Sadie

On that photo below, I mentioned son Jeff, grandson Gavin, but neglected Labrador Sadie.  Sorry, Sadie!

Seven months and 90 pounds later

On November 20, I weighed 184 -- 90 pounds less than when I started.  Now that's all well and good, but my mental image is still that of Fat Guy.  So when I looked at this photo, I had a hard time figuring out who the old guy at right was.  Haven't yet incorporated that into my image.  But this photo will help.  It was taken by Susan Boulden in her house on Thanksgiving 2011, and includes son Jeff, grandson Gavin, and me.


Other news of November:  Went to my diabetes specialist yesterday, and he told me all the numbers look great.  HbA1c was 6.2, and the other tests were equally good.  He told me I could stop taking the last diabetes medication that I still have.  (I had been off insulin since surgery, but continued taking Januvia until now.)  Earlier, they took me off blood pressure meds, and I'm gradually winding down the others.

Last night I started a custom exercise program offered through St. Vincent's, guided by a Physician Assistant named Brooke.  There were five of us there.  Four were experienced in the class, then there was me.  I worked out for an hour, then burned out and relied on dear wife Virginia to take me home and feed me.  My blood sugar was only 56, which was why I had crashed.  Hopefully, dropping Januvia and eating a bit more on exercise nights will safeguard against this in future visits.

Six months after surgery

In three days, it will be six months since Dr. Ben-Meir performed gastric bypass surgery on me.  Time for a quick status report.

I now weigh 194 pounds, for a weight loss of 80 lb.  Loss has plateaued over the last couple of weeks.  I'm trying to exercise more to keep things moving.

Am now walking 2.2 miles four or five days a week.  This gets me close to the distance I used to walk before open-heart surgery in 2006.

After taking blood pressure meds for 38 years, they are no longer part of my life.  Cardiologist Dr. N broke the news to me a few weeks ago:  You no longer have high blood pressure.  You can stop taking the pills.  And this morning, my primary care physician agreed.  Oh wonders of a merciful God!

I had been dizzy and unsteady on my feet, and asked another doc if dropping the BP meds would help.  Yes, she said, but you should also switch the Tamulozosin (prostate med) to nighttime.  It's an alpha-blocker and that is partly responsible for your dizziness.  So I made the change, and I haven't had any attacks of dizziness since.  Bless that woman!

Had family and friends here for my 70th birthday party over this last weekend.  Monica's family local, Jeff's family from Simsbury, CT: Skylar, Erick, Evangeline, Hannah, Susan and Jeff.  Gavin couldn't get off work, so we skyped Saturday afternoon.  I am truly blessed to have such a wonderful, supporting family!  And my dear wife Virginia worked her fanny off for a month doing the hard work involved in bringing off this special event.  Profound thanks to all!

Life before Bariatric Surgery (Life about 5 months later, Oct. 3, in red)

Life before Bariatric Surgery

(Life about 5 months later, Oct. 3, in red)

Last night in our presurgical meeting, they suggested that we leave a written record of how things were before the operation, and what we hoped to obtain from the surgery. The point they made is that after some elapsed time – say, a year or two –we'll be feeling good and keeping on a rigorous diet/activity program won't seem so important. So, to avoid backsliding then, it's best to leave a record of things now. Here goes.

How I feel Now

I am about 1/4^th through my 70^th year (now 100%). Weigh 274 lb (now 194). Am in weakened health, suffering from diabetes for 20+ years and hypertension for 33+ years. I joke that I take more pills than Elvis, and though I joke about it, it does bother me. Right now, I take three pills to control blood pressure, of which the most important is Diovan. To control diabetes, I use Lantus insulin and two types of pills. With all these meds, my BP comes in at about 122/74 (now 90/50), and my HbA1c at between 7.3-7.7 (now 6.6). Several of my pills warn me that “may cause dizziness,” and they do. I often feel light-headed in the morning after taking the pills, and a few times have fainted or fallen down from it.

I have always been fat... fluffy … stout. Pick your word. I remember going on my first diet when I was four years old. But for 60 years or so, I felt healthy and enjoyed my life. My favorite exercise was walking, and I would walk two miles nearly every day. Even when I traveled for business, I would slip away from my hotel and walk a couple miles in the evening, and enjoy it. Now, I wear pants with a 46-in. Waist and shirts with 19-1/2 collars; and 2XL shorts and sweats. Now, after “shopping in my closet” I'm wearing those size 40 pants and smaller shirts.

After open-heart surgery in 2006, I went through rehab at Lakewood Hospital and carefully restored my health until I could walk again for my normal two miles. Then something happened, and my walks had to be shortened to only one mile. This around 2007. And here's where I am now:

Exercise Rehab Value, 2006 Current value, 2011 And now

Walking 2 miles 1/3 mile, see below 1.4 miles

Stationary bike 10 minutes 90 seconds ?

Arm “bike” 10 minutes two minutes ?

It's a cold winter, so I'm not walking outside. I go to the Westlake Rec Center to use their indoor track, which is twelve laps per mile. I walk the first lap, then stop to catch my breath and do some leg stretches. Than after each additional lap, I stop briefly to take six deep breaths before continuing. I go a total of four laps, with equates to 1/3^rd of a mile.

When I go to the Rec Center, I focus much of my workout on resistance exercises. I've been told that resistance, rather than cardio, will increase my metabolism as well as increase strength. Can't tell if it's working yet. I usually spend 30-45 min. on resistance and give some of the effort to my legs as well as arms and chest muscles. Most resistance work on machines, rather than free weights. Typical weights worked with are about 20-25% less than three years ago:

Exercise Current Weights for two sets of 8 reps 3 yrs ago

Squat thrusts  170                                                   210

Leg curls 70                                                              90

leg extensions 70                                                      90

Arm curls 50                                                             50

Arm pulls 90                                                            110

And Now?  Haven't done that much resistance work post-surgery. Noticeably weaker. The ol' weightlifter now has stick arms. In short, I'm healthier, but not stronger yet.

I live in a two-story house with lots of stairs, and they tax me. My legs are strained to get me up stairs on their own, so I use my arms a lot, pulling on the handrails to get myself up the stairs. Then coming down, I need at least one hand on the rails. I fear losing control on descents, so hold carefully. On one business trip, to a Solid Works conference, I lost control and fell on a down escalator, falling and damaging my shins. At another conference, I damaged my right big toe, causing an ulcer that required several months to heal. In both cases, I attribute my problems to my excess weight.

What I Hope to Achieve 

When my brother Greg had bariatric surgery 13 years ago, it cured his diabetes. He no longer needed to take insulin. This is my first and major hope or expectation that drives me to have this surgery. It worked. Woo-Hoo!

• I've taken meds to control blood pressure since I was 33. Again, I am hoping that I will need less medication to avoid hypertension. Total BP meds reduced to one-eighth former level, and cardiologist says I can stop them entirely.

• I'm hoping I can walk two miles again, and walk a little faster than my current labored pace, so I can walk with my wife and family. Definite improvement, but I'm not walking as much as I should.

• I hear stories of fat old guys going through this type of surgery and then running marathons in a couple of years. Doesn't seem realistic, but I'm willing to try. Not at 194. Maybe at 174 or 164 or even, God willing, at 154.

• As I've gained weight and size, I've bought a few new clothes in larger sizes, but often have not disposed of the clothes that no longer fit. I'd like to wear them again. I'd love to wear the size 42 pants I once wore, or the size 40s that my wife bought me by mistake. How nice that will be. Again, a hearty Woo-Hoo!

• When I was younger I had dreams of major projects like perhaps walking the Appalachian Trail, or the smaller trail through Ohio. I've kind of given up on them, but when I lose some weight, I'll re-open those subjects.
• I'm trying to avoid any expectation that I'll feel younger. Or sexier. But when I shed weight, I do expect to feel better. And healthier. And I'm told that the combination of weight loss and increased exercise that it makes possible often lead to increased levels of testosterone, which can improve moods and spirits as well as body functioning. So we'll hope for this too. And I do look and feel better, and healthier. The other benefits are yet to manifest themselves.

Now, Life After Surgery

Went to a monthly follow-up meeting last night, and Dr. Courtney Holbrook, who ran the session, gave me two  writing assignments.  This is The Second.

For this assignment, Dr. H asked us to write about what our life was like After surgery, to help us remember why we decided to have it. She suggested answering questions like these to focus my attention on the prospects and possibilities of change.

Describe how you have changed.  Major change so far is dietary compliance with my pouch, my "tool" that has replaced my former stomach. I eat three meals each day, focusing on protein first. About 1200 calories per day, emphasizing meat protein sources (mainly chicken and fish) and veggies.  And some fruit.  Much less carbs than I ate before surgery (BS), and less fats.  And smaller servings, no grazing.  No sweets, either.  The only real sweet thing I've eaten in four months was a partial piece of wedding cake at grandson Erick's wedding to Evangeline.  And I felt guilty for 3 days.

What are your dreams and how are you achieving them?  I'm not much of a dreamer.  There are a number of things I'd like to do on my Bucket List, and the major change offered by the surgery is to improve the odds of me being here to do them.

What is it like to live in your new body?  Pretty much like the old body.  I've lost 70 pounds, but I don't yet feel really different  Much of the weight loss has been from my arms and legs, and so my torso feels unchanged.  Now, in honesty, my pants sizes have dropped from a tight 46 to a loose 42. And today I'm wearing a loose comfortable shirt that I couldn't button two months ago.  But I haven't really made an emotional adjustment to a "new body."  Yet.

How do you define health for yourself?  Not being blind.  Not having my feet cut off.

What are you looking forward to?  Pretty much the same things I looked forward to BS.  Family life, friends, spending time with my wife, children, grandkids, and great-granddaughter.  Still working on my bucket list, and would love to take a tour that would travel over the route of the Lewis and Clark route to the west coast.  I'm hoping to organize a family reunion next year to celebrate the life of a great-grandfather who pioneered settlements in eastern Utah.  And I may go back to my writing job.

What interests that you had wished for when you were overweight are you pursuing now?  Uh, I still feel like I'm overweight.  Ask me again after I lose another 35-40 pounds! :-)

Life Before Surgery?

Went to a monthly follow-up meeting last night, and Dr. Courtney Holbrook, who ran the session, gave me two  writing assignments.  This is The First.

For this assignment, Dr. H asked us to write about what our life was before surgery, to help us remember why we decided to have it.  For me, the answer was simple: diabetes.  I had fought this affliction for over 20 years, and despite reasonable care and close compliance, I was starting to see my end game, and it wasn't pretty.  My eyes were damaged, and I am restricted from night driving.  I had a stroke in 2006, followed by heart surgery.  And I was feeling effects of diabetes in my feet and legs.

Some of my friends and contemporaries have had much more serious issues.  Three of them have had leg/foot operations, and two have had parts of a foot amputated.  Because these are dear friends, it was easy to see myself in their shoes, and predict that another few years would leave me with amputations and blindness.

I had wanted to receive bariatric surgery five years or so ago, but my then-primary care physician vetoed it.  "Absolutely not," he said.  "That is dangerous, unproven surgery and I'll never approve it."  I eventually found a new PCP, but never trusted him enough to discuss this.  Fortunately, my insurance provided an alternative to requiring a PCP approval.

120 Interesting Days

Okay, it happened.  Surgery April 20.  Weighed 274 pounds, felt like crap.  Checked into St. Vincents hospital on 20th, and surgery performed by Dr. Ben-Mier that afternoon.  Was in hospital about 4 days total, dealing with issues of blood pressure, heart rate, etc.  They took me off insulin the day of surgery, which I thought was wonderful.

Now, four months later, where am I?  Today...
     ...I weigh 204, showing a weight loss of 70 pounds.
     ...I am still off Insulin, and my fasting blood glucose yesterday was an excellent 96.
     ...I am taking about one eighth as much blood pressure medicine as BS (Before Surgery.)
     ...I'm taking half as much heart rate medicine.
     ...I can walk 1.4 miles in less than 30 minutes without stopping to catch my breath.
     ...Curiously, I am not exercising as much as I need to.  This is a bit of a mystery to me.
     ...My arms and legs look to have carried me through a famine.  The ol' weightlifter has stick arms now.
     ...I'm troubled by intermittent bouts of dizziness.  Today at Costco, almost fell into my shopping cart.  Several other people pitched in to keep me upright.  This happens embarrassingly often, like maybe once a week now.  WTF???

Last-minute flap

Some excitement last week, followed by a reprieve of sorts.  My surgery still scheduled for the 20th, but early in the week, they told me I had flunked a blood test and needed clearance from a nephrologist.  A Kidney doc.  Now I don't have the greatest relationship with my kidney doc.  When I called mine for a rush appointment, they told me the earliest I could get one was in June.
>
(Why do I have a poor relationship?  Well, it feels like they mainly give gloomy warnings rather than useful therapies... grave warnings about how I'm killing myself with  diabetes... blood pressure... etc. It sometimes feels like the kidney docs are all operating a cosmic Ghoul Pool and the one who comes closest to guessing my departure date gets to wear the coveted black cloak for a week.  Or something.)
>
Since my regular kidney doc couldn't see me for two months, I called around and got an appointment with a young guy  I'd never heard of.  To my shock, he was a good guy, told me I was doing a good job managing things, and the surgery would provide an enormous step forward in my health and lifestyle.  And wrote me the needed letter, larded with wonderful phrases like "Stable over last four years" and  "...no contraindications .."  I could have kissed him.  And that was my reprieve.


Bottom line:  surgery still on track for April 20.>
>

Countdown to Surgery

April 20 is my scheduled date for Surgery.  Went in yesterday for the pre-op testing.  Started at 7:15 at the hospital, and finished about 2:00.  Wound up with a graduating class of four guys, and we went through together.  I gather this is an oddity; many of the nurses there to train us said they had never seen an all-guy group before.  Here are some of the things covered:

• Housekeeping details, like insurance, ID, co-pays, and release forms. Ah, yes, the release and consent forms.
• Lung-function tests.  Blow in the little machine.  Blow fast.  Blow slow.  Over and over again.  I passed, but had to promise to use a little torture machine (spirometer?) 100 times a day to keep lungs strong.
• Blood work and EKG.  Detailed medical history.  No surprises here.
• Met with MD for instructions on meds.  What to keep taking; what to stop (like aspirin) and what to reduce (like insulin.).  Good meeting, many questions answered.
• Nurse came in to review details of meds.  What to crush;  how to open capsules.  Why not to take whole pills (they can get caught in the surgically altered pouch) and how to swallow crushed pills (sprinkle powder on applesauce.)
• Dietitians Dina and Erin brought us order forms for high-protein snacks and drinks, along with samples.   I guess folks complain about taste, so they wanted to give us a preview.  Yummm.  Also diet log forms and day-by-day menus for post-surgical noshing.

At least one blogger gives the date of her surgery as the date she was reborn.  I need to take some picturea of myself, showing my fantastic physique (ha!) to document how I looked on my rebirth date.  These will become my "before" photos, and I'll post them for your amusement.

Gastric Bypass now Recommended Treatment for Diabetes

In an earlier post, I mentioned how friend Greg was cured of diabetes by having gastric bypass surgery.  And how that was my main reason for having it.


Watching ABC News last night, I was surprised, but delighted, to hear that GB is now a "recommended treatment" for diabetes.  They replayed that news item this morning, with Dr. Richard Besser weighing in and noting that the very act of the surgery can cure diabetes.  That you man not need to lose a lot of weight (although we all plan to), but that undergoing the surgery provides an immediate cure, often before you leave the hospital. 


How about that?


http://abcnews.go.com/Health/diabetes-organization-recommends-surgery-treatment-option/story?id=13241219

Insurance and Doctors

Earlier I promised to tell you what my insurance company required before they would approve weight-reduction surgery.  Four things:
First, a letter of approval from my primary-care physician, PCP.
Next, a similar letter from my cardiologist.
Then, an evaluation from a psychologist based on at least 3 interviews and 2 personality analyses.
Finally, an educational program with a dietitian three months long, with four visits, dietary instruction, logging of food consumed, teaching and training, with acceptable weight loss during this time.


We'll review all of these over the next week or so.


I had wanted this surgery several years ago, and started then to meet these requirements.  But when I talked to my then-PCP about approving it, he stunned me with the vigor of his refusal.  "Absolutely not!" he said.  That surgery is unproven, and for you, unnecessary.  There is an element of danger in any surgery, and you are not heavy enough to justify the risk.  I will never approve this for you.


Though disappointed, I accepted his counsel and dropped my plans.  And then was stunned again, several years later, to find he was leaving his PCP practice to join the Bariatric Center of a major hospital.  He was going, I realized, to specialize in that "unproven, unnecessary" program with "an element of danger."  How about that?


He and I have never spoken since that day.  And I left with this intent:  Dammit, I would have weight-reduction surgery, and I would not be talked out of it.  

Getting Approved for Bariatric Surgery

Latonya called yesterday with the good news.  My insurance company has approved me for weight-loss surgery, and I can expect a call from the scheduler.  In the next month, I'll check in at St. Vincent's for a gastric bypass, then hopefully start shrinking.


It seems everyone wants to lose weight, and lots of folks are considering a surgical approach.  You too?  Then stick with me, 'cause I'm going to tell you what works and what doesn't... what prep is required ... what changes in lifestyle are needed ...the good and the bad.  I'll let you know, up close and personal, what this entails.  Then you can decide if it's right for you.


I've been fat all my life.  Went on my first diet at 4, 65 years ago.  Could always lose weight, would always gain it back.  Married 48 years, raised kids, loved my grandkids.  So sort of a normal guy.  A normal fat guy.  Then became diabetic 20 years ago.  On insulin, I find it very hard to lose weight now.


Friend Greg was in the same fix.  Had a bypass years ago.  Dropped 130 pounds.  But found the surgery cured his diabetes.  No more insulin, no more testing.  This is what I want.  If I become a skinny, sexy new me, I can handle it.  But my first goal is to whip diabetes. 


Another major goal is to tell you what's involved.  The prep work, the education, the hoops that insurance made me jump through.  So in future posts, we'll talk about monthly meetings with Dina the Dietitian, Latonya the Patient Advocate, Lisle the Shrink required by insurance, and the others who have helped me.


And you.  I hope to hear your story.  We want this to be a dialog, not a monolog.  I'd love to hear where you are in the Journey to Skinny.  Perhaps we can learn from each other.