My friend Nikki got weight loss surgery. She and I thought her experience would make for an interesting article, so I called her a few days after her surgery.
Nikki has been uncomfortable with her weight since she was nine years old. She has always been pudgier than her peers and it made her self-concious and often unhappy.
One of my first questions was "What have you tried so far"?
I'm not a heartless jerk, but I did think that weight loss surgery has a certain appeal for folks who lack the strength or the will to successfully lose weight. Besides, I already knew that she had tried a bunch of different things, so I thought it might be enlightening to quantify what "I've tried everything" really means.
Things Nikki tried before she had surgery
Nikki tried Weight Watchers three times, first in Los Angeles, when Weight Watchers was focused on food groups, then again Weight Watchers was retooled into points, and a third time, when it was called "Weight Watchers Flex".
She tried medically supervised weight loss with a private doctor, Dr. Hendricks.
She tried the "SP cleanse".
She tried twice to lose weight with the guidance of a dietition.
She tried SlimFast.
She tried Nutrisystem.
She had a fitness trainer for two years. She has had a gym membership since she was 16 years old. In once stretch she went to the gym five times a week for eight months. She joined an ultimate frisbee team and found that she really liked playing frisbee. She joined a rowing team and found that she really liked rowing. Her mom had an idea to help her lose weight and cooked all of her meals for her, including a continuous supply of sugar free Jello. That lasted for an entire year.
She exercised so much in college that she was diagnosed as bulimic, apparently doctors call what she was doing "purge via exercise"
She did not try Jenny Craig.
Typically diets would work, then she would plateau and gain the weight back. For example she managed to reach 155 lbs. for her wedding in 2003, but was up to 220 lbs. in 2011.
She was not ever happy with her weight.
Considering a Surgical Solution
Late in 2010, Nikki became concerned that she might have a thyroid problem. She brought this up to her physician, who sent a sample to the lab for analysis. The physician said that her symptoms might be caused by her weight, and asked her to consider lap band or gastric bypass surgery if her thyroid results came back normal.
Nikki had considered surgery, but not seriously. Like many people, she thought of weight loss surgery as being for other people, people with a serious weight problem... morbidly obese people.
As you might have guessed, Nikki's thyroid results came back normal. Her symptoms were weight-related, and she was considering surgery as a solution.
Well, here's something I didn't know. Insurance covers weight loss surgery. Nikki has health insurance with UC Davis Medical Group through Western Health Advantage, and her surgery was covered 100% by insurance with no co-pay. Apparently overweight patients are more expensive for insurance companies in the long run, because they tend to need more medical care over time. For example, a single diabetes patient might cost an insurance company $50-$60,000 per year.
Gastric Bypass is the standard, most common and most successful bariatric (weight-loss) surgery, and it effectively cures (or mostly reverses) diabetes because it re-routes the small intestines guts in a way that eliminates problems with sugar and insulin imbalance.
There were a few things related to the surgery that Nikki had to pay for, such as medication and food.
Qualifying for Surgery
To someone who has been trying to lose weight, surgery might seem like an awesome shortcut to good health. But, of course preparing for surgery has its own set of mile markers.
After Nikki got a referral from her doctor, she attended a four-person group meeting with prospective surgeons, and a 1-on-1 with her surgeon, totalling four and a half hours. After that meeting, Nikki ruled out gastric bypass surgery. Based on her age, he reccomended gastric sleeve (also known as vertical sleeve)
She also attended an "introduction to surgery" meeting with about 100 people.
She also had to take a psychological evaluation, which consisted of about 80 true or false questions, such as "I often eat in private" and "my weight holds me back from doing things I enjoy". It also contains a few questions like "last week I was on the cover of 8 magazines" just to keep patients from marking "true" to every question. A few weeks later, she had an hour-long session with the hospital psychiatrist who asked questions from the written test. She also wanted to hear her position on why she was doing this.
Pre-Surgery Tests She had a pulmunary evaluation
She had 14 vials of blood drawn and tested
She met with an optomologist
She had an EKG
She had a physcial and Pap smear
She had an ultrasound of her abdomen
All were required before she would she could be considered for surgery. She was only assigned half of what could be assigned. Other things that might be assigned include a Cardiologist evaluation, sleep apnea test, diabetes testing, stress test, and a physical fitness evaluation.
After the panel screening and psych test, Nikki had a one-on-one meeting with her doctor, Dr. Ali. He listened to Nikki's expectations and recommended that she choose between the a) gastric sleeve surgery or b) waiting. This happend that first day.
Based on the choice presented to her by Dr. Ali, and by reading patient accounts on the web, Nikki decided against lap band surgery. Apparently there were more than a few lap-band patients who ran into problems with the band moving. Those patients who had suffered through a problem with lap band were often changed to gastric sleeve patients... that is to say that they had to have a second operation to fix the the lap band situation.
Gastric sleeve surgery
In gastric sleeve surgery, the stomach is reduced in size. The stomach starts off as a football shape - larger-than-a-pear pear shape, with an entrance at the top and an exit at the bottom. To put it as simply as possible, gastric sleeve surgery removes one side of the stomach, leaving a long, thinner bag, about the size of a hot dog. The entrance (from the throat) and exit (at the top of the intestines) are unchanged, which means that patients won't have a sugar shock problem, and they won't re-route intestines.
One shortcoming of gastric sleeve surgery is that it results in a long staple line, a long repair along the side of the stomach where the other half was removed. This long staple line is considered the main weakness of the gastric sleeve operation, so a lot of care goes into making sure it heals properly after the operation.
Gastric Sleeve: Removes 70-80% of the stomach along a long, somewhat vertical seam Gastric Bypass: Removes 75% of the stomach at the bottom, requires that the intestines be reconnected down there.
Before the Operation
After qualifying for surgery and getting a date set, Nikki was on her way.
Patients are advised to lose weight, a lot of weight. The pre-op goal is 10% of the difference between what you weigh at the start and your goal weight for after the surgery. Nikki did well, but ran out of time. She had been fast tracked due to her excellent heart and physical health. Normally, the process takes 6 months before you get a surgery date.
Leading up to the operation, she was restricted to clear liquids for the last two days. She had grape juice, jello and broth. Not at the same time.
Nikki's previous experience with surgery was having two children by Caesarian.
She was admitted to the hospital at 5:30 am and was ready in plenty of time for her 8:00am surgery. I don't know how common this is, but they actually tied her arms and legs down, to prevent her from thrashing around when she was on the operating table.
She was put under sedation and woke up 2 and a half hours later, at 10:30 or 11 a.m. The operation was a success.
She mostly slept the rest of the day, really waking up at around 7 pm that evening. At 11 pm she was encouraged to get up out of bed and walk around the hospital ward. This was to help the flow of blood and speed her recovery. This helps prevent blood clots - another common side effect. People at highest risk for clots are women, overweight people, and people who just had surgery... So Nikki got the trifecta.
The worst part of the hospital visit, including the surgery and recovery, was the dry mouth. When you have an operation on your stomach, the doctors have to watch your food and liquid intake extremely closely. That meant that Nikki had to go almost 48 hours with no liquid in her mouth. It was HORRIBLE. The only relief was that she could swab the inside of her mouth with a sponge-pop, a small sponge-on-a-stick that became her best friend that day. Another thing she had to deal with was the nausea from the anesthesia.
That afternoon at 4 pm, she was given a barium test, so that the doctor could check for leaks in her digestion with an x-ray. Nikki describes the barium drink, " It was disgusting and made you want to puke."
The barium test revealed no leaks, so two hours later, at about 6pm, she was finally allowed to drink. They removed her catheter.
She stayed one extra day because her barium swallow was so late, they didn't have adequate time to see how she would handle the clear liquid diet. so she stayed one extra night for monitoring and safety.
After that, a drainage tube was removed, which was in place to allow excess fluid and air to leave her body from the area of the surgery. This tube was about 4 or 5 feet long. It was nuts and to Nikki, by far the most disturbing thing about the surgery. The doctor had to brace her hand on Nikki's abdomen and yank as long and fast as she could to try and make it less evasive. It took her 3 or 4 full arm length yanks.
She had arrived at 5:30am on Thursday. On Saturday at noon, she was ready to leave the hospital. In sum, gastric sleeve surgery had been less painful that her caesarian section surgeries. Both required cuts through the abdominal muscles, which was a main factor in predicting her recovery comfort and time.
Nikki hadn't eaten during her time in the hospital, but she was super bloated when she got home because she had had a saline drip bag plumping her up. She lost that water weight over the next few days, and her first big weight loss step was revealed.
Nikki is actually getting used to abdominal surgery. The stomach muscles are apparently an invisible hand in every movement you make, and flexing the healing muscles is scary painful, because it feels like the movements are tearing something inside of you.
After Nikki's first caesarian, it was a month before she recovered enough to stand up out of a chair by herself. After her second caesarian, she did it in a week and a half.
After the gastric sleeve, she could stand from a chair within four days. This shortened time is likely a combination of factors, chiefly that she learned more about what her body could handle, and that the incisions were smaller for the gastric sleeve compared to the incisions from a Caesarian.
Continued recovery landmarks include waiting four weeks until she is cleared to go back to work, six weeks until she can lift more than 10 pounds, eight weeks until she can eat normal food, and six months until she can stop taking antacids and gall bladder medication (rapid weight loss can cause gall stones).
Q1. Weight-wise, where do you hope to be at the end of this?
A1. Maybe 155 lbs., down from 222 lbs. at the beginning of the process, down from 213 lbs. at the time of surgery.
Q2. Do you know anyone else who has had Gastric sleeve surgery?
A2. Most of the famous weight-loss-through-surgery figures have had gastric bypass instead, although Muhummad Ali's daughter has had the gastric sleeve surgery.
Q3. What is next?
A3. I've been advised that I should see a therapist, to avoid a transferrence of my eating habits to shopping addiction, alcoholism, sex addiction or gambling addiction.
Q4. What if you hadn't had health insurance?
A4. I'm not sure what I would have done. I do know that there is a clinic in Mexicali, Mexico which advertises their weight loss surgery package for about $8,000 US. U.S. doctors typically charge $20K for everything and because it's a new surgery, there are only a few insurances that agree to cover it. Most will cover gastric bypass, but not the sleeve.