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Surgeon: Dr. Ara Keshishian Latest update: February 1, 2004
by Kymberly: I’m not your typical fat girl. I mean… I was a very happy fat girl. I had a great career, a loving husband, 3 fantastic kids. It’s a dream life. I had succeeded at everything I had ever put my mind to except weight loss. My weight loss journey is different then most I think. I was vehemently opposed to weight loss surgery. I was a happy fat person and had spent significant amounts of time getting myself “ok” with the fact that I would never been thin, and I certainly would never be a normal weight. All diets I had tried had failed – eventually. If you measure success in terms of “years maintaining weight” I never had a success, even though I was able to drop 50-80 lbs at a time. But the overall trend was that every year I weighed more then the next. My sister told me that she was going to have the RNY. I saw it completely as a cosmetic approach to losing weight. I was dismissive and I wasn’t supportive. Why not spend her efforts getting ok with the fact that we have “famine resistant genes” and we are FAT. Just deal with it vs. always trying to swim upstream. We are fat, we are always going to be fat, why do something drastic that could possibly take your life? I wasn’t being honest about what 100 extra pounds on a body frame does to a person’s health over the long term. On September 11th, that all changed. I was visiting my parents in Florida and my father who is overweight and diabetic had noticeable personality changes since the last time I saw him. He was diagnosed with progressive dementia from diabetes several years before, but I didn’t see how debilitating and progressive it was until this trip. In that same time period, I learned that my mom had to have more foot surgeries. She too is diabetic and healing is a real problem for her. The last surgery left an ulcer on her foot that wouldn’t heal and resulted in the need for more surgeries. Her mobility was/is greatly effected. I couldn’t deny it anymore… my parents were both under 60 and were suffering incredible debilitation due to diabetes. I was diagnosed with diabetes in my early 30’s… decades before them. I felt like looking at their deterioration was like seeing a crystal ball into the future. Since I had three kids under the age of 5… I knew… I had to do something. It was a day of reckoning for me in more ways then one. I started out looking into the RNY. My sister had her surgery in December and I spent several months researching. I just couldn’t get my head around the fact that with the RNY I risked never being able to eat another Krispy Kreme donut again. I wanted a surgery that would allow me live NORMALLY… not obsess about everything I put into my mouth. Then I found out about the Duodenal Switch. I’ll be honest, at first I dismissed the DS because of the “malabsorbtion” word. In my head malabsorbtion equaled malnutrition. I was wrong. Here is a quote from my journal at the time on why I picked the DS: With the DS you have a fully functioning stomach. It's smaller due to a partial gastrectomy. The really cool part that is a strong differentiator from the RNY is that you have a functioning pylorus and part of the duodenum (these are important parts of digestion, and means no dumping syndrome as with the RNY). Why is the pylorus so important? Because it helps you to feel satiated! With the DS my stomach would be between 4 and 10 ozs depending on which surgeon I picked. I wouldn’t have to chew my food differently or worry about swallowing something a touch too large and it getting stuck in the stoma. My stomach would slowly over time (about 24 months) stretch to hold a normal amount of food. It won't be as much as I can eat now (thank God!)but it's will be *NORMAL*. Another reason I like DS is that you can still take NSAID drugs like Advil and Aleve because you have a fully functioning stomach. With the DS the entire stomach is accessible to endoscopy, with the RNY only the pouch is accessible. The non-functioning stomach that is left in the body is not accessible, there is no way to get to it without surgery. Now on to part two of the DS. The rearranging of the small intestines. This is the part of the surgery that "Keeps the weight off". After much I thought, I figured that this is important to me because this is where I have had so much trouble in the past. I put weight on VERY easily. And when I'm not exercising, just eating 1200 calories can put weight on me. The DS has a distal bypass of the small intestines creating a malabsorbtion of the foods I will eat. I will only absorb food in the created "common channel" that can be 50-125 cm in length. The doctor will create a Y with my intestines. One side of the Y the bile will come down the other side the food will come down. They will only mix in the bottom part of the Y. Since fat (and many complex carbs) need bile to absorb, I will simply not absorb everything I eat! To me, this sounds like the fountain of youth. It could only be made better if it was in pill form vs. a surgical intervention! So after much research, I found that the DS/BPD surgery is more successful long-term then the RNY at keeping the weight off. This "malabsorbtion" part of the surgery is similar to a DISTAL RNY...but I think the Distal is more dangerous. With a 2oz pouch and severe malabsorbtion, I don't think you can get in the nutrition necessary long-term. Just my own personal opinion. To me... the DS makes more sense. And since I am a volume eater, I like the idea of my stomach being able to hold more. Again, this is just my personal opinion. I picked Dr. Keshishian as my surgeon. My insurance had a flat out exclusion for weight loss surgery. So I reviewed all the surgeons down the west coast. I decided on Dr. Keshishian for several reasons: He had a great out of town program, excellent references, years of experience doing the DS, the hospital would “cap my costs” even if I needed to be in ICU for 6 days, and his office staff was pleasant to work with and answered all my questions to my satisfaction. Fast forward ten months. I am down 125 lbs. My weight loss is just now slowing down and I will need to watch my carbs more now. I can honestly tell you that I have eaten pretty much whatever I wanted. In fact, about 8 weeks ago they though I might have ovarian cancer and I was eating donuts and coffee cake like there was no tomorrow and I still lost 10 lbs in that month. Deciding to do the DS was one of the best decisions of my life. I had an easy recovery and would do it again in a heartbeat. I’d pay triple for this surgery because it’s made my life so better. I didn’t even realize everything I was missing out on. A tummy tuck is in my future as I have a nice apron of skin hanging in the front. When I started this journey I never thought I’d even consider plastics… but I know now that the DS was simply the first step in my metamorphosis. If you have any questions about the DS or my experience, please feel free to contact me at: Kymberly@hotmail.com I’ll update more in a few months.
If you had told me at the start of this journey that I would be considering plastic surgery I would not have believed you. Truth be told, I really think I looked down on people who had plastics. I saw them as “vain”. I don’t think I ever really thought of plastics in terms of reconstructive after weight loss. Mostly because I guess I didn’t really realize what 130+ lbs of weight loss was going to do to my body. And my definition of normal was warped. What is most remarkable to me is the progression of where I was in my head with this journey and where I am now. How I have come to realize that what I thought was “acceptable” has now changed. I have redefined “normal” in my own head in the same way I have redefined my physical body. In my own mind, I have had to justify why I am having plastic surgery. Plastics and their reasons are not quite as quantitative as the health reasons for WLS – so one leans towards just assumption that this is all for vanity right? There are no real medical reasons to get my boobs lifted. My stomach gets in the way of clothing fitting right. I feel deformed. But all this isn’t “medically necessary” to go under the knife yet again. So why do it? When I started my weight loss journey I defined normal as “healthy”. Now I have expanded my definition. I couldn’t define normal before because I had never really experienced it. It’s more then just being healthy. Health really isn't the end all goal anymore... now my goal has shifted to being NORMAL. Just healthy was enough when I was fat... now it's not. And normal is defined by not having a body with body parts where they don’t belong. Boobs I have to fan fold into my bra and a tummy flap I make sure isn’t hanging out of my bathing suit. These small things that I used to attribute to vanity I now recognize as impacting the quality of my life. And as I have gone through this weight loss process, what started out as a goal of "health" has now become a goal of "Normalcy". Amazing transformation all this is. I thought I was normal FAT...but I was making up my own “LaLa Land of Normal” to get by and accept my altered state. I don’t want to do that again with hanging skin and short change myself by accepting that as “normal”. I realize now that I want the GIFTS that normal AND healthy have to give me. Being normal, not just healthy, gives me more choices. And being “normal” increases the quality of life. I wonder what other transformations will come with the plastic surgery. I wonder if I will be "happy with me". I wonder if I will want more plastics. I wonder if I will ever feel "small" or "normal sized". I mean I still feel like an Amazon. I am six feet tall and I simply still have a whacky body image. I have NO IDEA how I will define NORMAL. I leave for Brazil on Aug 13, 2003 and will be back on Sept 1, 2003. I decided to have my plastics done in Brazil because I can get 30K worth of plastics done for about 8K in Brazil. For the record, I am having an extended tummy tuck (anchor incision) that wraps around to my butt. I am having Lipo in four zones. I am having a breast lift with part of my breast tissue being anchored UNDER the muscle so I can I have superior pole fullness like you get with implants. And I am having my chin lipo sucked. If you would like to learn more about plastic surgery in Brazil, you can join the yahoo group at: MedNetBrazil-subscribe@yahoogroups.com I plan on sharing postop photos in late fall. Wish me luck!
In August, I had 15 lbs of extra skin removed in Brazil. I ended up not having Liposuction or having my breasts planted under the muscle but did end up with a full extended tummy tuck breast lift and jaw line liposuction. My doctor was fabulous and the people were great, however I had a lot of complications. The biggest complication was that my pain wasn’t well controlled. I believe that this contributed to my watershed of complication events. At the same time, my mom was having Lap DS and I think because I was so worried about her, I also had difficultly getting relaxed. All these things contributed to several things: I lost the bottom 1/3 of my left areola due to loss of blood supply. I had an eraser size of necrotic skin and slight infection at the belly button, my right breast opened up underneath. I still, at six months out, have numbness in my left leg and loss of sensation in both breasts. But the biggest complication was uncontrollable pain. When I got back to the states, one plastic surgeon wanted to put me back in the hospital and open me up. The second opinion I got was much less aggressive and we simply debrided (cut away dead tissue with a scalpel every two days) my breasts for months. I lost about ½ cup of breast tissue which is now replaced with scar tissue on my right breast. At six months out, I am “almost” healed. The areola is simply very slow healing and still has a scab on it. Take note that I am making a very long, painful story short… but I am happy with my results. My tummy is flat, my boobs are perky, and other then horrific scars, I look dang good in clothing. I would do plastic surgery again in a heartbeat. I personally, would not choose to do it out of country… but that is with the benefit of hindsight! I am extremely pleased with my DS surgery. I have 19 lbs to lose to get my “ultimate” goal of a normal bmi. I am not having much luck getting off this last 19 lbs, so maybe where I am at, is where I am going to be. I am very tall, so I carry these 20 lbs well! I am over 18 months out and can now eat a medium size cut of prime rib from Outback, a loaded baked potato and half a salad and a piece of bread and half a glass of tea. I just wanted to give people an idea of how much food I can eat. I feel completely normal. No 2 oz. pouch here! I do not even feel like I had weightloss surgery. I do not obsess over food and I do not have to "work" at keeping off my weight. I feel like I have found Nirvana. My only regret is that I didn't do this sooner. I view the DS surgery as one of the best decisions of my life. I am completely 100% pleased!
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Decided to do a quick update before I head off for plastic surgery. I am down 133 lbs at 14 months preop DS and am VERY happy with my surgery. I would do this all again in a heartbeat. Only interesting thing is that I had a hystrectomy and that seems to have ground my weightloss to a stop... but I'm ok with it. Once I get this extra skin removed. I am mostly updating though to talk about what a head game this plastic surgery journey is for me.
You know you are overdue for updating here when people start sending you flame mail for not updating when you said you were going to!