Surgery Date!

It pays to be persistent and organized! The doctors office submitted the surgery under different Hiatal Hernia codes that my insurance WILL pay for. 


The only problem is that there will be an overnight stay needed, which will not be covered by insurance, but that's fine.  I will end up paying about 10 - 14K out of pocket.  Better than 40K. 


November 7th is the date. 


I had the option of Oct 31st, but my husband is traveling that week, so that won't work, but I REALLY would have loved to have had surgery on Halloween!! haha!


Regardless.  I am so excited for the surgery.  Hernia repair is needed - I had a piece of hard boiled egg get stuck in my esophagus a couple weeks ago and I can feel it moving more and more. 


Very Pleased to finally be on track. 


Pre-Op diet will start on Oct 23.  PERFECT.  No candy for me at all! 

I am a terrible failure at weight loss

I am a terrible failure at weight loss.

I have been my whole life and so why would that change in my 40’s?  In letting go of trying to be “good at this” and accepting that I need more help (revision), I am doing myself a favor.   

 

I have already talked about how I don’t like to “blame” me for failing the sleeve, but the truth is that I did a lot of things wrong.  Stuff that I knew I shouldn’t be doing, but it was easy, familiar and comfortable.  I did a lot of good things, and I changed significantly, however, I want to take time to look at what I want to do now that I have more information and experience.

 

I have been seeing a lot of newly sleeved people doing things (that I also did) that lead to decreased weight loss. Specifically - Eating small quantities of shit food, and saying things to justify them. IAMGUILTY TOO....I used to say all of these things to make myself feel better about eating bagels, ice cream, chips, cookies, candy, etc. etc. 

• It’s just a little
• I still have to enjoy myself or what's the point
• I can’t eat anything else
• I can’t tolerate anything but carbs today
• Sugar is fine
• I’ll never have a life without being able to eat X (insert whatever food is your poison of choice)

 

These shitty foods feel good to MY brain, and in so…. I was willing to overeat more of those foods and damage my results because the BRAIN GOOD overrode the STOMACH BAD feelings. Overeating, overeating, overeating.  

 

The reward was worth the agony, and that agony lead me here.

- I can eat 3+ cups of food in a sitting.

- I can easily eat 3,000cal a day

I have learned a lot of things about the sleeve and bariatric surgery through trial and error, as many of us do.  I am one of many that has become obsessed with food in a completely different way from when I was super obese.

 

In the last few months while thinking about getting a revision, getting my consultation, check-ups, and now waiting on an approval and date for surgery - I have been introspectively looking at my behaviors and thinking about the corrections that I want to make this time with my revision:

 

1. Eat more “whole foods” in the puréed, mushy and beyond stages. 
- Eat less pre-packaged bars, cups of pudding or jello, easy soft carbs like oats and grits mixed with protein powder.
- I bought a blender to purée my own meats, I make my own soups now, and I’ll have a LOT more eggs in all its variety of forms. 


2. Stay off the Gawd Damn carbs.
- I went straight to bread as soon as humanly possible, but I had been eating oats, grits, and soft carbs like that for my soft and purred stages.


3. Better hydration. End of statement. 


4. Stop thinking of my new stomach size as a challenge.
- I used the sleeve as a challenge instead of a tool. How much can I get in there, instead of how much should/can I put in there. Be more mindful.


5. Eat slower. I'm still a wolfer instead of a chewer.



6. Take full advantage of the honeymoon period.
- Last time I thought the easy & fast weight loss would continue for(ever) or at least a year or more. It came to a quick halt after about 4 months.  Then I had another 8 months of slow losses, and then… stopped.


7. Exercise.
- I didn't do anything at all the first time. I bought a treadmill for this time around, walking more will happen and does happen now.


8. Forget what others think.
- First time around I worried about what people would think about my food portions so I was always trying to eat more to appear "normal".  
- Avoid eating out with co-workers, that is a big one.  Everyone wanted to eat with me and talk about my weight loss… ironic!  I spent entire meals trying to look “normal”, this is no longer a concern for me.  I’m busy and I bring my lunch.


9. Better meal planning.
- I was always good about getting in my protein, keep at it.
- Keep packing my lunches. Make more meals at home.


10. Set better goals!
- I was so excited to have lost even 30lbs that I didn't care if I ever lost another pound again. That changed!!


11. Stay away from dessert longer.
- I always followed up meals with a spoonful of whatever was for dessert, and stating that “one spoonful can’t hurt, look at how good I’m doing etc”.
- Food will always be there – so no need to eat dessert every night. 

VSG Failure? depends on your perspective.

So I've had a lot of time to think about what a revision to my original WLS, vertical sleeve gastrectomy (VSG), means to me.  The word failure comes into mind a lot, and I try and fight that off, since I don't actually see the original VSG as a failure.

If you start looking around at information on VSG failure/regain you will see very quickly that the community really beats up on the person that is not successfully keeping weight off.  Its a pretty depressing situation, and actually, it kept me from seeking help a lot sooner as I did. I bought into the fact that it was me, my fault, my failure, my issues. 

However, when I evaluate the situation, it wasn't really a failure, in my perspective.

I did fail to make it to a normal BMI. 
I did fail to keep off all the weight I initially lost.

Based on those 2 things I am considered a medical failure, and I qualify for revision.

However, I don't see my journey as a failure and I don't see me as a failure.  The VSG has already done amazing things for me and my life.  I made massive changes to my eating habits, my portions, my choices.  100% good, no.  Better than they were before, yes.  

In 2012 I was on a slippery slope, 315lbs and gaining.  With the VSG I managed to get down to 230, and then springboard back into the 240-250lbs.  The surgery halted my upwards trajectory into the super-super morbid obesity and has made me a mostly normal looking, albeit hefty sized person. 

The "failure" comes into play for me in that I am still not a normal BMI, and I'm at least 50lbs heavier than I would like to be (my preference would be to be in the 190-200 range), and 86lbs heavier than a normal BMI for someone my size. 

Current BMI - 38, 250lbs
Normal BMI - 24.9, 164lbs

Hilariously, here I said that if I never lost another pound under 260lbs I would still be happy.  LOL perspective. That was 2 months post surgery in 2012.

I never made it to my goal weight of 190. Perhaps that is because I was comfortable? 

There are a lot of things that I am going to do differently this time as well.  I've been making a list of them and will make another post.  The main ones are that I ate too many carbs too soon, not enough water, and I didn't/don't exercise enough.

Regardless, there are also other things at play. My surgeon said that there are lots of people that VSG doesn't work for, those with metabolic concerns.  My fundus (stomach) is dilated. My normal anatomy might let food pass more quickly through then normal.

I can also say that my mom put me on my first diet when I was 5 years old, and basically I've been chubby ever since. I have lots of food anxiety, stress, and secret eating.  These are things that I have been working on.  I did a great emotional eating class earlier this year that help solidify my position that I should seek to see if there is another surgery/re-sleeve option for me.

So, I'm positive feeling about the upcoming duodenal switch. I am so excited to think about being a normal sized person for the first time ever in my adult life. 

For those that find their way here and are thinking about a revision for lack of weight loss, or regain, I'm with you.

Here is another great article on revisions to the VSG, a very easy to follow along power point from Duke University.

This is a long one, but if you are interested in this material, then you might find it worth reading.  The conclusion is one that is not very comforting, but pretty realistic. 

In summary, SG as a stand-alone operation is gaining popularity among both bariatric surgeons and patients. This enthusiasm, however, has to be balanced against a paucity of data in regards to potential long-term failure rates. Similar to other bariatric surgery procedures, SG failure is likely to be multifactorial and related to a combination of technical, physiological, and psychological parameters. When discussing SG, bariatric surgeons must review these unknowns with their patients to ensure they will make informed, long-term, surgical decisions based on all available information.

Another Hiatal Hernia... Good News, Bad New

Bad news, I have another hiatal hernia... Good new, that means that my insurance will cover the part of the surgery to fix that. 


Side note... barium is about as yucky as I expected.  When you have not had anything to drink in 10+ hours you would think that drinking anything would be awesome... yeah, no.

The curious part of me is wondering why I have one again.  I imagine that its a combination of genetically having a big hiatal hole (hahaha!), and being overweight with the majority of my weight being carried in the front of my abdomen. This creates more pressure on the organs and could be forcing the stomach up. 


Anyway... all problems that can be sorted out.


Onwards to tomorrows 5am wake up call.  At 6am I have my endoscopy to have a look see the inside and I'm guessing I have ulcers again. 


Regardless, it will be a day off after conscious sedation, so I'm going to turn my work phone off and rewatch Game of Thrones last season and this season (if I can stay awake), and snooze with the dog.


I'm super curious to see what the doctor has to say about my sleeve and how it looks and his opinions on how to move forward from here.  

Upper GI X-rays Tomorrow

Tonight at 10pm, nothing more by mouth for my upper GI tomorrow morning.

I've only had barium once before, post first VSG, to make sure there were no leaks. Or, at least I think it was barium... pain meds make things fuzzy.

Very excited to kick this off again. I've also started an instagram account: TammyTake_2 if you want to link up where the "kids hang out"!!

This morning I was down on the scales again, which is great! But then I get wracked with guilt... am I just not trying hard enough? Can I do this without another surgery!? Ug, such ugly feelings. I have worked hard and I never came close to my goal weight, so I know that this is the right decision. I have to keep reminding myself that.

I've struggled for three years and done nothing but creep ever upwards. This is the right decision.

I found my 1 year pictures from 2013 and I'm excited to see the next phase of progress!

Duodenal Switch

I had a good 24 hours to think on everything the doctor said about the re-sleeve and duodenal switch, which he thinks is the solution(unless the testing reveals another story), and I had gone into the appointment thinking that re-sleeve was the only option for me because I didn't want to have my intestines altered.

I have done a good bit of reading and soul searching... the husband and I talked about it and we both agree- whatever he recommends I will do.

We went and bought a bullet mixer so I can get through my pre op and post op liquids and puréed phases making my own baby food. I want to be sure to eat more protein this time and less pudding and cream of wheat. I also got some more small containers for food prep and some mini popcile maker for frozen yogurt pops of my own design.

My new passion is riced and mashed cauliflower!! Which will fit into the puréed phase and beyond. Tonight we had it with sautéed shrimp as the grits replacement- Devine.

All in all, I am feeling happy and now comes the long wait to testing, results, and scheduling. It would be great if they kind of find something else to fix in there that my insurance will pay for to divide out the costs, but I don't suspect so and that's fine. Husband is on board and I have a month of vacation time saved up so I will schedule my time off via that.

Feeling positive

Weight today: 248.2

Looking Back

I spent some time last night and read through all my first 2 years worth of posts.  It was a delightful and terrible walk down memory lane.


I can see all the errors that I made back then, things that I wouldn't do again. 
  - too many carbs
  - too much sugar
  - no exercise
  - always attempting to eat too more


I also see just how far I have come from and I'm still proud of that. 
Changes that I have made:
  - no soda
  - no booze (not that I was a big drinker anyway)
  - generally make better food choices, more protein
  - 50lbs gone and to be fair, I was headed to 350+, which is not my reality anymore


I feel like this surgery was a pendulum swing for me. I was so far to one side (binging and eating amounts) and the surgery swung it way to the other.  The final result was that I settled in the middle, which is still too many calories to get to where I want to be. I can and do eat 1700 - 2200 a day and I am hungry several times in the day. 

If I get approved and have surgery to re-sleeve myself, then the arc of the pendulum will be so much smaller this time, that I think the final resting place will be more reasonable than 250lbs and more like 1195/200.


Directly after my first surgery consultation in 2012 I went to Shipley's donuts and bought a dozen donuts and ate 11 of them in my car.  The week before my pre-surgery diet started I ate three full sized bagels and a tub of cream cheese.  I also used regularly eat a whole large pizza, followed by a pint of ice cream and a liter of soda. I never left anything on my plate.  

I feel that the mental leap from eating 4,000 calories in a sitting to ~1,000 calories a day was so huge that I couldn't even grasp it.  It was actually mentally impossible for me to see that I need so little food that I could get by on a 1/4 of what I had in a single sitting.  I couldn't conceive of a meal that didn't have a starch of some sort - WAS it even possible to HAVE A MEAL without carbs?


I do a lot better now, I eat better, more protein and actually follow the diet guidelines, +100g protein a day - but the issue is how much I can eat. 
 
I've read this a few times and I don't like how it sounds, but there it is.  Looking back through all my other posts it was nice to have a few that were stream of consciousness - much like this.  So, posting these thoughts for my own good.

Re-Sleeve Thoughts

I was correct in thinking that people don't really blog that much anymore about this, or .. not that I can find on google anyway.


I have found a few re-sleeved people on Instagram.  Most of the accounts were private, understandably, as its a platform for sharing photos, so I totally get that (I would likely do the same).  There were a couple of accounts that were open and had some good positive data on being re-sleeved and did a little poking around on their posts to see what they thought and how it went. That was a positive!


Sadly, all the WLS/Obesity forums I've found on re-sleeving revision have been almost unanimously negative towards the person that is asking about getting it done. 


Its one of those strange things about WLS surgery, there is a sort of hyper-competitiveness over how it has worked for some people, who is "doing it the best", etc.  Mostly I've noted that if it is not working for someone - there seems to be a significant amount of finger pointing to the person that is not successful. 


I was laying awake last night thinking about what the surgeon might say to me on Friday about not being as successful as I could have been  and what level of "disappointment" he is going to have. I was already lining up a bunch of excuses, but the truth is....


This is hard.  No matter if you have surgery or not.  If I was able to control this myself, I wouldn't have been in for surgery in the first place.  


I thought back to my first meeting with him and remembered how NON-judgmental he was.  So I hope that I get met with the same amount of care for my feelings again, and then I can move forward with finding out if I meet all the right criteria.


I did find another great medical article on the Re-Sleeve: Better Results in Weight Loss after the Second Gastrectomy in Re-Sleeve Gastrectomy




Very promising material. Here is a nice graph that shows the results.

Weight today: 250

BMI Progress (2012 to 2017) and ReSleeve article

The best article I've found so far is here: Re-sleeve Gastrectomy for Failure of Weight Loss After Primary Sleeve Gastrectomy; 3 Cases


Its a very interesting read and of course, they use BMI as that is a better indicator for research than weight, due to variation in body size etc.  I do feel that some BMI is bullshit, since I really don't even want to be 175lbs, I want to be 195lbs and all the rest of the usual argument, muscle mass etc. 


As a result of reading this article I had a look at my BMI changes to give me an indication of my progress.

Date	Weight	Lost	BMI
Start	301		45.8
6 month	240.8		36.6
12 months	236.4		35.9
18 months	234	-67	35.6
19 months (low)	232.2	-68.8	35.3
24months	240.6	-60.4	36.6
36month	247	-54	37.6
48months	247.4	-53.6	37.6
57 months	251.4	-49.6	38.2

So I lost 10 points off my BMI score, then gained back 3.  I would love to lose another 10 points off this BMI of 38 down to a BMI of 29 (190lbs) or 31 (205lbs).  This is the range that I am shooting for anyway.


I have started to track my food again, and make better choices for the interim and "work my sleeve".  As I said - I am not good at this, and now I am often hungry and don't feel full.  Which is my kryptonite.  Last night I was hungry after dinner (6oz of beef and 1.2C of veggies).  So that is a problem for me.   This morning since breakfast I've been thinking about food nonstop except for the 45min meeting that I was in.  


I have 10min before I can eat my lunch, countdown is on.

2017 update - revision/resleeve - 5 years later

Does anyone even use blogs anymore?  haha!  I think all this sh*t is done on Instagram now, but whatever.

I have updated my weights page and am back here because on Friday (august 11) I have a consultation to see about being "re-sleeved". 

I have been searching blogs to see ... has this been done? are there people out there that are talking about this?  What are the results?

Mostly I've only found medical articles, most of which are promising.  I'm not sure if that is because this is too narrow a search, or I'm bad at "googling", or if people are just not talking about this.   Regardless, I'll consult with my physician on Friday to see if I am a candidate. he has done and does do this procedure, so I'm cautiously optimistic.

I'm currently stuck in the 240-250 range.  Back to battling the same 5-10lbs over and over and over again.  I spent 20 years doing this pre sleeve, and now... I just don't want to waste time again.

I want to knock another 50+ pounds off and get a tummy tuck. I also want to do that before I'm in my late 40's instead of my early 40's. Since I was 43 last month, time is a wasting.  

I have also spent a good deal of time re-reading my early entries and wish wish WISH that I had paid attention to the bloggers that talked about the honeymoon phase and to use it to lose as much as possible. Anyway, certainly there are things that I could do better, and things that I would do differently this time around. 

I certainly do not regret getting the surgery, I would do it again in a heart beat and I hope to get a second swing at the plate as well (pun intended).   If I was good at losing weight and managing my eating, then I wouldn't be here.  So, we will see what the doc says.

Small recap:

	wgt	Lost
Start	301
6 month	240.8
12 months	236.4
18 months	234	-67
19 months (low)	232.2	-68.8
24months	240.6	-60.4
36month	247	-54
48months	247.4	-53.6
57 months	251.4	-49.6
	Average lost	-58.9