This Little Hell We Call WLS Part 1

For those of you "not in the know"--most of the population actually probably doesn't know what it means so don't worry--WLS stands for "weight loss surgery."  It's a great gig if you're a doctor as one third of this country is obese and quite a few of those are morbidly obese.  This country has an incredibe obsession with being skinny, and most of that is justified.  Like many in this country, I was clearly morbidly obese.  At the beginning of this year I weighed 334 pounds.  Thankfully I have a bone structure that can hold the weight but still, even I knew that was too heavy.

For my entire life with the exception of my college years I was always overweight.  Up until my late 20s it was never more than twenty or so pounds over what was considered "ideal" back then.  Though, to be honest, my doc kept on telling me that I should have been 120 pounds, which I think was physically impossible because of my bone structure.  My dad always told me that if I had been a guy I would've made a great linebacker for the Chicago Bears.  Heck, even at my skinniest I never got below 140 and people commented that I looked too skinny.

Then in the late 1990s I got sick.  I developed severe clinical depression and many of the meds that I was on caused me to gain a ridiculous amount of weight.  Even though I was physically active those first few years, I managed to balloon up to 225.  As time went on, the weight continued to go up.  Finally, I hit my peak of 334 earlier this year.

Now before you go into that diatribe of why didn't I diet or start exercising, it was easier said than done.  I did try to diet.  I did every diet out there from Weight Watchers to Nutrisystem to even being stupid enough to go on Fen Phen.  They worked great in the short term but something would happen--life mainly--and I would have to stop.  Then I would gain the weight back plus some.  Exercising became more and more difficult.  When I was younger I was incredibly active.  Even in my late 20s/early 30s I played ice hockey.  However, once that weight started to go up my ability to exercise became more and more difficult.  As my body had to deal with all that excess weight, I started to develop joint problems including severe arthritis in both my knees and ankles.  As I slowed down, my lungs started to decondition.  Walking up the stairs, which once was an easy jog, became literally painful as I was gasping for air.  Exercise was no longer an option.

I realized a while back that I needed to do something.  Luckily, the only co-morbidity I had developed was sleep apnea.  However, I knew it was just a matter of time before something even more severe like diabetes or a heart condition developed.  I had contemplated WLS but the whole idea of having my intestines rerouted (gastric by-pass) was not something I really wanted to do.  I had also thought about the Lap Band as an option but I had never met anybody until last year who had it done.  So I did some more research and finally in the fall of last year decided to seriously look into the Band.

Now every single bariatric (weight loss surgery) doctor requires that a person attend a informative seminar before meeting with them one-on-one, no matter how much research you may have done.  So last December I went to such a seminar and I found out about a relatively new surgery called the Vertical Sleeve Gastrectomy, more commonly referred to as the "Sleeve." It's an interesting procedure as it does not completely redo one's plumbing.  Instead, around 80-85% of the stomach is removed to change the stomach from a pouch into a sleeve-shaped organ.  The purpose of this is to cut down the food a person actually consumes and thus he/she should lose a significant amount of weight.  I was fascinated by this and did more research.  By January I had decided to have the Sleeve surgery and met with the doc who would perform it.

There is a lot involved in getting WLS.  It's not like I could just walk into the doc's office one day and have the surgery the next day or even the next week for that matter.  Besides the usual pre-op testing, I had to first meet with a nutritionist to make sure I understood what I was getting myself into.  I learned that I would never be able to eat more than 4oz of food at a time and that I had to permanently give up things like soda.  That I could live with.  Even the restrictions on bread and pasta were worth it in order to get my health back.  Next was pre-certification from a psychiatrist.  Basically, my doc wanted to make sure I didn't have any eating disorders and that my mental health was good enough to undergo a life altering surgery.  As I already had a psychiatrist this was easy as he knew my issues and believed I could handle the surgery from a mental point of view.  There were also more seminars and nutrition classes.  Even after all of this, I felt ready to handle the surgery both mentally and physically. I was prepared and scheduled my surgery for the middle of March.

Let me just say that anybody who thinks that WLS is the "easy way out" needs to be smacked.  Besides all of the work that I had to put in prior to the surgery, my life after the surgery was a living hell.  I had to spend three days in the hospital post-op because I couldn't drink enough water (4oz an hour).  The thought of putting anything into my stomach at that point was just torture.  Plus the barium test I had to go through...ugh.  I had to swallow barium, which has to be the nastiest liquid on the planet, the day after my surgery to make sure there were no leaks in my stomach.  I literally almost threw up all over the incredibly expensive x-ray machine. 

Things did not get any better when I got home.  I had scheduled my surgery so that I would have Spring Break to recover but I needed much more than a week.  A lot of this had to do with the post-op diet.  To help my stomach heal, I had to do two weeks of clear liquids only followed by two weeks of full liquids and then two weeks of mushies/soft foods.  That liquid diet was hell. 

First off, in all those nutrition classes I attended, I was told that everything should be sugar-free if possible.  So before the surgery I bought sugar-free jello, popsicles, apple juice, etc.  What they don't tell you is that your body needs SOME carbohydrates in order to function.  My body went into ketosis, fat-burning mode, which is what the doc and the nutritionist wanted to happen.  The thing is, my body did not like it.  Now I've heard that many people go through carb withdrawal and that it causes some serious unpleasantness like lightheadedness, shakiness, headaches, etc.  I definitely went through that but it's only supposed to last a few days.  However, as the first week went on I got worse and worse.  On top of those symptoms I started to feel groggy and mentally in a fog.  I looked up the symptoms of ketosis but beyond the really bad taste in my mouth I didn't have any of the others, including the increase in energy, so I grew concerned.  The mental fogginess was the worst though.  How was I supposed to teach if I could barely remember where I was?  My energy levels were also so low that I was afraid to drive for fear of passing out.  When I spoke to the nurse practitioner she told me what was wrong: I wasn't getting in enough carbs.  Uh...hello?  I was told no sugar and as I was on a clear liquid only diet that meant that my carbs were sugar.  She told me to try adding more sugar into my diet and I should feel better.  I did and I saw a small modicum of improvement but I was still not doing so great.

Things got a little better once I hit my third week and could enjoy "full" liquids.  I was so sick of Gatorade, Jell-o, and popsicles by this point that the thought of having soup was practically orgasmic.  Then by week five, I could have mushies.  I actually made a turn for the better once I started to get some solid foods into me as I was able to get close to my protein intake by this point.  Also, mushies meant sashimi and that was heaven, let me tell you. By week seven I was on solid foods.  Things were looking up at this point.  I was feeling better, still not 100% but better, and I had more flexibility with food.  I was getting my strength back up and was looking forward to starting exercising at the gym.

Then at the end of May things changed...