A new report by researchers at the Agency for Healthcare Research and Quality (AHRQ) has found that 40% of people who undergo weight loss surgery develop complications within the first six months. Complications include vomiting, diarrhea, abdominal hernias, infections, pneumonia, and respiratory failure. Whew! That’s bad.

On the other hand, most people experience significant weight loss (50 to 100 pounds or more) and they seem to keep it off for long periods of time. Obesity-linked diseases, such as type 2 diabetes, high blood pressure, and abnormal lipids often improve and many people report being able to discontinue medications for those conditions.

The research used data from insurance claims from 2001 and 2002. The president of the American Society for Bariatric Surgery, Dr. Philip R. Schauer, is correct when he points out that surgical technique and quality of care has improved greatly since that time so current complication rates are likely to be lower.

The decision to have bariatric surgery is highly personal. Each individual must weigh the risks and benefits according to their own unique set of preferences. Some folks would never have surgery and refer to losing weight with diet and exercise as “the right way”. Others, like Wendy Hanawalt, suffer from overwhelming complications of obesity and, for a variety of reasons, including insulin-related weight gain, turn to gastric bypass as a last hope life-saver.

Wendy has shared what it was like living as a “really, really fat person” in her compelling story, “Memoir of a Fat Broad.” Now, with her permission, she shares what it is like to live with the after-effects of gastric bypass surgery.

 

So Much Less, So Much More – Life After Bypass Surgery

by Wendy Hanawalt (initially published on www.gather.com)

 

I won’t bore you with the details of my gastric bypass surgery. They’re pretty much the same as the details of anyone else’s surgery, minus the yucky hospital food, because I couldn’t eat any of that. I was on small sips of water for a couple of days. On the last day, they gave me some really, really putrid chicken broth, which I declined to finish.

What’s neat about the surgery is that for the longest time, I wasn’t even remotely interested in food. Something inside your body quite literally gets turned off, and you have no appetite for perhaps six months. You have to remind yourself to eat. What an experience THAT was!

So here are some of the things you might not know about gastric bypass surgery:

Your body does not metabolize vitamins really well anymore, never will. You must take chewable vitamins, stuff that dissolves quickly, because you’ve had a good chunk of your intestines rendered useless. Everything goes through that much faster. This also means that you can’t take time-release medications because it’ll be out of your body before it gets released! This was particularly annoying since I had to go from taking two verapamil a day to six, spread out in three-hour intervals. It’s hard to remember. You also need to have regular blood work done to ensure that your vitamin levels are staying up there. People who’ve had gastric bypass surgery and are not careful about their vitamin intake can actually develop fun diseases like beriberi, neuropathy from vitamin B deficiency—fun stuff like that.

You also need to be very rigorous about getting enough protein, because after all, you are losing weight so quickly that there’s always a danger that your body will start eating your protein stores—which is to say, your muscles. And you need to also drink lots and lots of water. My dietitian’s rule is the 60/60 rule: 60 grams of protein a day, and 60 ounces of water. However, you may NOT drink liquids and eat at the same time. I have heard a number of explanations for why this is so, and indeed, there may be more than one reason. One is that liquids cause food to expand in your stomach—not a good idea when your stomach is about the size of your thumb. Another is that it washes everything out of your system too quickly, which prevents you from experiencing satiation (and therefore, you’ll eat more), and prevents you from getting the full nutritional benefit from the food. Whatever. You cannot eat a meal and drink a liquid at the same time, so the first couple of months after surgery are basically a balancing act of trying to figure out when to eat and when to drink so that you can get everything in on time. It gets harrowing.

You also need to keep an eye on carbohydrate consumption, because too many carbs and you run the risk of having an experience called “dumping”.

Ah, dumping, how can I describe it? It’s like the worst drunken-sickies, stomach flu, and case of food poisoning, all rolled up into one. Nausea, possibly vomiting, diarrhea, the shakes, incredible pain, exhaustion, sweating. This is the most effective behavioral modification tool of the whole gastric bypass experience. Trust me on this: You don’t ever want to experience dumping if you can possibly avoid it.

Now the weird thing about dumping is that it’s not necessarily predictable. Different foods cause different responses in people. My surgeon says, “Most people have their first experience with Chinese food. They think they want to try it, and they’re feeling pretty cocky.” I didn’t do too badly with Chinese food, and I can actually have a piece of pizza without too much trouble. But chocolate cake. Oh my God, chocolate cake.

I didn’t even have that big a piece, you know? It was Christmas, for cryin’ out loud, and I just had the teensiest weensiest sliver imaginable. Well, not teensy weensy enough, apparently, because it wasn’t long before I was bent over in pain, begging to die. It lasted about an hour, the longest hour of my life. I can’t even look at cake now without cringing.

Because I am a weasel and a total chocoholic, and because I would rather be dead than live without chocolate, I tried skating the edge of my usual chocolate frenzy to see what would happen. A full Snickers bar sent me over the edge, like the cake, but I found that I could manage a couple pieces of dark chocolate from a store in town where they make their own, heavenly, chocolate. I buy a half a pound of dark chocolate creams—orange or lemon or strawberry, oh my!—and I dole out two a day to myself. I thought that I would never be satisfied with two, but I don’t know what it is—it could be that before, when I wolfed them down, I never left time to taste them, or it could be that my taste buds have actually improved as a result of the surgery—but, in any case, the experience of just those two little pieces of candy is exquisite.

But as I said, dumping—or, for that matter, tolerating food in general—is not predictable. Prior to surgery, people kept telling me, “Oh, you’ll never be able to eat beef. You’ll have to eat chicken and fish.” Imagine my surprise when I discovered that beef was the only meat I COULD eat. I can eat tiny bits of chicken, either ground into chicken salad or cut up into a Caesar salad, but any more than that, and it gets stuck. When I say it “gets stuck”, that’s quite literally what happens. It won’t pass through the tiny little opening in my stomach, for some reason. The physical sensation is of having a rock in the middle of your chest, not pleasant. Fish can do the same thing. Pasta? Forget it. No way. Rice? Not happening. Bread? Interestingly, if it’s whole wheat bread, it’s not a problem, but anything of the white bread variety sits like a rock. And it seems to change, so that one day, something that works fine suddenly makes you sick. It can be very upsetting. I have, on more than one occasion, bemoaned the fact that I have done this to myself.

Whenever I get to feeling that way, I go for a walk. It helps not for the stress relief necessarily, or for the release of endorphins, or any other “athletic” reasons. It helps because it forces me to remember that I CAN walk! One short year ago, I was, for all intents and purposes, crippled by my weight, by bad knees, by neuropathy in my feet, by incredible pain in my back. But now, I just up and go, sometimes walking two miles without breaking a sweat. Why, I actually jogged for a little bit the other day! I’m not sure it’s such a great idea, what with the knees and all, but the fact that I could even entertain the possibility of running down a woodland trail was nothing short of miraculous.


This blog was originally published on the PEERtrainer on July 24, 2006.