Duodenal Switch Information Zone

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Surgeon: Dr. McMullen and Dr. Nicastro, Staten Island, NY
Surgery date: July 21, 2003
Pre-op weight/BMI: 389/53
Current weight/BMI: 258.5/33.6 (as of February 2, 2005)

Most recent update: February 2, 2005

 
Left: Night before surgery (389lb.); Right: 101 days post-ops (330lb.)

 
Left: February 2004 (286lb.); Right: Eleven months post-op (272lb.)

Above: February 2005 (258.5lb.)

by Bill:

Part One – The decision to have surgery

Welcome to my page. I am writing this because I read nearly every patient page on this site before having my surgery, and, now that I am on the other side, I hope that someone else will benefit from my experience.

Writing about the decision to have surgery requires a bit of background. I have been morbidly obese my entire life, but it wasn’t really a problem to me until the past few years. What I mean is, I led a very happy fat kid’s life, and grew up to be a very happy fat adult. I played a lot of baseball. I would always play Catcher because I couldn’t run after fly balls, and I had to be a long-ball hitter because I couldn’t get out of my own way on the bases (picture “Engleberg” from The Bad News Bears meets Babe Ruth). I was in the band in school too. I started out playing the trumpet in third grade, but the music teacher needed a tuba player. I was the obvious choice because I was the only kid big enough. This too was pretty cool, however, because I enjoyed playing the tuba very much and it brought a certain amount of celebrity (there were lots of trumpets, but there was only one tuba). The point I am trying to make is that I was not miserable with being obese. I was entirely comfortable with it for a long time.

What I did have going on, however, and what turned out to be a godsend later was that I had been trying for fifteen years to become a police officer. Starting at about age 18, I began signing up for the entrance exams. I took over a hundred exams and passed all of them only to move forward in the process and fail the physical agility tests. For that reason alone I was involved in an endless series of weight loss projects. I joined and left seven different gyms, and was on every diet known to man with mixed results, but no long-term benefit. This was important because my insurance carrier and many others require you to be able to document the fact that diets and exercise just don’t work for you.

About five years ago, my life came to a crossroad. I didn’t know exactly how much I weighed – only that I was off the end of the standard 350-pound physician’s scale. I was diagnosed with hypertension and my sugar was as close as it could be without being a full-blown diabetic. I also developed gout, acid reflux and sleep apnea. I soon was on seven prescriptions and needed two pillboxes to sort them out each week. I had to change blood pressure medications four times. Accupril made me cough and there was another that gave me hot flashes. All of this at the ripe age of 32. There were creepy little quality-of-life things going on too. I got booted off a roller coaster at Hershey Park because they couldn’t close the safety rail over me; I outgrew the largest dress shirts that you could get at most big and tall stores; I had decided to buy a particular new car, only to go the dealer and find that there wasn’t one model I could get into; and other stuff like that.

Part 2 – What surgery and where?

It was about this time that Al Roker and Carnie Wilson were hitting the media with their RNY surgeries. I started doing some research and wasn’t thrilled with that surgery nor with the restrictions afterwards. Also the percentage of excess body fat potentially lost didn’t seem to justify the effort. Then one day my wife, Ellen, took one of the kids to a birthday party. There was another parent there who everyone was falling all over about how much weight she had lost. The words “duodenal switch” entered my life for the first time that day and nothing has been the same since.

I did tons of research. I spoke to my primary care physician who was on board with the idea right away (I believe his exact words were “if you don’t do something soon, you will be dead in ten years”). I figured a few things out right away. I wanted the DS and only the DS. I didn’t care if it was “open” or “lap” and, therefore, leaned toward having it done “open” because I had read about problems with leaks and such when it was done “lap”. The last thing I figured out was there was no way in hell I could afford to pay for the surgery.

By now it was the summer of 2002. My insurance carrier was Horizon BC/BS of NJ. I tried approaching them to find out if they covered weight-loss surgery at all and the DS in particular. The hours I spent on the phone with Horizon would have been better spent banging my head against a wall. To me, the insured, they were entirely unhelpful. I worked the question from the other end and called every surgeon around my area that was doing the DS (all were in New York City) and asked them if they participated with Horizon. This got mixed results. Some places simply stonewalled me and told me I would have to show up at an information session in order to have any questions answered. Another place told me that they did participate, scheduled me for a consultation four months down the road, then when they called me to confirm the consult four months later, they asked me if I had heard that they no longer participated with my insurance. I asked them how, exactly, I would have heard that, and thanked them for wasting four months of my life.

The next call I made was to United Surgical Associates at Staten Island University Hospital. They confirmed that they participated with my insurance right away, and I got scheduled for an information class on February 4, 2003. I really had no idea what “participating with my insurance” meant. All it meant to me was that they were not asking me for any money up front. It meant that I could at least move forward and I would worry about the money later when the EOB’s started coming from Horizon. I figured the worst case was Horizon would pay at 85% or some percent of “usual and customary”, but I was also sure that there was no way of finding out in advance what Horizon was going to do. The only way was to do it and deal with them later (“Damn the torpedoes, full speed ahead!”).

Part 3 – The road to surgery.

Now, I have to insert a little disclaimer here. If you are an “ends justifies the means” kind of person, I will save you from reading all of this and just tell you that despite being unhelpful to me at all, Horizon, thus far, has paid well over 95% of the pre-surgery costs. I haven’t gotten any bills or EOBs from the surgery itself yet, but it appears that they are going to pay most, if not all, of it too. So maybe I don’t have a right to complain about them. Also, I was the most miserable and uncomfortable patient in the history of hospitals, and I am going to be whining to you about that too, but thus far I have had a miraculously smooth and complication-free recovery. My point is that I am telling you what I went through because it was helpful to me to read what others went through. I am neither unaware of, nor ungrateful for, the benefits I have received.

The information session was great. I got weighed that day and was 370 pounds with a BMI of 49.9. I went alone, but should have made an effort to get a babysitter and have Ellen go with me. It didn’t hit me until later on how much I was going to need her and how much of a partner she was going to be through all of this. I hear that now the office requires you to bring a family member or close friend to the info session and any office visits. It’s a good rule.

I left that day with what became known as “the blue book,” which is basically everything they tell you at the class reduced to writing. It set out a list of seven or so evaluations that would have to be done before I could get my surgery date, and before the office would seek pre-authorization from my insurance. These included blood work, venous doppler, pulmonary, cardiac, gastro, and psychological evaluations. I got the venous doppler done first. There was an office across the hall from the surgeon that got me in right away. It was a simple, but gooey, and I’ve heard they don’t require it anymore.

The blood work was a mini nightmare. You have to get some pretty obscure tests done, some of which require freezing and protecting the vials from light. It requires about ten vials of blood to be drawn. The lab I went to blew it the first time and failed to freeze or protect any of the vials. I had to go back again and then they told me they lost the vial that they put in the freezer. After finally getting the vice president of Lab Corporation of America (LabCorp) on the phone, they found my frozen blood somewhere and I got my results faxed to me. Incidentally, you have to have all of these tests done every six months or so, forever.

The psych was interesting. The blue book included a page that explained what the psychologist (or psychiatrist) had to include in their report. There was a list of practitioners who were familiar with the surgery included also. Some insurance companies required the report to be made by a psychiatrist, but fortunately mine did not. I called a few of the suggested names, but quickly determined that they must be taking the medications they are supposed to be giving to their patients. I had dollar figures into the thousands thrown at me. I had others who mailed me 40 page written examinations that they wanted me to complete prior to the first visit. Ultimately I called a local psychologist who had seen another member of my family at one time, and who participated with my insurance. I faxed her the page from the blue book and asked her if she could do what I needed. She charged be about $90 per hour for two hours, one for the visit and one to write the report. All but $18 of it was paid by my insurance.

The cardiac stress test was, well, stressful. I thought I was going to die on the treadmill, but I made it. The pulmonary evaluation was no big deal either. I knew walking in there that I had sleep apnea (just ask my wife), so I knew I was going to need a sleep study. That turned out to be a good thing. I got to the hospital at about 9:00 p.m. and was wired up and tucked-in by 10. I didn’t bother trying to watch TV, just turned off the lights and tried to sleep. They let me toss and turn for about three hours. I was told later that I had over 150 apnea “events” per hour for those three hours. Then they came in, woke me up from what little sleep I was in, and hooked me up to a CPAP machine. The next thing I knew – and it literally felt like the blink of an eye – it was 6:00 and they were telling me I was all done. I slept those last five hours like a dead person. I laid on my back, didn’t move, had only 3 apnea events (total), and woke up feeling like I could run a marathon. Two weeks later I had my own CPAP machine at home. That machine alone has changed my life, but I am still hoping (or expecting) that some weight loss will reduce my snoring and let me live as well without it.

The gastro evaluation required a general anesthesia and having a scope shoved down my throat. Other than my apprehension about general anesthesia, it was painless and effortless. (There was the scary moment when the anesthesiologist introduced himself to me and said “so, we are going to do a colonoscopy, right?” To which I said “oh, no WE are NOT!”) The strange part was they took some sample from my stomach and sent it off to some lab (small glitch getting the lab and anesthesia covered by insurance, but it worked out). Then they get the lab work back and tell me I have some bacterial problem that is very common and has, apparently, no symptoms. But, I have to take some enormous dose of antibiotics to treat it. I still don’t understand this one too much but for some reason I had to take some pills that made me sick to my stomach to cure a problem with my stomach that I may have had forever, but that I didn’t know about because it doesn’t do anything. Whatever – it was another hurdle behind me.

The last hurdle was that I was required to attend one of the monthly support meetings held by the surgeon’s office. This was pretty cool and it is important that you go. The one I attended was moderated by the staff nutritionist and by Dr. Nicastro. It was about half pre-ops and half post-ops. The post-ops were a mixture of people who had the DS, the RNY and the Lap-Band, but ALL of the pre-ops were there for the DS. It is clearly becoming the surgery of choice. You don’t hear too much bad news at the support meetings. The vast majority of post-ops that go to them are success stories and true believers. There was one girl there who said she was being treated for depression because she felt that she had lost too much weight and was not comfortable with her new body. I have heard that post-op depression is very common. I guess even a $2000 psych evaluation isn’t perfect. Personally I think they need to stop requiring them too, or change the focus of the evaluation drastically.

Somewhere in the middle of all these evaluations I had a consultation with the surgeon. Perhaps I should say I had a consultation with a member of the surgical team. I didn’t find out for a long time who, exactly, was doing my surgery, but more about that later. I met with Dr. Jerzy Macura. I liked Dr. Macura very much. He was confident, knowledgeable, had a great sense of humor and this delicious accent that reminded me of Martin Short’s character from the “Father of the Bride” movies. We hit it off well and I left the meeting feeling pretty good about the whole thing. A few months later I was on the phone with the office about some other things and they nonchalantly said, “By the way, Dr. Macura has left the practice and we need to know whether you will be staying with the practice or having Dr. Macura do your surgery.” The way they asked the question threw me a curve and made me actually think that there was a choice available here. In truth, even though I met with Macura didn’t mean he was going to be performing the surgery, I didn’t know what his new insurance affiliations were going to be, and the new hospital he was going to was in Brooklyn, which was more of a schlep for me than Staten Island was. I told United Surgical that I would stay with them, meaning whoever “them” was by the time my surgery actually got here.

Finally the day came that I got the call saying that I had been approved by my insurance (but STILL couldn’t find out what that was going to mean in terms of real dollars), and I got my surgery date of July 21, 2003. About a week ahead of that date I went in for the pre-admission tests (PATs). The PATs were what military people refer to as “hurry up and wait”. I was told to be there at 8:00 a.m., got there at 7:45, was checked in at 8:30, then waited 2 hours for a P.A. to do a physical, and two hours more for a chest x-ray. Some interesting things popped up at the PATs. First they asked me if I had been giving blood for myself in case I needed a transfusion. This was the first time anyone had brought up the idea, so I really hadn’t thought of it. However, they said you had to do it at least two weeks before the surgery and we were now 6 days out. Also, they asked if I had any removable dental work, which I do not. I did have a “permanent” bridge – permanent meaning it was cemented in, but still popped out every four to six years. It had been in for four years, so I just counted on it staying there, but wouldn’t you know it popped out the night before the surgery? I felt pretty lucky that it came out then rather than during the surgery.

A day or two later I met with Dr. McMullen and found out that she and Dr. Nicastro would be doing my surgery together. The meeting with Dr. McMullen was fine, and I was again fully confident in my “choice”. Dr. McMullen is very kind and very compassionate. She is both young in fact and in personality, which makes her very approachable, although finding out my surgeon was younger than we were made my wife and I feel old! All of the information we had gotten up to this point said that I would be on the regular surgical floor by the night of my surgery, but Dr. McMullen told me there was a good chance they would keep me in recovery all night the first night, and that this was normal. I also got weighed again and was up to 389 with a BMI of 53. I had gained 19 pounds in the last five months before the surgery.

Part 4 – Surgery

I think I was originally scheduled for 1:00 p.m. on a Monday, then they called me and pushed me back to 4:00, which still meant getting there at 1:30. At the PATs they gave me a paper about a “hospital comfort kit” but I missed reading the part about having someone bring it to you when you are in your room, and not bringing it the day of the surgery. The only thing I needed to bring to the surgery was my CPAP machine. I think some major apprehensions set in when I got to the hospital. One of the ways this came out was in my veins. All my life, and even the two times I had to go for the pre-op blood work, people who had to draw my blood loved my veins. I was easy. Lots of big fat juicy veins and almost anyone could stick me on the first shot. But from the point where I got to the hospital, all of my veins shriveled up and no one, but no one, the whole time I was at the hospital, could get a decent vein on me. Two different pre-op nurses couldn’t do it, and they had to leave me for the anesthesiologist. Once I got to the floor, they had such a hard time that they brought in the nurse that trained other nurses, and even she couldn’t get a vein. I left the hospital with over a dozen bruises on the backs of my hands and up and down both arms. It didn’t matter, though, because I was so doped up at the hospital that I was a very willing and even happy-go-lucky pincushion. I suppose it wasn’t all because of anxiety. You have to stop eating or drinking at midnight the night before the surgery, so maybe I was dehydrated too.

So they get me gowned up, and introduce me to “my” bed. They have special beds for bariatric patients (a “bari bed”). Very shortly two transport guys who spoke little or no English started wheeling me down the hall to a pre-op holding room. About halfway down the hall they started motioning to Ellen that this was as far as she was going and directing her to a waiting room. We said a quick goodbye and good luck and then I was whisked away. At this point, the possibility that I would be one of the less than 1% of patients who die on the operating table hit me like a ton of bricks. I wished she could have stayed with me longer. I wished I had more life insurance. The silly part was that the room I was in was just a few doors down and around a corner from the room she was in, and I just sat there cooling my jets for about an hour. Would have been nice if they had let her wait with me since I wasn’t doing anything anyway.

Finally, a really nice man showed up and introduced himself as my anesthesiologist. To this day I wish I had gotten his name and had gotten a chance to thank him. He was older, exuded confidence, and talked with me for a long while before the surgery which made me feel better. We couldn’t find the transport guys again to wheel me into the operating room, so we just decided to walk since I still didn’t have an I.V. or anything hanging off me.

Walking into an O.R., particularly when you know that you are the main event, is an eerie thing. I guess I had watched too many episodes of E.R., because this particular O.R. seemed to be an older room done in white bathroom tile with stainless steel fixtures and arrays of medical devices befitting a good horror movie. I remember looking at the tools and thinking “who do they think they are using THOSE on??” I remember lying back on the table and being under the largest lighting fixture I have ever seen and hoping it wasn’t going to fall on me. But then events accelerated. The room was empty when we walked in, but as soon as I was on the table it seemed like a dozen people streamed out of the nooks and crannies. The anesthesiologist started working on my arm for an I.V., someone laid warm towels on me, and someone else was just talking to me about the town I lived in and who she knew there. Then the anesthesiologist said to me, “this is just some numbing medicine before we put [something else] in you…” and that was it. Lights out.

The next thing I remember, I don’t really remember. It feels more like a dream. I came out of the anesthesia just a bit while they were pulling the tube out of my throat. I was panicked, flailing around, gagging, and calling out for Ellen. The anesthesiologist was there again and he told me that it was all over, I was fine, and that Ellen had seen me earlier and they had sent her home. He smiled at me and told me that if the subject ever came up again in the future, tell the next anesthesiologist that I am very hard to intubate. I passed back out for a while.

By the time I really started to wake up, I was in the recovery room and it was 8:30 the next morning. I felt like a truck had hit me. I had these pump-things on my lower legs, which I knew about and I knew were keeping me from throwing a clot and dying, but they also kept me from getting any rest. I also had a Foley catheter in place, which was a miserable experience. But, I did have a terrific nurse who had been one-on-one with me the whole night. She did everything she could to make me feel better, the best part of which was hooking up a phone so I could call Ellen.

An hour or so later, they started moving my up to “4-B” which is the surgical floor at SIUH. I got into a room at about 10:00 a.m. on Tuesday. Now, visiting hours didn’t start until noon, but for some reason the guy they put me with had his wife and son there with him. They only spoke Italian, but made it clear that my being there was a huge inconvenience. They closed the curtain between us, then shoved their chairs up against the curtain and into the side of my bed. They even elbowed me through the curtain a few times for good measure. The old guy who was the patient liked to run around naked with his colonostomy bag, so his wife turned off the air conditioning so he wouldn’t be cold. When I managed to complain a little about that, she turned it back on but covered all the vents with a blanket. I was too doped up to move or complain, so I just slid over to the far side of my bed and cried a while. Finally, when visiting hours really started, Ellen came in at about the same time that six more relative came to see colonostomy man (the limit on visitors was supposed to be two). A major argument ensued with his family. Five minutes later Ellen had the charge nurse in my room. Five minutes after that I was in a different room.

Unfortunately, despite a string of highly competent and compassionate nurses, being on 4-B was a miserable experience. Not every miserable thing was something that could have been avoided, but some sure could have been. The rooms are fairly typical, but between two beds, chairs, bed-tables, cabinets, I.V. poles, and the like, the rooms were entirely too small. When I was able to get up and move around later, it was like being one square on a Rubic’s Cube and having to jockey all the other squares around so I could get to the bathroom or out the door.

At this point, still only hours after the surgery, I was very much like a turtle on its back. I had a ten-and-a-half inch midline incision, which meant I couldn’t bend my abdomen muscles to sit up, and I couldn’t twist my abdomen to reach for things. I learned how to raise the back on the bed all the way, and how to drop the side rails so I could pivot and, after the foley was taken out, sit up on the edge of the bed and stand. The kept the leg-pump thing hanging off the foot of my bed, but they never put it back on me. I was grateful for this because it helped me sleep, but I also knew how important it was to get up and get walking now.

The biggest problem I had was with the I.V. The I.V. bag hung on a pole with its own pump and one of those pain-pump things. But the batteries on both pumps were dead, so if you unplugged it to take your pole for a walk or go to the bathroom, it would peep incessantly or make you press the reset button every 90 seconds, even after you plugged it back in. Also, the vein in my wrist had blown, so the fluids blew my hand up like a softball. My I.D. bracelet became so tight around my water-balloon of a hand that it cut the circulation off to my hand. Every time I complained about it, they told me it was OK.

After a while, the only doctors there I trusted were my surgeons. The surgeons would come in early each morning and check on me, move me along in the food progression, and fix whatever ailed me. Then, moments later, a school of residents would come visiting and one of them would screw up all of the orders the surgeon just wrote, then it would take the nurses four hours to reach the surgeons again, get the orders changed back, and implement them. The pain meds worked pretty well, I think I only used the pain-pump three times on the first day and not at all after that. I still had to lug it around the whole time, even after the transport guys got me into a stretch accident an the way to radiology and the pump got smashed up and broken – but not so badly that it would stop beeping at me.

During the hospital stay they sent me for an upper GI series and another venous doppler. The GI series was another miserable thing. For months I had been reading about how small my stomach was going to be. Now they take you down to radiology, you are as sore as can be and they make you lay on the rock-hard x-ray table for an eternity. They mixed up a full cup of the goop you need to drink that shows up on the x-ray and you actually become scared. You have had nothing by mouth for two days and you know your stomach only holds a few ounces, and they come at you with a 24 ounce cup of brown chalk dust and a straw to drink it with. You wonder “do they know why I am here? Do they know I will explode if I drink that whole thing??” However, I guess they knew because I survived.

Everything progressed much faster than I expected. I was on pureed foods by the third day and my felt quite good overall, except for the pain of the actual incision. I was discharged Thursday night just in time for the evening rush hour, so it took two hours to get home rather than the usual 45 minutes, but I was a happy camper now that I was going home.

Part 5 – Life with the new stomach.

Again, I think my recovery went remarkably well. I got home from the hospital with my incision looking like a zipper (37 staples, I think..) and with two drains dangling from me like tassels, but the only thing that hurt, or that I couldn’t do, was bend my abdomen. I needed help sitting or standing back up after sitting. I couldn’t twist by body from side to side, and could only lie on my back. We didn’t have the foresight to get a recliner, but commandeered one from my brother-in-law the next day. The recliner was great because I could get in and out of it on my own, and I could sleep in it (I was still on the CPAP machine, so I had been sleeping on my back before the surgery anyway).

I followed the diet progression in the blue book closely. I ate soft foods for the first week. Using the toilet became, and remains, a pretty miserable experience. I went back for my first post-op visit eight days after the surgery, got my drains and staples removed, and weighed in at 373. I had lost 16 pounds in the first 8 days (granted I was on a liquid diet for the first two days).

By 14 days post-op, I felt great. I gained back almost all of my strength and flexibility. I sent the recliner back and was able to sleep in bed and roll over. I began experimenting with different foods and found that I was tolerating everything well, but that I was definitely becoming lactose intolerant. I started to learn what my stomach was going to feel like when I tried to overeat. I began to play with some things like Lactaid, Beano, etc., but found that there wasn’t anything that was that hard to put up with. I started to see that the “diet” was not really a diet but a set of priorities. Eat protein first so you get it in before you get full, stay away from carbonated drinks, and take your vitamins. I returned to work (note that I have a desk job) at three weeks post-op, and then had another follow up 30 days post-op and was now 359 (that’s 30 pounds in 30 days, for those of you keeping score at home)!

And so, that brings us to today. I started writing this story back in July, a few days before the surgery. It is now the end of August. I have my next follow-up in October, by which time I will be three months post-op and will have gotten my first post-op blood work done. I feel great and am already off Claritin-D, Alopurinal, Baby Aspirin, and HCTZ. My pressure is still on the high end of normal, but my face is thinning out and my apnea has improved already. I have fallen asleep without the CPAP machine on a few times, and tossed it off in the middle of the night sometimes, and I seem to be sleeping OK without it. I still mean to put it on every night, but there are signs of progress.

As for the “diet,” from one perspective I am being bad and am non-compliant already. From another perspective, I am doing fine, because I feel great and I’m losing weight. I am sticking with the big rules, lots of protein and vitamins, but, with the exception of major lactose intolerance, my stomach “tolerates” everything. The portions are small, and I pay for it when I try to overeat, but beyond that I can’t really tell you what my diet is. I am getting active in the DS message boards and am starting to adopt a potentially dangerous philosophy that I have heard from others. First, the reason one has a DS as opposed to a RNY is that you DON’T want the dietary restrictions of a RNY. Second, most of the nutrition guidelines for DS patients were written by people who were writing them for RNY patients for years first. I know of only one nutritionist who actually started out with DS patients and who has had a DS herself. Maybe we are more like explorers or trailblazers and have to find out what works for ourselves for now.

This brings me to my last thought for now. I have started to hate, HATE, being introduced to other surgical weight-loss patients, and I will tell you why. Invariably when someone hears that you have had a weight-loss surgery, they know someone else who did, and the someone else they know has invariably had a RNY. This has happened about six times in the 39 days since my surgery. You meet this person and the very first thing they ask you is “how are you doing with the dumping thing,” or “are you on solid food yet?” I try to explain, as gently as I can, that dumping can happen in DS cases, but it is less likely and has never happened to me. Also, the diet progression was very fast and I am not having any problems with my “diet.” Now, it is to be expected that the RNY patient has no idea what a DS is, but what I am finding, and what is really tragic, is that I have been meeting RNY patients who don’t even know what the anatomy of THEIR OWN surgeries is. At about this point the RNY patient develops this look of dread as they start to figure out that they are going to be dumping and watching foods go by them for the rest of their lives and there may have been another alternative that they missed.

I know that at some point I will meet someone who will make me feel this dread. I know that going in for something like this is sort of like buying a computer – it is obsolete by the time you get it home from the store, but you have to jump in somewhere. Right now in some far away land someone is perfecting the next hottest surgery after the DS, or, worse, in a laboratory at some pharmaceutical company the “silver bullet” weight loss pill is being developed that will obviate the need for surgery at all. But still, it brings me no joy to talk about surgeries with RNY patients. I’ll write more after the three-month visit, but for now, I am delighted with my decision and its results.

Part 6 – Three Months post-op

At 93 days post-op I went back to United Surgical for a follow up and weighed in at 330.3. That’s a loss of 59 pounds. My BMI is now 45. I feel great and have had NO complications. My incision is healing perfectly. LabCorp screwed up my blood work again, but the results that did come through were perfect. My cholesterol, which was never high, is now remarkably low. My B-12 level was in the 300s, which was still in the normal band on the lab results, but the office wants it in the 400s.

As for life post-op, I am sorry to say that I continue to be “non-compliant” as far as any diet goes. I mean, I subscribe to the big picture, I eat lots of proteins, few carbs, almost no lactose, gave up carbonated drinks entirely, but if you were to ask me what “the diet” is like, I really couldn’t tell you. I am also sorry to say that I love it. Unless I eat something really stupid like fresh doughy bread, I never feel anything that indicates I had the surgery. What I do feel is that I have built in portion control and an appetite suppressant. I am simply not hungry the same way I used to be, and I can only eat a fraction of what I used to eat before I feel full.

Further along in the digestive track, however, things are different. (I apologize for this part being a little clinical and graphic, but that is what you are reading this for, right?) I do get a lot of lower-end gas that can come on suddenly and painfully. I have been playing with Gas-X and that kind of stuff but I am just so happy to be off all the prescription pills I was on, that I don’t want to start taking a dozen OTC pills now. (I am off all blood pressure meds now too.)

Using the toilet is also a new and miserable experience. Diarrhea occurs frequently, but most of the time stools are more like the consistency of cake icing. This too comes on very suddenly and sometimes painfully. Also, believe anything you have read about the odors. I have cans of air freshener in every bathroom at home and at work. I hooked up with Vita4Life Inc. (www.vita4life.net) for my vitamins, and I am playing around with a product called Devrom (www.parthenoninc.com) to knock down the odors. I’ll reserve my opinions on both until next time.

Anyway, did I mention that I feel great? I’ve started getting some exercise, mostly by doing more walking every day. I also moved into an office on the third floor of a building with no elevator (on purpose) knowing that it would force me to use the stairs more. All of my clothes are loose, I just had my first pair of suit pants taken in, shirt collars that used to be too tight now hang an inch below my neck, pants that were tight in the thighs now fit.

Despite being very miserable during my hospital stay, I am entirely grateful to Dr. McMullen and Dr. Nicastro for what appears to have been a flawless surgery. I have no regrets about having had the surgery, about having had an open procedure, or having had it done by United Surgical. If they could just do something about the traffic on the Staten Island Expressway, we would be golden.

More in a few months…

Part 7 – Six months post-op
February 14, 2004

Hello all! It’s a brutally cold winter here in the Garden State, particularly if you are wearing 103 pounds less insulation then you were wearing last winter!  208 days post-op, I weighed in this morning at 286 and I feel great!  No complications, no major issues.  I fit in a regular-old “XL” clothes (down from XXXXL) and can shop anywhere.  I am even stealing t-shirts from my oldest kid.

I want to start off this chapter by toning down my anti-diet rhetoric. It is very important to watch what you eat. As a famous professor once said, “hear me now, believe me later.” Unfortunately, I still can’t tell the difference between good and bad (at least not as far as food goes..).  But I do know that eating good foods gives you more energy and makes the whole digestive process much more pleasant.  Eating bad foods makes you feel run down, makes using the bathroom a miserable experience, and makes your stomach feel like it is going to explode.

Here is the story for the past three months:

When I had the surgery done, I was a contract employee with great benefits.  The contract ran out at the end of August and I have been floundering around semi-employment land ever since. I carried COBRA benefits for as long as I could afford them, even picked up a benefit paying job for a while in late November and December, but the commute was a bear and I gave it up. So, my next tip to you if you are thinking about the surgery is to have some security has far as your benefits go, or be independently wealthy.

For the moment, I have no benefits and, therefore, I haven’t gone back to United Surgical for my six-month yet, nor have I had the six-month blood work done. I expect to have the blood done soon, but I am not so sure that I am going to be running back to the surgeon’s office anytime soon. Truth be told, United Surgical has (at least) two nurse practitioners who do the follow-up visits.  I suppose you could insist on seeing one of the surgeons if you felt it was important, but there comes a point after the surgery where you are supposed to stop going back to the surgeon’s office.  You just go back to your regular physician and fax the blood work periodically to the surgeon. I am just getting into that mode sooner than expected out of necessity.

The vitamins from vita4life seem to be OK (I could probably evaluate them better if I had the blood results..).  You have to take between 8 and 12 pills per day, and you want to spread them out because they are tough on your stomach.  In fact, the days when my lower digestive track is happiest are the same days when I forget my vitamins.  The Devrom does make a difference, but I can’t say that it is so noticeable as to justify continuing to take it. My wife wants me to keep taking it, so she must think its working :-).

Also, I stopped using my CPAP machine about a week ago.  I think I was supposed to go back for a follow up with the pulmonologist, and maybe another sleep study, but these too are on the back burner for now.  My face has shrunk so much that I can’t get a good seal around the mask anymore without torquing it down so tight that it makes my teeth loose.  Besides, I seem to be sleeping well without it. I don’t subconsciously sleep sitting up anymore like I did before the surgery (just so I could breath while I slept, I suppose..)

Anyway, that’s it for now. These will probably be the last pictures of me in these khaki shorts since I have to cinch them up so much in the back that they are ready to be retired!

Part 8 – Eleven Months Post-Op

Right now it is June 13, 2004. I weigh 272.0 with a BMI of 35.4 (that’s a loss of 117 pounds in 333 days). I finally did what any self-respecting self-employed guy would do and sent my wife back into the workforce full-time so we could get some benefits :-).  I got my blood work done two weeks ago and I have a visit scheduled with United Surgical a week or two from now. LabCorp screwed up my blood tests, AGAIN. It took two visits to get all of the tests ordered, and have the vials drawn, frozen and protected from light correctly. My blood is fine overall, my cholesterol is still remarkably low, especially since I eat eggs almost every day at some point, but my zinc and beta-carotene, which were low pre-surgery, have bottomed out.  We’ll see what United Surgical says about that next week.

I’m actually at a loss for things to say in this installment.  Life post-op is, well, normal.  I know my rate of weight loss has flattened out a bit.  I need to get more exercise.  I had to stop paying guys to mow the lawn, so I am pushing a lawnmower every weekend now and that’s a good thing. Also, I wrote a while back about problems I had fitting on rides at an amusement park, well, last month I chaperoned my daughter’s school trip to Six Flags Great Adventure and rode every ride they went on. It was (pardon the pun) great. I also bought two new suits last week. The last time I bought suits was in 2002. Back then I wore a 58 long jacket and 52 pants. Now I am in a 50 long (or, dare I say it, “athletic”) and 42 pants. Also going to the Eddie Bauer outlet in Central Valley, NY and buying jeans for $20 a pair beats the $50 I used to have to pay at the big & tall stores.

Food continues to be a mystery.  Bread is bad. Pasta is bad. I wound up forced to eat a bowl of linguini and white clam sauce a while back and I felt like an alien was going to burst out of my abdomen.  If I eat shrimp or pea soup, I wind up sleeping alone due to the resultant odors.  Steak and eggs is the world’s most perfect dish.  The vitamins from Vita4Life.net are great, and seem to be working. They can be tough on your stomach if you take them without some food to soften the impact. The Devrom works well, and they changed the tablets recently to make them chewable and banana flavored.  Also, not all bottled water is created equally. My stomach has become very sensitive since the surgery, and since you have to drink a lot of water, you have to be careful.  In general, purified waters are better than spring waters. Not that Coca-Cola needs a plug from me, but their Dasani water is very drinkable, but so is Fiji water.  Regular green-label Poland Spring gives me a hard time for some reason (weren’t they sued for false advertising recently??  :-)

Well, I am starting to ramble, so e-mail me if you have any questions, or if you are in NY or NJ and need a good criminal defense attorney... I think this is going to be my last update for a while.

18 months post-op

Hello all. It’s now February 2, 2005. I think I’ve gone as far as the surgery alone will take me pound-wise. I hit my all time low of 257 (33.4 BMI) back on September 16, 2004 and have actually gained a pound and a half since then. My weight loss graph has completely flattened out. I am now 258.5 pounds, 33.6 BMI. In my mind, the result of the surgery was a loss of 132 pounds in 429 days. We’re past that now. I know I will get these last 25 or 30 pounds that I want to lose off in time. I need to focus. I need to get exercise . I bought a treadmill. It watches a lot of TV.

Some good news is that in early September I got rehired by the same employer that I had at the time of the surgery, and I am permanent this time, not contract. Sixty days later I was back on board with Horizon BC/BS of NJ. I called up United Surgical, scheduled an appointment, and had them mail me a new script for blood work. Miraculously, LabCorp got it right this time. I know the manager of the local lab by name these days. We had a big snowstorm the day before my appointment so I took off that day (love this job…) and then postponed my appointment so I wouldn’t miss two days of work. I haven’t rescheduled it yet, but I did get a copy of my labs which are nearly perfect. My total cholesterol and HDL are still below normal, but they have been creeping up since the surgery. My B12 has shot through the roof for some reason. One potentially big problem is that my Beta Carotene fell to zero. So, a change was in order.

Remember the woman who introduced me to the DS surgery at the beginning of this story? She continues to be my guru and consultant. We decided to mess around with my vitamins a little. Although Vita-4-life vitamins seem to be working well (particularly considering I should be taking 12 a day, and usually forget about half of them..) and they are very simple and straightforward, we changed to a mixture of different things – in part because of the Beta Carotene concerns. Having gone off the Vita-4-life for a few weeks now, one major change I noticed right away is that my whole lower digestive system is MUCH happier. I always knew I had to take the Vita-4-life pills with food to soften the impact a little, but on this new blend, I have virtually no discomfort at all and everything feels much more normal. This is a huge improvement. I just hope they work as well. Another change is that all of my vitamins now are chewable, except one, and because of that I haven’t missed one pill yet. I am now taking Viactiv Calcium plus D & K, ADEK, Dry A, and a chewable multivitamin.

All in all, things are going quite well. I feel great. Even though I haven’t lost a pound since September, lots of people tell me look like I am still losing. “Inches not pounds” I’m told.. Another funny anecdote: Went suit shopping on the Saturday before Christmas. I bought one suit at Syms’ and one at Penney’s (no Big & Tall for me anymore..). I was going to drop them off to be tailored on Monday. Monday morning comes, one of the kids misses the bus and I don’t have time to stop at the tailor before work. Come out of work in the evening and find that my car had been broken into and both suits are gone. Really needed the suits, by now I had lost a week by the time I could go shopping again, and I was out the cash I paid for the suits that were stolen. Fortunately, being 130 pounds lighter and wearing a 42 inch waist these days, I was able to buy two suits off the rack at Macy’s that fit perfectly and cost less than I had ever spent on suits before.

See ya next time..

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