Building Knight 2.0

Aug. 29, 2006

I lay on the hospital gurney listening to the click click of the wheels as the young woman wheeled me down the corridor. A pair of double doors appeared ahead of me. A big white sign on them said OR. My heart started pounding as the doors swung wide and the gurney sailed through.

For a moment, I had the sensation of riding a roller coaster -- that instant when you reach the top of the first great hill and see the endless swoop ahead of you, and your every instinct screams "I WANT TO GET OFF!" But of course, you can't.

I had been working for this moment for months. I could have bought a mini-van for what I spent on this particular E-ticket. I'd swung from panic to exhilaration, and I'd had to reschedule the deadline for a book. I'd read countless books on the subject, and I was convinced I was doing the only thing I possibly could -- the right thing for me.

Gastric bypass surgery.

Unlike many MO -- morbidly obese -- people, I had not been hugely fat from childhood. In fact, I exercised and watched my weight until I got pregnant with my son. Unfortunately, I took my pregnancy as a licence to eat.

By the time Anthony was born 21 years ago, I was 40 pounds overweight. I then hit the yo-yo diet syndrome with a vengeance, dieting, exercising, trying everything I could to lose weight. Then sabotaging myself between diets by yielding to every tempting sweet that came my way. Not surprisingly, I only got heavier and heavier. The last five or six years, I'd given up on dieting completely and begun a free fall into weight gain.

Finally my mother told me she thought I should have the surgery, because otherwise I was going to die. I was stunned. Mom had always been violently opposed to bariatric surgery, viewing it as dangerous and ineffective. For her to suggest I had come to the point of needing something that radical suggested I was indeed headed for self-destruction if I didn't do something.

So I started doing research, deeply interested in anything that would help me out of the hole I'd dug for myself.

I had somehow come up with the idea that gastric bypass surgery was the "easy" way out, and that I would never have to diet again. I quickly found out there ain't no such thing as a free lunch. Yes, gastric bypass comes with a wonderful honeymoon period in which people lose huge amounts of weight in very short periods of time. And yes, it can be very effective, allowing people to lose hundreds of pounds, going from obese to slim and healthy in a couple of years.

This miracle takes a good deal of surgical engineering.

The surgeon creates a small pouch at the top of the stomach and then re-routes part of the small intestine to it, where the two are surgically fused. Though a normal stomach is about the size of a human head, the new pouch is only the size of an egg. And immediately post-op, it's actually smaller than that, holding only about an ounce of food.

Yet the patient experiences no real hunger for months. The tiny pouch is so quickly filled, hunger is short-circuited. The pouch will come to hold more as it heals, but not as much as it did before. Hunger eventually returns, but I'm told it's never as savage as it is pre-op. It can be managed by concentrating on proteins and keeping fat and sugar to a minimum.

(Actually, many patients can't eat anything with fat or sugar for years afterward without experiencing dumping syndrome, a condition peculiar to gastric patients. Rich food hits the small intestine and the liver dumps insulin into the blood, which causes increased heartbeat, chest pains, dizziness, nausea and vomiting for one really miserable hour. It's the ultimate in negative conditioning; many people lose all taste for the cakes and candies that they were once addicted to.)

Unfortunately, some people learn to "eat around the pouch," by grazing on small amounts of food all day long, or by breaking the rules and drinking alcohol or eating high-fat food. That's when they put back on the weight they lost.

But for 80 percent of gastric bypass patients, the surgery is successful, allowing them to keep off the majority of their weight permanently. Studies show the surgery can lengthen the life expectancy of a MO person by fifteen years or more. Many serious problems, like diabetes, sleep apnea, joint problems, and even heart disease are all but cured.

Unfortunately, because it's major surgery, there is a small risk of death. Any time a MO person goes under the knife, there's a higher risk of death from a variety of causes, including blood clots, pneumonia, and unforseen complications. My surgeon, Dr. Paul Ross, had done over 300 surgeries with two fatalities, which is pretty good. Ross is a compassionate, caring man, who is dedicated to helping morbidly obese people reclaim their lives. I really liked him, so I felt very comfortable putting my life in his hands.

Well, as comfortable as you can feel putting your life in anybody's hands. Which is why I was having an anxiety attack as they wheeled me into pre-op to get my IVs inserted.

That was a major challenge in itself. I was dehydrated from the bowel prep the day before -- I'll spare you the details of THAT little adventure-- and I was scared out of my furry little mind, so my veins had shrunk down in my arms. The nurses stuck me repeatedly but couldn't get the IV to thread. They eventually had to wrap my arms in hot towels and wait 30 minutes while I went slowly out of my mind. I wanted it over so bad.

Finally they succeeded, and off I went to surgery. I was surrounded by briskly moving figures in green, with huge white lights hovering over my head. Then the doctor put me to sleep, and that was that.

There's something in the drugs that keep you from remembering the immediate aftermath of the procedure. I don't remember the recovery room at all. The first thing I do remember is the agonizing process of getting to my feet with the help of my husband and a physical therapist soon after coming back from surgery.

Yes, I had just been gutted like a carp, but if they didn't get me up and moving, my chances of a blood clot or pneumonia were really high. So I took three steps one way and three steps the other before I was allowed to collapse back into bed.

The pain was not good, but I had a happy little morphine pump that helped a lot. My dreams are normally vivid, but that morphine gave them a real kick.

What maddened me the most was thirst. I wasn't allowed anything by mouth until the day after surgery, because they had to make sure my new digestive system wasn't leaking. Hours of thirst resulted, with me sucking on little sponges on sticks to try to keep my mouth wet. I wasn't actually dehydrated, because of my IV, but my mouth didn't know that. By the time I went down for the x-rays, my tongue felt the size and texture of an old athletic sock, and tasted about that good.

Luckily, everything was fine, and I went back to my room for a glorious sugar-free popsicle and water.

Over the days that followed, my husband removed any doubts I ever may have had about how much he loves me. He left the hospital only to change clothes and shower, staying with me all the rest of the time and gently badgering me to drink. Solid food wasn't on the menu, but I could have jell-O and protein drinks. I finally went home last Friday, four days after the surgery.

In the week since then, I have lost --according to my home scales -- 21 pounds. From 316, I'm down to 295. That's a staggering amount in such a short time.

They weren't kidding about not being hungry either. I can only eat about half a scrambled egg before I feel stuffed. Yet though my stomach isn't hungry, I found food commercials maddening at first. Now they don't bother me as much.

I am still struggling with weakness -- not surprising, considering I'm only getting about 300 to 600 calories a day -- and pain is nagging. But that was to be expected. In truth, I'm doing much, much better than I feared.

But my relationship with food is changing. Instead of being something I crave as a sensual indulgence, it's become a somewhat grim necessity. I need about 60 grams of protein a day, but when you can only eat a tablespoon of food at a time, you simply can't get that much in. You have to drink protein shakes, each of which has 20 grams of protein. Some of the shakes I've tried in the past week would make a vulture gag, but without them, I feel too rotten to move. Protein is the only thing that helps the energy level, as is drinking 64 oz of fluid a day.

I'm also deathly afraid of dumping syndrome. I experienced a minor episode with some creamed chicken soup that made my heart race and my chest hurt. I definitely do not want the full-fledged deal, not with my insides still healing. My sister and I went grocery shopping, and I studied ingredient lists, searching for hidden sugar and considering fat content. It seems if something's low sugar, it's high fat and vice versa.

I am only eleven days into my quest for the new Angela Knight. I have a great deal to learn, new habits to acquire and bad ones to break.

Wish me luck.

Oh, for more on gastric bypass surgery, check out this support group:

http://www.livingafterwls.com/


--Angela Knight