on restricted calories and from dietary imbalances. After all, our bodies are designed to resist losing weight.

A close friend had a gastric bypass operation in 2008 and lost one hundred pounds or so, seemingly effortlessly. During part of this time period, I was on a fairly successful diet and lost sixty or seventy pounds. Still, following my past history, I began to gain it back. During the summer of 2009, I began thinking of my own possible weight loss surgery. I was approaching sixty years old and forty years of struggling with the weight, on balance, had been unsuccessful and the future didn’t look any better. The various 12 step programs define ‘insanity’ as continuously doing the same thing while expecting a different result. By that definition, my approach to food and dieting and weight loss had been insane. At age 60, I needed to solve this problem before this problem solved (ended) me.

So, I tell my story, as it might benefit someone reading it. I am not a medical doctor and my explanation of the medical/physical parts of it reflect my understanding of these things. In the final analysis, if you decide to go further, your own internet research and contacts with physicians can give you more accurate/detailed medical explanations. Still, this is what I experienced. . . .

My Experience

My inquiries centered on Newton-Wellesley Hospital (NW) in Newton, MA, as I knew people who had gone through their program, which is a good one. I had my initial meeting with the doctors in August of 2009. At that time, I weighed 258 pounds and I was gaining weight. One of the reasons I had not really seriously considered this operation before this time was that I just assumed that being sixty years old was ‘too old’ for the operation. I learned that they perform the operation for people in their early twenties and operate on people into their seventies. So, virtually wherever you are chronologically, this option is something that might be available to you.

The preparation for getting approved to have the operation includes a detailed physical and attending several nightly meetings that NW has for the weight loss program for people in different stages of the process. This includes a small amount of psychological testing and meeting with a dietician. Quite a few forms have to be filled out, some of which have to be completed by your primary care physician. Much like the attitude that one sees towards weight loss surgery in shows like “The Biggest Loser”, two of my doctors seemed to have a mild antipathy towards this option. In the popular press, people criticize this operation as ‘taking the easy way out’. There is nothing easy about living with a gastric bypass! At this time, one had to have a 40 BMI (body mass index) to qualify for the operation from an insurance standpoint. (You can learn more about BMI by doing an internet search. Most of the BMI sites have a calculator, so you can figure out your own score rather quickly.) However, if one has a variety of co-morbidities (gastric reflux, high cholesterol, high blood pressure and a number of other things), one could get the operation with a BMI of 35 or higher. My BMI was 35 and change. I was definitely a smaller patient. NW has any number of patients who weigh three hundred pounds, four hundred pounds and more. I know of one patient who had her operation when she weighed more than seven hundred pounds.

NW does an operation known as a “roux-en-y gastric bypass”. This is their typical bypass operation. As I understand this, two essential things are done. For one thing, a normal person’s stomach contains forty ounces. With this operation, your stomach is reduced to a ‘pouch’ to hold between one and two ounces. (The pouch will stretch some afterwards). Essentially, a corner is cut off of your existing stomach near the esophagus and this becomes your new stomach, now called a pouch. The rest of the stomach is left in your abdomen and does perform certain physical functions that are useful but does not process food. Secondly, a portion of your intestine is “by-passed” so that your body doesn’t absorb nutrients (and calories) for this portion. As I understand this, the new stomach is hooked up some distance below where the current intestine is attached to the existing stomach so that a portion of the intestine becomes ineffective for absorbing nutrition (and calories). For this and other reasons, part of the bypass patient’s life is taking a fair number of vitamins and supplements daily for the rest of your life. I take about fifteen pills every day, some of which are my wife’s additions for good health. Vitamin D seems to be particularly important for bypass patients to take, as bone density seems to be a particular concern. Here’s an interesting point. In Europe, this operation is done primarily as a treatment for diabetes. The literature suggests that for people who have diabetes, eighty-five percent of these people have the diabetes disappear after this surgery.

Incidentally, it is my understanding that NW does not do “lap band” surgery (less invasive) where a plastic collar is inserted around your stomach with a port under your skin whereby through injections of sterile water, the band either tightens or loosens the pressure on the stomach (making it smaller or larger). According to my understanding of what I learned at various meetings at NW, ninety percent of these “lap bands” have to be removed in the first ten years after the operation, as they fail for one reason or another. Also, since the lap band will necessarily expand over time, people can eat more and the band becomes less effective. My sense is that since people can eat more, they don’t go and have them tightened and they become less effective. After all, part of the reason people get into obesity issues is that they like to eat. So, if a lap band loosens, they can eat more. An essential beauty of the roux-en-y gastric bypass operation – and what makes it in some ways so difficult to live with – is its non-adjustable nature. Once the surgeon does his/her work, your new pouch marches to the beat of its own drummer!

The majority of the gastric bypasses done by NW involve “laparascopes” (scopes), which look like long wands, which are inserted in your abdomen through “ports” (holes) in your abdomen. Surgery is less invasive with scopes because the operation is accomplished through six one-half inch holes rather than through one four or five inch “open” incision - one large cut - which takes longer to heal and poses greater opportunities for infection and for complications such as hernias. One of the wands has a camera in it and this is how the surgeons see what they need to see. Essentially, the surgeons operate while looking at a tv monitor. Just like in Big Medicine!

Surgery

I had my operation on October 5, 2009. Things proceeded normally. You are admitted to the hospital on the day of your surgery. This surgery typically takes between one and one-half and two hours. My operation was more than three hours due to some adhesions in my abdomen from previous surgeries, which had to be dealt with. Since you are asleep, whatever the time is that the operation requires passes quickly! When I woke up, I tried to determine how much pain I was in. I decided, rather, that I was simply sore, rather than in pain. At NW, they give you a pain pump that you self-administer, which allows you to give yourself pain medication as frequently as every eight minutes. My operation was on a Monday and I left the hospital that Wednesday: in about two days. The worse part of being in the hospital is that due to their rather enthusiastic (frequent) taking of vital signs throughout the night, sleep other than in short naps is quite simply impossible. The surgeons will tell you that they would like you to take four to six weeks off before returning to work after the surgery, although this is principally because you have to relearn how to eat and drink and this is very hard work and almost a full-time job for quite a period of time. When your name is on the door, as is mine, taking four to six weeks off of work is simply not realistic. I returned to work in about ten days but I had a number of partial days working in the first two weeks and climbing the several flights of stairs necessary to get to my office was less than fun.

Eating and drinking with a pouch are very different than eating and drinking with a ‘normal’ stomach. If you won’t follow the Program’s suggestions for how to eat and drink post-surgery, your chances of an ultimately successful result may be less. It is possible to gain all of your weight back after the surgery, as your pouch can be stretched. My sense is, however, that to do so, one would really have to work at it! At NW, when you begin the process of being considered for surgery, you are given a green notebook that discusses all aspects of the procedure from before the surgery to living with the surgery for the rest of your life. Realistically, if you are unwilling or unable to follow the program laid out in this notebook (the Program) reasonably closely, this operation may not be right for you. I hasten to say, however, that I have been fairly successful and my own compliance with these materials is nowhere near perfect. The surgeons don’t refer to the by-pass as a cure but as a ‘tool’. And, the tool is only effective if it is used in the manner that substantial experience has demonstrated to be most useful in removing and then keeping off weight.

The first two or three months or so after a gastric bypass are not a lot of fun. For a month or so, one has to pursue a purely liquid diet, which is very boring and hard to follow. This type of diet is limited to various juices, jello, instant breakfast, soup, etc. Some people will take actual meals and then blend them into a liquid, which is acceptable to the dietician but something I didn’t do, as it seemed gross and disgusting. Many readers know what a ‘Magic Bullet’ is and gastric by- pass patients make use of these particularly in that first month or so. As the stomach heals - and while you are re-learning how to eat and drink, which is what you will need to do to be successful - you may have some abdominal discomfort. For example, when your “pouch” doesn’t like what you have put into it, you may “foam”, which is a kind of gastric by-pass throwing up, which is really more like spitting up. Everyone lives through this and this generally passes in two or three months. Gastric bypass patients, with their modified ‘exhaust’ systems, tend to pass more gas than they did pre-surgery. Some post-surgical disciplines are completely new and hard to adjust to. For example, one is not supposed to eat and drink at the same time during meals. Basically, one eats, waits at least one-half hour and then drinks and vice versa.

This has been very hard for me to adapt to, even seventeen months post-surgery. To be honest, I don’t follow this particular rule all that closely.

Complications

I had some complications. I hasten to point out that I have been to thirty or forty evening meetings of bypass patients at NW and the vast majority of patients report a fairly smooth experience and no significant problems. I am only aware of two or three other individuals who have had significant complications.

I had continuing discomfort after the surgery. This lead to one operation about one year after the first operation where the surgeons found that I had a twisted bowel, which they simply repositioned, performing no new surgery. So, in addition to the six holes from the first operation, I had five new holes with this one. (No hole for a drain in the second operation, as nothing inside was cut.) This problem may have been caused by simple extreme weight loss, which can change

the attachment points and position of your bowel inside your body. (I lost eighty-four pounds after the first operation.) My symptoms continued, however, after the second operation.

Ultimately, it was determined that notwithstanding my having had my gallbladder removed thirty years ago, I had a gallstone in my common bile duct. This was removed by open incision in late December, 2010 and my case seems to have stabilized. I still have greater problems eating a lot of foods than some other gastric by-pass patients have. For example, many bypass patients have difficulty eating meat after the operation. The literature suggests that some patients may never be able to eat meat again. I can eat some meats, although this can vary from time to time and from day to day. My body seems to prefer fish and vegetarian dishes to meat. Bread is very difficult to eat for any by-pass patient, as it expands quickly inside the pouch, filling you up quickly. Prior to my first surgery, bread and bread-like things (i.e., cake, cookies and pizza) were my favorite things to eat. Reluctantly, I have removed almost all bread from my diet, as my body simply doesn’t like it. Also, I have seemed to develop some lactose intolerance after my surgery. The doctors will tell you that they don’t want you drinking coffee or alcohol after the surgery. I can drink both, although coffee is pretty harsh on an empty stomach. (Two or three sips of a good cocktail is all that I need to feel comfortable!) My wife and I still go out to eat, although I find that four or five bites of nearly anything is all that I really want or need. Can you imagine eating four or five bites of dinner and being satisfied? This is very different from my prior history! The doctors stress that they want your first calories ingested in any meal to be protein.

This cuts down dramatically on ordering salads, appetizers and desserts. Particularly, as an athlete, I am taking these suggestions more seriously as time goes on. The closer my adherence to the Program suggestions, the better I feel.

Life As Physically Fit

I am going on sixty-two years old and haven’t been this healthy since high school. I am up about ten pounds over my lowest post-surgical weight. (My low of one hundred seventy-five pounds is currently around one hundred eighty-five pounds.) Also, when one loses weight after the surgery - the weight loss can be quite dramatic and very fast - I lost a lot of upper body muscle. People who go through this process just assume (hope?) that your body loses only fat, not muscle.

However, your body will burn whatever it feels like burning and this includes muscle. So, I anticipate that I will ultimately have to add about another ten pounds of muscle to my upper body, as I have lost a fair measure of upper body strength. So, I suspect that I will be going from being 258 pounds pre-surgery (but gaining at the time) to about 195 pounds and stable at that weight post-surgery.

I had hoped to retire from the law at some point and pursue a second career in my dream job as an exotic dancer! However, with eleven holes in the abdomen from the first two surgeries and a five inch incision from the third surgery, this doesn’t seem likely! Adding to previous scars from other operations, I like to say that I just need one more good incision and I will have a fairly accurate depiction of the runways at Logan Airport on my abdomen!

My wife and I run two 5k’s (3.1 miles) most weekends. We also do a variety of five to seven mile runs. 10k’s are popular in Massachusetts and they are 6.2 miles in length. I recently ran my first half marathon (13 miles) in New Bedford, MA. My most recent five mile race found me accelerating during most of the last mile, which was very exciting and rewarding, particularly where in high school I was a sprinter specializing in short distances. The five mile race before that one I ended the race by sprinting at top speed for the last fifty yards or so to achieve a certain time. I take special pleasure in passing runners, especially younger runners, which increasingly is mostly everyone! Mick Jagger could have been describing what I think of running in “Jumpin’ Jack Flash” when he sang ‘it’s a gas’!

Racing is a new activity for me and I was fairly inactive prior to my first operation. My times for the runs are getting better all the time and I won four or five medals in my age class (60-69 years old) last season. The essential racing season seems to be April or May through about Thanksgiving. However, there are some races during the winter, including club races. We have run in the rain, in the snow and at 25 degrees. I work-out six days per week either through a race (or races) and/or at the gym and I enjoy doing so! My resting heart rate is incredibly low. I have gone off all of my prescription medications except for one (and I seriously question whether I even need that one.) I consider myself to be an elite athlete and I feel like one and, except for some loose skin, I look like one. (Although not for me, a lot of gastric bypass patients end up having plastic surgery to ‘take up the slack’.) At my highest weight, I barely fit into size forty- six inch waist pants and wore 1x and 2x shirts. I now wear medium shirts and size thirty-two inch waist pants. If I had plastic surgery and removed some loose skin around the waist, I could fit into thirty inch waist pants. NW does have an affiliated plastic surgeon who generally leads an evening meeting once or twice a year. Those sessions seem to be especially popular!

The literature would say that I have added a number of healthy years to my life. Note that I described them as ‘healthy’ years. For an obese person, years at my age would most likely be “sick” years with lots of medications and conditions and frequent trips to the doctor. I can’t tell you what that means to me to have extra healthy years. If you are an obese person, the question might be: what would this mean to you?

Concluding Remarks

I’d have the operation again tomorrow, no questions asked, and notwithstanding my having had a number of complications. Most patients say the same thing: they’d certainly do it again and with no reservations! Check out Center for Weight Loss Surgery for more information. NW has a new patients’ meeting one night per month where you can go and have one of their four surgeons present the whole procedure to you in an entertaining power point presentation and then answer whatever questions you might have. You can get the dates for the meetings off of their website. There is no charge for the meeting and the meetings are generally from 6:30 to 8:00 pm, either on Tuesdays or Thursdays. NW even validates parking for folks attending these events so that the parking is free. You won’t even have to identify yourself, if you don’t wish to. For a post-surgery patient, going to these meetings is a kick (as well as strongly recommended by the doctors, to assist the post-surgery patients in maintaining focus on their new life-style and the demands that it requires.) At these meetings, there are a number of people there who are very over weight, which you would expect seeing.

And, there are an equal number of people who just look . . . average! If you are reading this and have a severe weight problem, what would you give to look (and pass for) ‘average’? Here is the brutal question that each of us with a long-term weight problem has to answer: ‘If I have been this heavy for (fill in the number) years and nothing I have done to date has worked with lasting results, what realistic chance do I have of somehow getting rid of the weight and then keeping it off!’ Many folks are never successful in getting all of the weight off. And, the literature says that keeping it off is much harder than losing it. In forty years of dieting, I only got to goal weight one time - back in 1987 - and I achieved this on the day I went on a vacation to Maine. I lasted only one entire day on my diet and then discovered a really killer fried wonton place in Wells, Maine. Statistically, one has something between a two percent and a five percent chance of losing long term significant weight and then keeping it off. And, those of us who have done it know that every additional diet one does only makes the next one that much harder and that much less effective.