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Answer 55
Depression
Hi Cheryl,
It is very common to feel down after surgery.  It is from a variety of sources.  First of all, the anesthesia is working its way out of your system and that causes depression. That is a major cause.  And your body is playing tricks on you. Your body wants you to eat the way you used to.  Not that you are hungry.  But this expectation of being fed that is not being met throws your body into something that is referred to as hibernation syndrome. This is another source of depression.  Another source of depression can be dealing with pain.  Some people may experience more pain than others, but dealing with chronic pain even if it is minor can be a source of depression.  So there are some of the physical reasons.

Then there are also a host of psychological reasons.  If you were like me you anticipated this surgery so much.  You were excited, you couldn't wait for the day, and now you have had the surgery. And like postpartum depression, you are dealing with the let down after something so anticipated. Also, you are dealing with the discomfort from the surgery, the lack of variety of food, the occasional nausea, and you are wondering when you are going to wake up thin.  You have all the bad things about the surgery to get through before you can enjoy the good things like good health, good looks and the ability to do so many things that you haven't been able to do before. You feel like you have paid your dues by having the surgery, and you're not even thin yet!!! It hardly seems fair.

Be patient with yourself.  Learn to be your own best friend.  And know that everything will get better - slowly and day by day, but it will get better.

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Answer 54
Interesting Phenomenon About Losing Weight
It is not your imagination.  The difference is bone density! We morbidly obese people have at least one physical advantage over those who do not have a weight problem.  Because of our size, our bodies must have a large frame to support our weight.  Because bone is composed of vibrant living tissue, it is able to compensate for our weight by producing more bone tissue so that we have very dense bones.  So as your weight is going down, your bones have not as yet compensated for a lower weight.  So your size is smaller even though your weight is higher because those dense bones make you heavier.  You will eventually lose bone density and your size will stay the same but your weight will be decreasing.  This is also why we have to be very careful to guard against osteoporosis.  As we become normal weighted people, osteoporosis is now much more of a concern.  So take calcium and remember that the best form of calcium is calcium citrate.

 

 

 

 

 

 

 

 

 

 

 

 

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Answer 53
Learning healthy eating patterns
There are 2 critical elements to this surgery that I have discovered.  The first is negative reinforcement.  I would sometimes binge eat prior to surgery.  I would eat and eat even though I wasn’t hungry anymore.  I could literally “pack away” a lot of food.  I could easily out eat my husband and 30 minutes later eat more.  I loved eating. Yes, I dieted over and over, but those were horrible oases in my sea of eating.  What felt comfortable and natural to me was to be always eating. 

What has changed now is that I cannot overeat.  When I do, I get a sharp pain in my chest just between my breasts.  I don’t feel nauseated when I overeat.  I just feel pain.  Sometimes I will start salivating (ugh). And from experience, I know that I am going to spit up.  It is not like vomiting which feels like it is coming from your toes and turning you inside out and tastes just awful.  It is more like a baby spitting up and it does not have a bad taste at all because the food is not mixed with gastric juice.  When this event is over, my pouch feels a little tender and I don’t want to eat for a while.  Over time this has definitely taught me not to overeat.  This was not an easy lesson to learn.  A few months after my surgery, I was sitting beside someone who was eating a steak hoagie that was dripping with cheese, mushrooms and onions.  I was dying.  I wanted one so badly.  My husband reminded me that I could order the hoagie and just eat a small piece if I wanted.  Yes, I could.  But at that moment I wanted to eat the whole thing with a pile of greasy French fries.  That desire has gotten less and less over the months and now I never feel that way.  I enjoy food more now than I ever did before.

The next consideration in negative reinforcement is dumping. Dumping occurs when you eat too much sugar causing RNY patients to have a bad reaction ranging from nausea, a feeling of weakness and shaking to vomiting.  I must admit that I don’t get really bad dumping.  Some people have said that they feel like they want to die.  I get mild nausea, shaking, and I get very sleepy.  I have a dumping reaction from not only sweets but also an overdose of carbohydrates.  I have learned my limit.  For instance, I can have ˝ piece of pie but if I eat a whole piece of pie, I dump. And since I am at my goal weight, ˝ piece of pie is fine to eat.  My family went out for dessert last Saturday and I ordered my favorite – blackberry pie.  I ate ˝ of a piece and took the rest home.  It wasn’t until Wednesday night that I finished the other half.  Prior to surgery, I would have easily polished off an entire pie in a weekend. 

The second critical element in this surgery is a feeling of satisfaction.  It seems like I spent the first 50 years of my life in search of a feeling of satisfaction from food. I would feel a desire to eat and would search in the cupboard or the refrigerator for something to satisfy me.  I would eat something, yet know that didn’t satisfy me.  So I would eat something else only to realize that wasn’t it either.  I would continue in this pattern until I couldn’t eat anymore and would literally feel sick.  Since surgery, I have discovered a feeling of food satisfaction for the first time in my life.  Surgeons do not understand why we now have that feeling post surgery, but it is there.  It is wonderful! It is liberating!

 

 

 

 

 

 

 

 

 

 

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Answer 52
What about Blood Clots?
Dear Dawn,
As morbidly obese patients we are very susceptible to pulmonary embolism when we have any kind of surgery, but especially abdominal surgery.  A pulmonary embolism is a blood clot that forms, often in your legs and travels to your lungs. This is not only related to gastric bypass surgery.  If you had to have your gall bladder removed, you would be as likely to have a blood clot.  

In 1994, my former husband, Lou, went into the hospital for outpatient hernia surgery.  He was released, went home and his incision opened.  He had to go back into the hospital because of the open incision and mentioned to the hospital staff that his leg was swollen.  He had a Doppler study done which did not show a blood clot.  He stayed in the hospital the entire week and all through the week he complained of shortness of breath, rapid heartbeat, and dizziness.  He was diagnosed with hospital phobia and was counseled by a psychologist.  After 6 days in the hospital, he died of a pulmonary embolism. The hospital staff missed the blood clot.

 I tell you this very personal story to say to you that as a morbidly obese patient when you have gastric bypass surgery you are treated by an entire staff who knows how susceptible you are to blood clots and they look for the signs.  The hospital ignored the signs with my late husband. During your weight loss surgery stay, you are treated with injections of Heprin, given special stockings to help prevent clots and encouraged to walk the same day as your surgery so that your blood will not pool and clot. If you are very prone to blood clots you may want to talk to your doctor about a vena cava filter.

Should you not have your gastric bypass surgery and continue as a morbidly obese person, chances are very high that you will need some other surgery and you will not have a bariatric staff of surgeons and nurses watching out for you in the same way.  Your friend's blood clots were discovered and it sounds like they are being successfully treated.  Better to get your weight under control through gastric bypass surgery before you have need of other surgery. 

I know so well the fears you have.  Because of Lou, I faced those same fears. Try to be brave and know that I will pray for both of you.   

 

 

 

 

 

 

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Answer 51
I'm very discouraged about my weight loss

You need to keep things in perspective.  When have you ever lost so much weight in such a short period of time? You are doing just great!!! What you are experiencing is a very normal plateau.  You lost 42 pounds in one month!  That is actually too rapid a weight loss which is why you are experiencing a plateau.  Your first month or two (maybe 3 or 4 depending upon how overweight you are), you should lose 15 to 20 pounds per month. Some lose less.  When you lose more than that, your body tries to slow down your metabolism and holds onto every calorie that you consume.  But if you continue doing exactly what you said you are doing, then you will probably suddenly drop about 5 pounds and then resume losing at a more regular rate. You are doing everything right. You are exercising and watching carefully what you are eating.

When you say you are eating next to nothing, that could also be a problem.  If you are eating too little, your body will go into a starvation mode and also hold onto every calorie.  As soon as you start on solid food, you should be consuming from 600 to 800 calories per day.  Too little food will result in slower weight loss.  You didn't mention anything about water.  It is important to try to drink  8 glasses of water per day also. That will definitely help your weight loss.

Be careful not to become obsessed with the scale.  That was a fault of mine and still is.  I still weigh myself every day.  But if you are one who gets upset by the scale, then try to weigh yourself only once a week or only when you go to your doctor's appointments.

Something that I stress in my book is that the scale is not necessarily an accurate reflection of your body size.  Something that I discovered when I was losing my weight was that at those times when I plateaued, I found that my body size was still decreasing. In my book, I urge all patients to take their measurements just before the surgery and periodically along the way. When the weight stops dropping for awhile, current measurements should be compared with the recorded measurements.  You will most likely find that your body size is decreasing.

Don't lose faith in yourself.  You are succeeding and you will continue to succeed.  If you continue to exercise, eat protein first, drink water and not snack, you will continue to do just great!

 

 

 

 

 

 

 

 

 

 

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Answer 50
I am very afraid of doctors and hospitals
I was very frightened about the idea of surgery also.  My previous husband died when my daughter was 6 and she and I have always been very close.  I am remarried to a wonderful loving man who I know would take care of her.  But I know that losing me would just devastate my daughter.

However, the mortality rate of this surgery is less than 1%, which is the same as having a C-section.  When you have this surgery, you are watched so carefully by people who are accustomed to dealing with morbidly obese patients, so your care is very special.  Should you have a need for any kind of surgery and be morbidly obese (say you would need to have an emergency appendectomy, etc.) you would be so much more at risk because you are morbidly obese and because the hospital staff wouldn't be as skilled with the morbidly obese. Extra weight puts so much more stress on the heart and respiratory system, that a routine surgery can become much more risky.  It is important to consider dealing with your weight before you have very serious health issues caused by your obesity.

This surgery is not an easy road to take.  It is not about having surgery because you are too lazy or weak to diet.  It is not about doing something risky for yourself because you want to look good in jeans. It is about grabbing the healthy way of life because surgery is the only thing that will work for you, the only way that you can become healthy.  And it is about ensuring that you will be around to watch that little one grow and not die an early death because you are morbidly obese and 12 times more likely to die of sudden death than if you were a normal healthy weight.  And this surgery is about grabbing at a quality of life so that you can enjoy that little one and be a positive role model for her.

One of the ways to overcome fear is to become knowledgeable.  Do your own research, get a copy of my book which will explain everything to you about the surgery, and go to support group meetings and meet people who have had the surgery. Take care and give that little girl a kiss for me!

 

 

 

 

 

 

 

 

 

 

 

 

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