A Suitably Innocuous Blog

Had my three year follow up and while my weight fluctuated some over the past eighteen months with the mystery anemia episode in early 2007, I only gained five pounds from last year's checkup. I'll take that. Exercise is becoming more and more a regular thing, so the weight should actually decrease by next year's checkup.

Anne said the biggest problem relating to weight gain is carbs. They are too easy to eat. Don't I know it!

The way things are going, I shouldn't have another WLS specific post until this time next year. Life after a gastric bypass is pretty good :)

Technorati Tags: WLS, gastric, bypass, weight-loss-surgery

I missed out on gallstones and gallbladder removal surgery (cholecystectomy) after my gastric bypass, but probably only because I had lost a lot of weight on protein sparing fast several years before.

Here's a rule of thumb: If you lose a 100 pounds, you will lose your gall bladder at some point.

Gallstones and the ensuing spasms as your body tries and fails to pass them are the worst pain I have ever felt. Additionally, mine were misdiagnosed by an ER doc who did not listen to what I said and decided it was bogus chest pain. I endured months of attacks before I found out what was going on.

I know what "10 out of 10" pain feels like now.

I had a reminder of that pain Thursday night/Friday morning when I started trying to pass a rather large kidney stone. No lead up symptoms that seemed to indicate kidney stones, and I was confused by the pain at first, but I finally figured it out.

The pain is different from gallstone spasms but it is just as excruciating. Unlike gallstones, the spasms never went away, and I could not find an analgesic to reduce the pain. Fortunately, the docs at Christ Hospital did find something. The only thing I found that seemed to help the pain at all at home was a hot shower. The house has a great water heater and I took a couple of hour long hot showers before I gave up and went to the ER. The relief lasted only about 15 minutes after each shower, but if you've been there, you know that helps.

Several hours waiting for an OR to open up and my urologist to free up we concluded with me getting doped and scoped and the stone removed via ureteroscopy. It was a big one, 5mm, almost but not quite through the duct from the right kidney to my bladder. Apparently it broke up easily once they got to it. 5mm doesn't sound like much, but the duct is only 3mm in diameter.

It isn't clear to me why kidney stones are more likely for gastric bypass patients. I suspect it's a combination of insufficient fluid intake, higher ratio of protein in our diets, and the calcium supplements we take. I'll find out more about what caused this and how to minimize my future risk, and If it's relevant, I'll make a WLS related posting.

WLS works because it changes our bodies in many ways, but some of those changes can cause problems in other body systems. Be aware of these potential problems if you are evaluating WLS. If your provider doesn't explain these issues, or minimizes them, I suggest finding another provider.

UPDATE:

Given the runs to the hospital this year, for whatever reason, I was advised to get the Pneumococcal Polysaccharide Vaccine (PPV). Not many phrases will have three words with double-Cs in them :) This is the pneumonia vaccine, and while I'm younger than the target age and I don't have any of the long term health problems listed in the flier, and my spleen is just fine thank you very much, it seems like a good idea to get this.

I got the shot while being discharged yesterday and I haven't noticed any adverse reaction.

I slept well at home last night and while I do feel a need for some pain killers, I'm doing well enough. The one bit of pain I didn't expect but have gotten used to is that when I do go empty my bladder, my right kidney hurts. I assume that's just soreness aggravated by fluid flow.

Tags: gastric bypass, health, kidney stones, weight loss surgery, wls

Jackie spotted this in today's Enquirer Weight Loss Surgery improves survival rates:

The first long-term studies of stomach stapling and other radical obesity treatments show that they not only lead to lasting weight loss but also dramatically improve survival. The results are expected to lead to more such operations, possibly for less severely obese people, too.

Researchers in Sweden and the United States separately found that obese people who underwent drastic surgery had a 30 percent to 40 percent lower risk of dying seven to 10 years later compared with those who did not have such operations.

That's two separate long term studies. While the surgery is not without risks, there are real benefits.

The research, published in Thursday's New England Journal of Medicine, should put to rest uncertainties about the benefits and risks of weight-loss surgery and may cause governments and insurers to rethink who should qualify for the procedure, some doctors said.

"It's going to dispel the notion that bariatric surgery is cosmetic surgery and support the notion that it saves lives," said Dr. Philip Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, who had no role in the research.

I have to say that I've been lucky and haven't run into anyone who seems to regard WLS as a cosmetic procedure, but I know some people who have. I'm not sure evidence matters to such folk, but it's good to see the evidence anyway.

Tags: health, obesity, weight loss surgery, wls

While you don't go "all Atkins" after a gastric bypass, some things are on the should not eat list, and other things are on the can't really eat anymore list. Many pastas and grains are on both lists.

I'm more tolerant of some rices and some pastas than other bypass patients, but there are times when it gets really boring and it becomes easier just to stay home and eat cheese and crackers. The cheese is OK, but the crackers aren't. I've found that couscous in small servings is good, as are some ravioli style pastas, but I miss a stir fry with rice and veggies.

While browsing the produce section of Fresh Market, I found some tempeh. I've never made anything with tempeh, though I do like soy and tofu. I found this "three grain tempeh" from Lightlife. It's got some brown rice, millet, and barley in it for texture. It stirfries up great with some fresh asparagus. It provides plenty of protein while giving some of that rice texture that is so nice to have from time to time.

It's also a fiber bomb at 13 grams per serving, but they say fiber is good for you :)

Recommended to other gastric bypass patients looking for something grain like to try. It was easy to work with and cooks up quickly.

Tags: cooking, wls, weight loss surgery, soy, tempeh

My most recent blood work came back with my "h&h" both well into normal and my iron also in the middle of the normal range. I went over all the results with Anne and everything was, finally, normal.

I was able to avoid iron infusions, and I only take two iron tablets a day instead of three. I'll do follow up blood work sometime mid summer assuming I don't have any relapse. The cause of the anemia is still a mystery, but if it doesn't recur, I can live with a little mystery in my life.

Over the past three weeks, there has been a real upswing in my abilities. People have noticed that I look better (pinked up is a term they used in the hospital at one point) and Bob says my "smart ass factor" is definitely back to normal :)

The thing I notice most is that I can think again. Pent up code is flowing from my fingers into Visual Studio and I'm cranking out functionality at a good rate. Tom says "don't get sick again" and I'll do my best not to.

Oh, and I've noticed that my vision has improved and I can actually see the squinty fonts on this high DPI display. They aren't always comfortable, but I couldn't read them through most of the spring.

For the gastric bypass patient, I'd say be on the look out for mysterious fatigue and almost depression like mental impairment. If that happens and persists, get your iron and hemoglobin/hematacrit levels checked, and checked again in a month or so if they were reported as ok but you still haven't improved.

Technorati Tags: WLS, WeightLossSurgery, anemia, gastricbypass, health

Wow. I clean forgot that yesterday was the two year anniversary of my gastric bypass. I was too busy at work to notice. Doing well, eating better, and happy with the surgery.

Technorati Tags: WeightLossSurgery, WLS, bariatricsurgery, obesity, bariatric, gastricbypass

Well, mostly well :) I went to see Anne (the PA at my surgeon's office) for my two year follow up.

My iron stores are still messed up since the hospital stay in early February, but unless something untoward shows up in the blood work Anne ordered I'm OK. I feel more like exercising this week, and haven't had an "exhaustion crash" episode even though we did shopping and yard work this weekend. Three weeks or so ago, a shopping trip put me flat on my back for a while.

I'm to keep up with my iron supplements, but those will drop to two per day once my iron stores stabilize. I also need to get blood work and follow up with my primary care doctor every couple of months until they do stabilize.

My anniversary is the 23rd. Looking back, I still think this was a great thing to do. Bariatric surgery worked for me!

Tags: bariatric, health, obesity, Weight Loss Surgery, WLS

I'm in Colorado for the week at an oral health conference with Jackie. The conference ends mid-week and we'll take a mini vacation afterward. My mom lives down near the Springs, Jackie has friends in Denver proper, and we want to go to Boulder.

In spite of my recent problems with fatigue and anemia, I figured now was as good a time as any to see how I handle flying these days. I used to enjoy traveling on business, but as I got older and my weight crept ever higher, travel was more draining and I felt flying was literally "brutal". I got big enough that I had to fly first class to get a wide enough seat, and even then I needed a seat belt extension, and it was usually still too snug.

Brutal.

My last flight was a multi-week visit to Salt Lake for a Cincom project. After that trip, I never really wanted to fly again./m

Well, now it's two years after my gastric bypass, and I finally hopped on a plane. We flew out on a small Comair flight from CVG to DIA. Two and a half hours in the air in a cramped cabin with no first class travel options and I was fine. Dragging bags through both airports and then our hotel (a rather large conference center sort of place) was a bit much, but I'm really fine.

This is another example of a positive outcome from weight loss surgery. Being able to fit in a cramped airliner may not sound all that great, but when you can't do so, it makes a big difference.

When you are really obese, morbidly obese, everything is too small and too tight, and life is usually too tiring.

I'll be taking it easy and won't be playing tourist for a few days. I'm planning on working from the hotel--have laptop, will travel--until Jackie's conference is over.

Now, back to NFL draft coverage. How 'bout dem Bengals? Hall seems like a solid player with no character issues, and they really needed help in the defensive backfield.

Technorati Tags: bariatric, health, WLS, WeightLossSurgery, GastricBypass, Obesity

The other stuff I alluded to a while back is completely unrelated to my gastric bypass, but now that it's resolved I need to focus attention back on anemia, and at this point I am convinced it must relate to the gastric bypass in some way. It could be just a matter of malabsorption leading to a slow loss of iron, leading to the acute episode that landed me in the hospital at the end of January.

I'm sure that the constant fighting with tiredness that I've been doing since the middle of last summer is due to anemia. I started taking iron supplements in November, but was only taking it twice a day maybe 4 times per week. My blood work did not show any anemia in the summer, so this was recommended as a "try it and see if it helps" thing at my 18 month post-op check.

I have an appointment early next week with my primary care physician. The acute episode in the hospital was managed by the GI docs there, but now we're dealing with chronic issues and it's me and my doctor. I have a good doctor, and she'll help me get to the bottom of this, but I'm one of her first patients to have a gastric bypass. Moreso than for other patients, I feel that I have to take charge of my own care. There are plenty of things I can't do and don't know, but I can keep on top of my care.

As part of this effort, I called my surgeon's office to talk with the PA. Anne at UC Surgeons is great. If you are in Cincinnati and looking into a gastric bypass, I highly recommend the UC Surgeon's practice.

She returned my call and went over my history, the numbers I had (RBC, hemoglobin counts), and described some treatment options and tests based on her experience with WLS patients. I am now better equipped to talk with my doctor next week.

For the WLS patients out there wondering about iron deficiency anemia issues, here's some more details in the hope that this might be informative.

We never found a real bleeder in my GI tract, but the small intestine was not checked. We found no blood, the colonoscopy and EGD found nothing that would cause significant blood loss. We did not do a capsule endoscopy, so the small intestine could still be hiding a bleeder, but I've seen no signs of blood when I go to the bathroom. There could also be a bleeder in my remnant stomach. There are no non-invasive tests to look in there for bleeding.

At this point, a complete blood work up is in order, and should be repeated at regular intervals until we resolve this or my blood and iron levels are acceptable. The recommended tests are:

• CBC
• Renal panel
• Hepatic panel
• Folic Acid
• B12
• B1
• Iron

I'd get most of those at my two year surgical followup, but I'll ask my doctor to do these next week and send the results to my surgeon.

Seeing another gastroenterologist (I liked the folks at the hospital, but I'd rather not be hospitalized to see them again) may also be indicated. Anne recommend doing a couple of hemoccult tests as well to make sure they didn't just miss my passing blood back in January and February. If we get a positive result, it's definitely time for a specialist.

If this is really just an iron deficiency due to malabsorption and oral iron isn't getting the job done, a series (3) of iron infusion treatments down here at University Hospital to jack up my iron levels. Once they are restored, oral supplementation seems successful at keeping WLS patients healthy if they stick with it.

I'll stick with it.

I'll report more as I get more information. And, to answer the inevitable question, I still think the gastric bypass was a great idea and I'd still get one. I'm better off than I was 160 pounds ago :)

Tags: bariatric, anemia, Gastric Bypass, health, Weight Loss Surgery, WLS

The Enquirer - Cincy study: Obesity surgery soaring:

Inge, of Cincinnati Children’s, said the new study suggests the risks outweigh the benefits for most patients. But it also left many unanswered questions, including how teens fared after leaving the hospital.

Obesity surgery during the teen years poses different psychological risks than for adults, Inge said. Many teens already are struggling with identity issues, and rapid weight loss after surgery can catapult them “into situations that they didn’t really imagine before,” he said.

His center is taking part in a five-year study to examine the medical and psychological results of obesity surgery among teens.

This looks like an interesting meta analysis of a significant number of gastric bypass operations, including large numbers of patients in the 12-19 age group. I see more severely obese teens these days than I noticed in my teens and twenties, which seems in line with various obesity statistics that have been reported over the past several years.

Even with the apparent increase of both severe and morbid obesity in this age group, I do share the concern over possible psychological/identity problems. I had my "mid-life crisis" over a decade ago, and I have a great support system, so I haven't had any psychological problems related to my weight loss surgery. However, I don't think my situation is typical.

My surgeon required a psychological evaluation and release. Addictive behavior and binge eating are disqualifying factors, as they should be. Using food as a mood medication doesn't work after surgery, you can't "stuff" your feelings and bury them under food, the pouch just isn't big enough unless you are willing to hurt yourself.

One anecdote that I thought of immediately when I read the "situations that they didn't really imagine" quote above was about a married couple who both had gastric bypasses. The husband handled it well, but the wife began to be noticed by men, and went on a sexual bender. I believe they got divorced, I don't know what happened to her after that. I find this completely believable--I noticed some women "noticing" me in a positive way as the weight came off. It was nice, and I had the confidence to acknowledge it politely, but I have no urge to see just how far my body will take me.

Still, there was a time after I'd lost about 80 pounds where what I call the "Patrick Brain" (Coupling) tried to kick in and I had an annoying couple of months where parts of me were quite interested in getting promiscuous. I recognized it for what it was, my body felt good for a change, and got through it without doing anything stupid, but I can easily see how these feelings can lead one to do things best not done.

And that's as an adult. What about a teenager? Well, using the Coupling analogy, think Jeff or Jane.

I think more research is needed, but clearly good psychological health and self awareness are important to a completely successful gastric bypass.

Tags: bariatric, Gastric Bypass, health, psychology, Weight Loss Surgery, WLS