27 November, 2013

A Very Important Weighpoint

My wife is undergoing bariatric surgery tomorrow.

I have kept mum about this surgery to all but close family and a very few trusted friends. This has been, obviously, out of respect for my wife's privacy, especially given the very personal and sensitive nature of the surgery. Since Eva has broken  her own silence on Facebook, I have, with her permission and review, written this in hopes people will understand what's entailed here, and most of all that this procedure is not an end but a means; not a cure but a tool; not the destination but really a waypoint (a weighpoint?)  on the journey towards a prolonged healthy life for her.

I'm sure you, dear reader, are not so crass as to suggest to Eva or myself that this surgery represents anything like "the easy way out". Though you might be thinking it, which is  forgivable because bariatric surgery is not well understood and rarely discussed at any length. So perhaps I can give you some snapshots of my wife's journey thus far, and describe in some detail  what is yet to come for her.

To begin with, you can't just walk in to a hospital and demand bariatric surgery. You need a doctor's express permission to even apply for the program, and doctors don't recommend it idly. Being fat won't cut it...there have to be underlying conditions making it impossible, or at least extraordinarily difficult, for you to lose weight.

Permission granted, you are invited to a seminar on what surgery  entails and what it means for your future life, especially as regards food and drink. I can tell you from having attended that seminar with Eva that most people who thought they were interested in surgery decide then and there that they aren't and never will be, for reasons I'll get to shortly.

But suppose you decide you still want the surgery, as Eva did. Then the real grilling begins: it reminded me of nothing so much as our failed adoption process. Her complete state is scrutinized: a complete physical, as well as a few sessions with a social worker to assess her mental, emotional and spiritual fitness, as well as the strength of her support network. She was put on a diet and closely monitored to see if she could stick to it, because post surgery, sticking to a diet is absolutely critical.And I'm only touching on some of the steps here.  At any time, you can be told 'sorry' and booted out of the program.

Should you clear every hurdle--I got the distinct sense they try very hard to trip you up--you're put on a strict liquid diet for a minimum of two weeks pre-surgery. This is not something you can buy in a store. It's called Optifast and at that seminar, I watched people's eyes light up like pinball machines when they found out they could drink nothing but this for two weeks or a month and skip the surgery entirely. I can confidently suggest that many people took that option...and very few of them will maintain their weight loss. If it was that easy to keep weight off, Optifast would be outselling food in grocery stores. Nevertheless, the stuff does work. If I told you how much weight my wife has lost in the past fortnight you wouldn't believe me. Nine hundred calories a day will have that effect.

So then we arrive at the surgery.

The operation is called a Roux-en-y gastric bypass. In normal digestion, what you eat passes through your stomach into your small intestine, where most of the nutrients and calories are absorbed, and what's left goes through your colon and gets excreted. This surgery creates an egg-sized pouch to serve as your new stomach, and then bypasses the upper part of the small intestine. This has several consequences. The obvious one is that Eva will not be able to eat very much at any one time. In fact, her meals are to be no more than half a cup total. That half a cup is to take her half an hour to eat: her intestine will not be able to aid her digestion, which means she'll basically have to liquefy the food before it gets there. If she eats too much, or eats too quickly, this happens to her. Apparently everybody who undergoes this surgery experiences gastric dumping syndrome once and vows "never again". In researching this to better understand Eva's position, I read vivid testimonials wherein people earnestly wished they were dead.

Nausea and vomiting may become Eva's constant companions for a while even if she follows every instruction to the letter. There is a very delicate balance in play here: the surgery and reduced diet lowers the absorbance rate of food, which increases the amount of stomach acid. Eva will be put on something to lower that acid content, but if it goes too low...you guessed it...nausea and vomiting.

The not-so-obvious consequences to this surgery involve things Eva may not, or definitely will not, be able to eat ever again. In the 'may not' category are red meat, milk, and pasta, none of which digests particularly easily and in her case may not digest at all. The things to avoid are caffeine, alcohol, and especially carbonated beverages like pop or mineral water. That last is an absolute no-no: it can actually be lethal. At the very least it will rapidly expand her new stomach, provoking that dumping syndrome. Too much will rip things that aren't supposed to be ripped, with repercussions I'd rather not imagine.

Because meals are so small, inadequate nutrition is a real concern. Accordingly, Eva must be on several supplements for the rest of her life.  Protein is her first concern: much of what she eats will be protein


For the first week or two post-op, Eva will be eating applesauce and broth and she's looking forward to the applesauce on the grounds she can at least pretend to chew it. It has been two weeks since she has chewed anything at all and she dearly misses food. I have tried to be as considerate as I can short of going on this Optifast with her.  (I did try a sip: the chocolate kind tastes like chrome-flavoured chocolate milk. This is not something you would choose to drink, believe me.)  I eat hot stuff in another room and my recent diet consists (mostly) of food she has never liked: pea soup, clam chowder, salmon sandwiches...occasionally I've had something she finds a little more palatable, like Kraft Dinner. I have been informed that Kraft Dinner smells good when it's cooking. I was unaware KD had a smell.

We'll gradually be reintroducing solid food: after a year, with the restrictions noted above, her diet looks almost normal, albeit those portion sizes I find ridiculous. I'll grant you my sense of portion size is not at all appropriate--that Kraft Dinner is one box, one serving as far as I'm concerned--but half a cup meals unto eternity, no pop, no booze, no sweets, and people think this is the EASY way out?

The damnedest thing is your weight loss isn't even guaranteed. If you are bound and determined you can gradually, over years, stretch your stomach back to its pre-op girth and beyond. Gastric bypass is not a cure for obesity. It is merely a tool. And as I've been saying, it has some very sharp edges.

Now let's talk physical appearance. By the time all is said and done, Eva will have cut her weight roughly in half. While this is obviously an unalloyed Good Thing (tm), it might not look as good as she'd like it to. The fat will be gone, but the skin that wrapped it will remain. I have joked with her that I'll be able to take her for walks by yanking on her 'leash' and I fully intend to start calling her my little caramel bonbon...she knows I love her no matter what, but she's understandably worried about her appearance.
 There are operations she can undergo to tighten things up. Unlike the bariatric surgery itself, they are not covered and they are not cheap.  But we'll be doing whatever is necessary because Eva's mental health and self-esteem are a least as important as her physical health.

So with all of this awful stuff detailed, you're probably wondering what the benefit is to this surgery...besides the weight loss, which as I said isn't even a sure thing. So here we go.  The surgery will not likely prolong Eva's life any, but it will DEFINITELY prolong her healthy life. Up to ninety percent of patients see their type-2 diabetes cured, sometimes within days. Her energy level will dramatically increase. She's always been the fittest fat person I know, but in a year I suspect she'll be able to outrun me. Her hormones will stabilize somewhat, the pain she lives with will be markedly decreased if not eliminated, and most importantly? She'll have slain the last of her demons. This will allow her to get her final tattoo, something she has not felt worthy of even though she really is: Durga, the multifaceted, supremely powerful woman I know Eva to be.

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One more thing. This is not trivial surgery. The rate of complication is not quite Russian roulette level, but it's definitely not minuscule either. Any positive thoughts you can send our way are more than welcome, they are greatly appreciated.

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