What it Feels like to Have Vertical Sleeve Gastrectomy

This post might’ve come a little earlier in the process, if not for the weight of the process itself. And the first bit of what I want to describe is directly connected to that.

For the first few weeks and months after surgery, I was overwhelmed. The combination of pain, discomfort, fear, confusion, decisions, etc. etc. etc. is a big weight to bear. If you have really really good coping mechanisms and/or tend to ignore stressors in your life, your VSG might not be as heavy. But for me, it took over my life for a few months. Sure, I was able to get back to work and be a good husband, etc. But ALL my extra energy and time was soaked up in thinking about, working on, and addressing my new physical reality. In my opinion, a person should do their very best to not embark on any new big projects, goals, or activities in the months following surgery. You’ll probably be able to get back to work within a week or two, but if you’re anything like me, it’ll take some time to get your mojo back.

Some other observations about the experience of being a VSG patient early on:

  1. It was painful. If you read back on my posts, you’ll see that I actually had a couple of different surgeries. The story is long so I’ll spare you. But in my experience, the second one (which actually succeeded in removing part of my stomach as planned) was far more painful than the first. Eating/drinking was EXTREMELY labored for several weeks following surgery. For at least 2 weeks, one or two small swallows made me feel nauseous, full to the point of pain, and very uncomfortable. It often took an hour or two just to get my pills down (a three time a day process).
  2. It was scary. If your clinic is anything like mine, they put the fear of God in their patients to follow the plan. My folks reiterated many times that if I cheated the eating plan, I risked my safety. They said they’d had a couple leaks over the past 10 years – but very few. And each time it was because a person had eating out of plan, too early. Because I live 3 hours away from the hospital where I had surgery, I was especially terrified. Almost more than anything, I didn’t want to have a problem. That fear, for better or for worse, kept me on the straight and narrow.
  3. At first – for at least a couple months – I really did have no appetite at all. Food for me became strictly fuel. It was utilitarian. I didn’t really find myself craving food all that much; it just wasn’t on my mind. I like that. I am no longer in that frame of mind now almost a year later.
  4. Once I started being able to eat little bits of even soft food, I had to CHEW A TON before swallowing. The practice that my dietician had me doing before surgery for months, suddenly had a cause and made sense. It’s preparation for what it will be like after. While I can take bigger sized bites today; even a year out, I cannot eat big giant bites of food. And if I swallow something that isn’t very well chewed, it is uncomfortable in my stomach. No good. If you are considering VSG, practice eating differently: Slower, Smaller bites, Chew longer – these practices will necessarily become the new normal after surgery.
  5. I had 5 small cuts on my stomach where the instruments were used for surgery. Each of these were glued closed with some kind of surgical glue. After about a week, they began to fall off on their own. I had very small scars for a while; but today they’re almost unnoticeable. Especially with body hair (sorry if TMI); females without body hair on abdomens might have more noticeable markings. But really, they’re tiny. And at least for me, I kind of like the battle scars – almost like a tattoo of my journey. These cuts were a little painful for a while; but nothing compared to the internal discomfort.
  6. Another When I started eating, the floodgates of desire opened if you will. While I was still on liquids, I hardly thought of food. I was on a schedule, every 2 hours I drank a shake, and that was that. But once I started reintroducing food, my mind nestled back into old patterns. This was disturbing to me. Scary. But almost immediately, cravings returned once I started eating real food. I knew I couldn’t have certain things; but I WANTED them. I wrote about this dynamic before – but there was a time in my life when I imagined I’d get to  a place where I’d never have to think about my diet again. I imagined just being able to eat whatever, and have it be the right thing where I wouldn’t  be at risk of weight gain.
    I’ve come to believe that that time will never come. It’s a pipe dream. I will always have to pay attention to my eating. And I will always have to tangle with cravings to one degree or another. Surgery wasn’t on my brain. And my brain still wants ice cream and white bread and junk from time to time.
  7. A surprising thing for me early on was that I really was able to tolerate most foods very well. Some folk describe having really messed up palates or physical reaction to certain items. I didn’t get that for the most part.
    However, I did find that if I ate very dry, very rough meats especially, my stomach revolted and I would vomit. This has only happened a couple times since surgery but both times it was in response to Italian style meatballs. Even after chewing very very well, they haven’t set right with me. But otherwise, I’ve been shocked by the minimal consequences to food choice the surgery has seemed to have.
    Despite sampling sweets from time to time, I’ve never experienced dumping syndrome per se (unless that was it after the meatballs) – and all the foods I liked before surgery are still appealing to me.
    I wouldn’t bank on NOT having an issue (i.e. if you can’t imagine losing certain foods forever, surgery might not be fore you) – and I wouldn’t bank on definitely having issues (i.e. choose not to have surgery for fear or losing foods). It’s kind of a crap shoot I’d guess, and it’s difficult to predict. Be flexible.
  8. Vitamins. My clinic checks labs every single visit. The first was 1 week post op. The next was 1 month. Then 3 months, then 6. And in a few weeks I’ll be going up for the 12 month check. some of the things they have looked after so far include: Iron, B12, Vit. D, plus all the normal stuff. I started with a chewable celebrate brand multi vitamin for bariatric patients. I couldn’t tolerate it. I threw up daily for 4-5 days and then quit. Once I was able to eat food, I switched to swallowable Bariatric Advantage multi with Iron. I like these a lot and have had no issues since. It’s about $20/mo and I have no idea how normal that cost is. I wish insurance would cover it since it’s required because of my surgery. No such luck yet.
  9. Quantities. At first, I was able to eat just a tiny bit of food before feeling uncomfortably full. One small personal container of greek yogurt was very difficult to finish at one sitting. I had to stretch drinking a protein shake out to 30-40min. But over the subsequent months, my volume of consumption has grown from just a few bites – to be able to consume maybe 2cups of volume of food at a time. As one might expect, the nature of the food matters. Salad/lettuce/veggies fill me up much quicker than creamy strained soup or shakes. I can eat more chili than I can cooked, drained, pinto beans. If foods are “lubricated” with sauce, grease, gravy, etc., I can eat way more. This has probably always been the case, but it’s highlighted now because of my  new physiology.
    At moments, I’ve been scared about what for a while seemed like consistently increasing capacity. “What if I am stretching it out!?” was my fear that has been shared by hundreds of others before me.
    Well – so far, I still can’t gorge myself. In moments where I might be drawn to eat out of control (a night a couple weeks back when my family had purchased some big cream-sauce pizzas comes to mind), I still am limited far beyond what I could put down before. In a circumstance like that in the past, I probably could’ve eaten over half of a large pizza, if not the whole thing over the course of a couple hours. Now, I may be able to push myself to 2 slices at ~900 total calories. But it becomes impossible to eat more after that.
    While my challenge over the years has been far more about grazing and snacking, my new physiology saves me – and has already saved me – from getting out of control.

 

I’ll probably think of more initial reactions later. But again, like I’ve said, it’s been absolutely worth every hiccup all along the way. I would choose the same 10x over.

Day 327

It’s been quite the path since December 17.

One thing is for certain however, I have had zero regrets. If back in my situation of one year ago – and if given the opportunity to do what I am doing now, I would choose it again in a heartbeat. I feel good. I am grateful.

At the day of surgery, I weighed in at 276. Today I’m 231. So that’s ~45lbs lost SINCE surgery. When I first saw the doctor back in April/May of 2015, I weighed close to 320. So total weight loss is 90-100 depending on how you’re counting. I’m not fixated on the scale number, but I’d like to get down another 10-20lbs or so – so that exercising is a little more comfortable/enjoyable. I’d be happy if I stayed where I am though. It’s good.

But as I’ve said all along, the scale was never my primary measuring stick or landmark. So here goes, I want to share a list here of non-scale-victories I am now enjoying:

  1. I am off all my weight-related medications. Every morning I take vitamins and one other pill for an unrelated issue. That’s it. I was on 1 handful twice a day before. This is a gift.
  2. Blood pressure is normal. Went from 140/90 medicated – to 110/70 unmedicated. Feels miraculous.
  3. Liver panel normalized within 2 months of surgery. Seriously. By February 2016, all my values were back within the recommended range. Unreal. After literally years of having elevated enzymes. Fatty liver no more.
  4. All other relevant labs that were at issue are now normal.
  5. Cardio exercise is bearable/enjoyable. I find I have much more stamina and much less pain and suffering in a workout.
  6. Resting heart rate went from ~80 to ~60.
  7. Over the summer, I completed 2 triathlons. 1 was a short-speed length and the second was an olympic length. These were both major accomplishments for me – and absolutely would’ve been impossible before my weight loss. So fun.
  8. I run 3-4 times per week. 3 miles minimum each time. I don’t have to stop. I maintain a 10min/mile pace which is slow relatively speaking – but lighting fast compared with where I had been. A year ago, I wouldn’t have been able to run a half mile without stopping to walk. This too feels miraculous.
  9. While I can’t say that I don’t think about food often – and I’m not even sure if I can say I think about food LESS than before, I do feel less controlled by it. There was a time when I felt deprived if I missed out on an opportunity to eat particularly good/decadent food. I had a scarcity mindset. Today, I feel less of that. Overall, i think I’m less attached to food even though I still do crave it often. Not sure if that makes sense, but I feel progress in this area.
  10. I feel like I have more energy overall. I’m less tired; I’m more motivated. I feel healthier.
  11. I look better in clothes. This was never a big deal or a big goal of mine. But I do in fact like how I look better now. (As an aside, today 327 days out, I am still mostly in goodwill clothing – only a few items I’ve purchased new to replace my old wardrobe. I only buy name brand stuff from Goodwill, and only things that are like new. But a piece here and a piece there has yielded a pretty nice wardrobe. I’m not sure I’ll go back to “NEW” clothes 🙂
  12. A while back I wrote about how as a big guy, I rarely was invited to join people for outdoors/physical activities. In the last year, I’ve been invited to join friends and acquaintances in different workouts etc. more than I’ve probably been in my whole life. It’s remarkable. And nice.
  13. I flew in an airplane in September. It was relatively comfortable. I fit between the seat armrests. The seatbelt reached. I wasn’t in complete pain the entire time. Enough said.
  14. My shoes (expensive running shoes mostly) are lasting longer, wearing out more slowly. Less wear and tear from the weight I’d suppose.
  15. I am enjoying getting down on the floor with my sons. The best thing yet.

Anyways, I’m going to write more in the coming weeks. But this is just a quick sample of where I’m at. If you’re considering the surgery, know that this ‘survivor’ wouldn’t turn back if given the option. I’m forever grateful.running

Done. Day 17

Today I don’t feel so much “done” as I did back on day 1. Going through with the surgery itself was a huge hurdle. What has become crystal clear is that surgery day was just barely the beginning. I knew this was true. But experiencing it is different than thinking about it. What a wild ride.

I really meant to spend some time describing what my hospital stay was like — but I’m going to delay that a bit in order to write about the main focus of my past two weeks: eating and drinking.

As difficult as I found the liquid pre-op diet to be; it’s nothing compared to the post op diet. I read posts from some people on forums and other blogs about how the pre-op is partially about shrinking the liver, and partially about training for what is yet to come. That couldn’t be closer to the truth. While before surgery, I was required to only drink protein shakes and water, if I cheated once or twice it wasn’t a risk to my life. Now, a bite of jerkey or a few chips could put me in the hospital with a perforation or staple line leak. Sticking to the plan is more life or death than it is discipline.

*I just found this draft hidden in a folder here on wordpress. Posting it today even though I am now roughly 300 days out of surgery. More updates forthcoming.

Done. Day 1

Quick update. Unfortunately I don’t presently look quite as amazing as I did at check in yesterday. Be that as it may, the surgery went very well. No unexpected problems! I’m in my room with Paige and we even had a visitor last night. Much love to you all and thanks for your prayer and positive thoughts 🤕

Some observations:

  1. I’ve had a very difficult time peeing (tmi I know- dignity goes out the window when you’re in the hospital.)
  2. I got to have a thimble full of water this morning (day 1 after surgery) and it made me feel crampy, nauseated and just generally bad. 
  3. I’m in more pain this time than the last (I think). I can’t imagine how I survived at home last time with only Tylenol. Ugh. 
  4. This is hard. Pretty much Anyone who thinks this is ‘the easy way out’ Is either ignorant or an asshole (and probably both). 

That’s all for now. 

Here We Go (round 2)

After a two week hiatus since my first go at vsg, I’m headed to the hospital today for a second attempt. 

This time around I feel much less anxious and much more relaxed. Part of it may be that I already have been through it once – that I already know a lot of what will happen. Maybe a part of it is that I already had a pretty terrible awakening – disappointing to say the least. Maybe my thought is that I’ve already been through the worst!

Anyways, here goes. I’m down about 32lbs overall since May and feeling pretty well – roughly 70 more to go depending on how I look and feel once I get into the low 200s. 

Wish me luck! Surgery in 2hrs. 

  

Next Steps: Being both Post and Pre-Op

The first few days after surgery, I think I was in shock. Complete shock.

What just happened to me? I had gone from this long 8 month march to a very intense 2 week period of pre-op dieting and preparation — all to a pinnacle. And then in that moment, what I had waited for didn’t happen. Instead, I woke up with news about a tumor.

How could this be reality?

It actually took me several days to get to the place where my sadness and disappointment came out in tears. I had been in so much physical pain for the first 2-3 days after surgery, it was all I could do to sleep and stay caught up on medications. But once I began to reflect on how this thing I had hoped for didn’t actually take place — and that I got a tumor in its place — the disappointment rolled in. I tend to be a cup-half-fully kind of guy. I move forward. I am curious. I look for what I can learn. I try to be grateful even in pain.

But when this spirit keeps me from actually feeling the core of an experience, it becomes a little problematic. The truth is that this has been a painful experience. I’m sad. I woke up after all that hard work and fear and courage to find I hadn’t got what I had hoped for.

Now – In the days since my surgery, it has been a waiting game. I got a CT scan this past week which examined me from my neck to abdomen — looking for any additional tumors that the surgeon didn’t detect through the laparoscopy tools. I have yet to receive the report. However, on Friday night, just before the weekend, I did receive a call from the surgeon informing me that the initial pathology report on the tumor indicates that it is a rare lymph node tumor called Castleman’s disease. They simply grow in one off places, no where else, and aren’t cancerous per se or malignant. The curative treatment is to remove the tumor (which in my case has already been done). The doctor said he’d call me back on Monday with more information but that essentially I can rest easy with the report.

Needless to say – an amazing message to receive on a Friday afternoon.

Now – a question comes to mind: does this situation I find myself in change my want or need for bariatric surgery?

I mean, for all intents and purposes, I’ve gone through it. Yet of course my physiology hasn’t been changed. I’m still the same person I was before the last surgery.

Before we knew the tumor was benign, everything was on hold because if it were cancer, I would need treatment. That’s why the surgeon (rightly) stopped the initial surgery after discovering the tumor. If I had had a vertical sleeve gastrectomy, that would delay treatment for lymphoma or a cancer. Underneath that reality however, though, was that if the tumor turned out to be benign, nothing medically would stand in my way of undergoing surgery again.

In fact, while I was still in the hospital, my case manager called and talked with my wife and said as much. She even penciled me in for surgery again on December 17 — saying that as soon as we get the report that the tumor is benign, she’ll resubmit my case for insurance approval (because they ended up removing a mass and not doing the VSG, the first surgery will not be billed as bariatric surgery).

So this is where I’m at at the moment: Not yet approved for surgery — but planning on moving forward pending that course of events.

Some people have asked me if the discovery of this tumor changes my thoughts about surgery in general: is it a sign of some sort that I shouldn’t do it? Am I pushing my luck? Ought I forgo surgery a second time and keep trying to lose weight on my own (I am down around 30lbs in 8 months right now).

However, I actually see the equation in the exact opposite way. If I hadn’t had the courage to undergo this surgery in the first place, we wouldn’t have discovered the tumor. To me, doing what I’ve done so far is verification that I’m on the right path. And in terms of my health, nothing at all has changed. I need this VSG just as badly as I needed it before.

Time will tell.

 

 

 

 

 

Surgery: What Happened, Part 2

When I woke up, it felt almost immediate — and yet like an eternity. A truly odd sensation. I was put under for wisdom teeth removal about 8 years ago and it was a similar thing although yesterday’s experience was more pronounced.

The first thing I remember is nurses talking with me, asking about my pain, asking me if I knew where I was, etc. I was definitely in pain. My whole stomach and chest ached. I believe they gave me IV Dilaudid a couple different times and that stuff…man…that stuff is happy making. I can truly see how people get addicted. Mercy.

My only problem was that with my sleep apnea, I kept trying to not breathe during these periods of happy, joyous, pain free, stupor. So the nurse kept goading me to take deeper breaths; to get my O2 up. To work to stay awake. It was hard. And foggy.

The surgery took place right at about 7:30. The first I remember feeling lucid was around 9:45 in the PACU (post anesthesia care unit). At some point, the surgeon came to my bed and talked with me. He told me that they hadn’t been able to perform the gastrectomy.

This didn’t register with me completely at first. What? What did you do then? Wait…What? Again?

He explained that when they were inside me, they found a tumor, about 2 inches in diameter, resting on the back side of my stomach and entangled in a lymph node. They had to remove it. And because they don’t know if its malignant or lymphoma, they couldn’t proceed with the weight loss surgery. He told me I’d be going home that day. I was immediately disappointed. I wanted to cry but it hurt too band and I was too knocked out. I wasn’t with it enough to even ask the doc any questions.

A short while later (an hour maybe?), around 11am?, they wheeled me to a recovery room. This whole time, I had been asking for my wife and the nurse kept politely telling me that I had to get my breathing under control; had to get my oxygen up; had to wake up more before I could see her. It was in this second recovery room, on a hard recliner type chair, that my wife finally came in. Both she and my sister had obviously been crying. A lot. We hugged and hung out there again for quite a long time.

I kind of went in and out of consciousness in this room due to the pain killers I was on – but I recall the nurse (a different one this time) yelling at me every few seconds because the oxygen sensor would go off – I had stopped breathing. It of course wouldn’t have happened if I had been allowed to use my CPAP – but they wanted to get me out.

The surgeon eventually came out to this room and talked with us again. And yes, I had heard right. They found an enlarged lymph node or tumor right next to my stomach. It was 5-6cm in diameter he said and he in fact had a consult with an oncologist and pathologist right in the surgery suite while I was still under. All had agreed that he shouldn’t proceed with the gastrectomy because if it turned out to be lymphoma, I would need to get treatment for that: and a gastrectomy would prohibit it. Each of them also agreed that they thought it was an isolated tumor which makes it actually a very rare disease, Cattleman’s. The positive thing is that if this indeed is what it is, the curative treatment has already been completed: removal.

They sent me home from the hospital and over the past two days I’ve been in a LOT of pain. I can see why people stay in the hospital after having laparoscopic procedures like this. Mercy. The air bubbles in by body and traveling up to my shoulder have been extremely painful. Not fun.