Make an “okay” sign with your thumb and index finger. You’re looking at the approximate size of my stomach. That tiny circle, the result of gastric-bypass surgery, has made an enormous difference in my life. It’s taken me from 360 pounds to 180, from a 60-inch waist to a 36, and from a four-door sedan to a cherry red convertible.
My journey into fatness began around age 7, when I started stretching the seams of my Sears Husky Boys pants. My parents weren’t heavy and I had no siblings, so I got the milk and cookies all to myself. I began reaching adult weight by the time I was in seventh grade, and I practically had to oil myself to squeeze into the school desk. Gym class was a nightmare—I couldn’t run (the teacher used to make me race against a kid who had one leg), and just the anticipation of a game of basketball would make me break out in a cold sweat. At our school, the teams would be “shirts against skins,” and if you’re a 12-year-old boy with breasts, you’d rather die than suffer the embarrassment of running up the court topless.
In high school and college (where I reached the magical 300-pound mark), I had a couple of girlfriends, but mostly I had girl friends who wanted advice on, of course, their boyfriends. Like many fat guys, I simply shut down the libidinous part of myself. One pathetic example: In college, I took a trip to Manhattan and had one night solo, the perfect opportunity to indulge in some primal pleasure. A night at Scores just wouldn’t have done it. Instead, I was in my hotel room, alone with . . . a pastrami sandwich from the Carnegie Deli.
To be that fat was to be constantly self-conscious and uncomfortable. Never let ’em see you sweat? My thick casing of insulation meant I always felt trapped in my own personal sauna. At job interviews (wearing my too-tight sport coat and tie), I’d feel sweat dot my forehead and occasionally run down my cheek, and I would instantly recognize the look from across the desk: “You are just not the image we want for our company.” I got the same look when talking to women. Carrying around more than 100 extra pounds was a burden on my heart, physically and emotionally.
Of course, after depressing and humiliating experiences like these, a guy needs some comfort. So on the way home from an interview, or any other fat-related rejection, I would hit the drive-thru and get a Big Mac, a Quarter Pounder, two small orders of fries, and a chocolate shake. (Two small fries? I always hoped this would fool the drive-thru person into thinking the order was for two people.) When I got home I would top off the tank with some ice cream and cookies. Anybody see a cycle here?
The only thing more frustrating than being fat was trying to get thin. I tried eating grapefruit before every meal, all carbs, no carbs, high protein, low protein, liquid diets (twice), and injection with the urine of pregnant women. (In the ’70s, injecting HCG, a hormone extracted from pregnant women’s pee, was the latest groovy diet aid.) I ventured into more legitimate approaches, too—Weight Watchers, NutriSystem, and Overeaters Anonymous, where I tried, but failed, to admit I was Powerless over Pizza.
It was through one of these dieting attempts that I met my wife. We were both at the lower end of our yo-yo weight patterns, and throughout our marriage our weight went up and down, sometimes in sync, sometimes not. As with any relationship in which both people are addicted to something (food, booze, cigarettes), attempts to get unhooked led to either support or sabotage. When we were both determined to succeed, the teamwork was great.
But when one of us was ready to fall off the wagon, we could drag the other off, too.
As the years ticked by, the scale clicked higher. But at least my health, for the most part, was good. A heart palpitation here, some pain in the knees there, but my blood pressure was surprisingly normal, and I wasn’t having much shortness of breath, lower-back pain, or any of the other usual symptoms of being (I still hate this term) “morbidly obese.”
My big wake-up came during a routine visit to my doctor, Ed Miller, in 1998. I stepped on the standard doctor’s scale, ready to watch the numbers climb once again, but this time the numbers couldn’t climb any higher. The scale’s 350-pound max wasn’t enough to weigh me. When the nurse told Dr. Miller, the two of them went to another exam room and wheeled in a second scale (as others watched, of course). I was shocked, scared, and red-faced with complete humiliation. They put the two scales side by side and had me step up, one foot on each. The result wasn’t exact, but it at least gave a rough idea of my weight. One thing, though, was perfectly clear: My run of moderately good health was sure not to last. I was approaching 40, heart disease and diabetes ran in my family, and I couldn’t recall seeing many old men schlepping around 360 pounds.
“You’ve tried everything else, so you might as well go all the way,” Dr. Miller said, and he recommended obesity surgery. He told me about the gastric bypass, a surgery that would forever alter my plumbing so that I absolutely had to lose weight and keep it off.
A DETOUR AROUND MY DUODENUM
How does a gastric bypass work? Two answers: restricted food intake and malabsorption.
With Roux-en-Y (pronounced roo-en-wy), the most popular type of bypass, the stomach is divided into two sections: a tiny pouch for all future digestion and a larger area that will never hold food again. The idea is to make a patient feel full after only a few ounces of food. Next, a Y-shaped section of the small intestine is stapled and sutured to the new stomach to allow food to bypass the duodenum (the first segment of the small intestine) and jejunum (the second segment). Because most nutrients are absorbed by the small intestine, bypassing several feet of this digestive piping means fewer evil calories converted into fat. (There’s also less opportunity for nutrients to be absorbed, making daily vitamin and mineral supplements a necessity.)
Due to the length of the operation, a pulmonary embolism—a blood clot in an artery to the lungs—is one rare but possible surgical complication. Intestinal leakage into the abdomen, resulting in an infection, is another. Overall, the risk of death with Roux-en-Y is 0.5 to 1 percent.
Obviously, this is a complex, major operation, a true last resort in the fight against fat. The way Dr. Miller described the surgery, I would have a long, painful incision down my middle, days and days in the hospital, and weeks laid up at home.
Despite my desperation, I balked at the scope (and pain) of the procedure. Not sure what else to do, I ate. Then I did some research online, where I discovered another option: A local surgeon was performing Roux-en-Y using a laparoscope rather than the more invasive “open method.”
A laparoscope is a fiber-optic video camera that’s inserted through a small incision to show a patient’s innards on several television monitors. This makes it possible to perform a gastric bypass from “inside” the body; the surgeon simply makes five or six tiny incisions in the abdomen and inserts his surgical instruments through the holes, using the monitors to guide him. The result is minimal post-op pain, only a few days in the hospital, and a return to work in just 2 to 3 weeks. I made my decision. Dr. Miller checked out the surgeon, and I was on my way.
It turned out that the local surgeon I’d stumbled upon was one of the best. Forty-one-year-old Philip R. Schauer, M.D., is the codirector of the University of Pittsburgh Medical Center (UPMC) center for minimally invasive surgery and director of bariatric surgery. With approximately 1,000 gastric-bypass surgeries to his credit, he’s a leader in his field. Tall, with dark hair and blue eyes, he’s also the object of a crush for every female patient he’s treated. And that’s one big fan club: More than 80 percent of Dr. Schauer’s bypass patients are women. “Women are usually first to try a method of treating obesity,” he says. “Men tend to get in touch with us when they’re older and the health problems of their obesity have caught up with them.”
THE FEAST BEFORE THE FAMINE
The doctors tell you not to overeat during the days before the bypass. “Overeating prior to surgery can adversely alter glucose metabolism and lead to post-op complications,” says Dr. Schauer. But how could I help it? Just the thought of that little stomach was enough to send me into food panic. Instead of looking forward to being thin, I obsessed about how in a few weeks the overeating that had given me comfort and pleasure for so many years was about to be gone for good. Unlike with a diet, a gastric bypass doesn’t let you hop off the wagon for a Super Bowl binge or a cruise-ship gorge-athon. It’s a lifelong chastity belt around your gullet, and only your surgeon has the key. (The surgery can be reversed, but that’s rarely requested.)
My 2 weeks before surgery became a fortnight of Last Suppers—Baskin-Robbins, steak and baked potato, pumpkin pie, Pittsburgh favorites like fries from the Original, pizza from Mineo’s, and a Primanti’s sandwich. And it even meant a pilgrimage, a trip from Pittsburgh to Corky & Lenny’s, just outside Cleveland, for some real deli food. (Pittsburghers usually avoid the trip to Cleveland, unless it’s Steelers fans going to “take care of” some Browns fans.) Yes, I spent hours on the turnpike just to gorge myself on a meal of stuffed kishke, corned beef, cheesecake, and matzoh balls. Now my stomach is about one-third the size of one of those matzoh balls.
The actual day of the bypass meant early rising, a shower, and off to UPMC and la-la land, for my life to be saved and changed. My operation took Dr. Schauer more than 5 hours to perform (including some extra time because I also had a diseased gallbladder to remove). That was 6 years ago. Today, hundreds of surgeries later, Dr. Schauer can complete a Roux-en-Y bypass in as little as an hour.
The few days after surgery were, amazingly, no big deal. As advertised, the laparoscopic method left me with little need for painkillers and just a few buttonhole incisions instead of one as tall as a magazine. Still, there was no denying that my gut had just undergone a major renovation. The replumbing, stapling, and stitching were so extensive that my new digestive system needed to be eased slowly back into eating. So Dr. Schauer prescribed a three-phase diet regimen: Phase 1 (first 2 weeks) was liquid; phase 2 (weeks 3 through 6) was pureed and soft stuff, like yogurt and canned fruit; and finally, phase 3 was real American solid food.
Phase 1 went pretty well, both physically and psychologically. I say psychologically because I tend to be a very visual person. It was easy for me to imagine chicken broth and iced tea sliding through my rerouted system. But when it came to the yogurt in Phase 2, I was a little shaky. What’s more, it had been so long since I’d eaten anything solid that simply holding a spoon was strange. It ended up taking me longer to eat a container of yogurt than it would have to eat an entire pizza just a few weeks earlier. Once I had finished phase 2, real food—chewing food—was on deck. Phase 3 taught me what I’d never known—you’re supposed to chew your food before you swallow.
THE SEVENTH-INNING RETCH
One of the (many) ingenious aspects of gastric-bypass surgery is that the surgeon makes the opening (the stoma) from the new stomach into the bypass much smaller—approximately the diameter of the tip of your pinkie finger. “A small stoma slows down the transit of food into the intestine,” says Dr. Schauer. “This gives a sensation of being full for a longer period of time.” It also forces you to chew your food completely or risk getting something lodged in the stoma. When your stoma is blocked, it causes a dull but significant pain square in the middle of your chest. (If you’re morbidly obese, this can make you think your heart has finally had enough.) Actually, this blockage is usually no big deal. Often, the piece will work its way through. But if it won’t go down, of course, it must come up.
This is one of the things people hear about most when they start to investigate gastric-bypass surgery. “You’re having the surgery? I hear you puke your guts out!” The truth is, plenty of people don’t vomit at all. Most do so very rarely. I didn’t belong to either of those camps. I was a puker, and every wretched retch was my fault.
The best example of this for me was taking my 9-year-old son, Alex, to a Pirates game. I figured, ballgame with the boy, gotta have a dog. But I was too busy concentrating on the action to think about chewing, and a piece of Hebrew National got stuck. This was a bad one. In fact, it was the worst case of stuck-in-the-stoma I ever had. I went to the busy men’s room and tried to work it out. No go. I was too uncomfortable to stay at the game, so we headed home midway through. Alex was understanding about needing to leave. The part he didn’t like was the drive home. I had one hand on the wheel and the other holding a Pirates souvenir cup into which I was slowly coughing up my wiener.
One appeal of the surgery is that I can eat practically whatever I want, just not very much of it. The operative word is “practically.” Some foods, particularly sweets, can be hard to handle. “Sugars can move too quickly through the intestine to be properly digested, causing ‘dumping syndrome,’ ” says Dr. Schauer. “The effects can include abdominal cramps, nausea, sweating, weakness, and diarrhea.” Dumping isn’t dangerous, but it is a horrible feeling, as if your entire body were melting and sinking into the ground. When I told Dr. Schauer that too many sweets made me sick, he smiled and said, “Great, I’m glad to hear that.” The docs know you can’t consume many calories, so they want you to avoid the empty ones.
Other foods, such as red meat and milk products, can cause problems for a few patients, and some vegetables (celery, asparagus, lettuce) can be hard to digest, too, partially because they’re stringy and difficult to chew well. And with alcohol, a little bit goes a long way. “Alcohol is absorbed quicker, and relatively small amounts can have a big effect,” says Dr. Schauer. He’s right—and it can be embarrassing. Recently, I was dining at a fine Italian restaurant and ordered a vodka and tonic. I drank exactly half. When I woke up about 10 minutes later, my face was flat on the table, permitting a nice side view of my Penne Mediterranean.
LIFE WITHOUT THE LARD
Fortunately, puking stopped being a problem early on, and I haven’t done it in the past few years. What I have done, though, is lose weight—every pound I had hoped to.
In anticipating the weight loss, Dr. Schauer had said to me, “The bigger you are, the faster you fall.” As an example, he said a man who’s 5’9” and 350 pounds usually will lose 85 to 100 pounds in the first 6 months, and then 75 to 100 additional pounds over the next year. When I started, I hoped to eventually get under 200 pounds. I now weigh around 180, exactly half the man I used to be.
Of course, the effects of losing weight reach beyond the physical. People treat you differently when you’re fat, and dealing with the world from a “normal” perspective takes some adjusting. To start with, women flirt (I never knew!), and that was fun and slightly intimidating at first. There’s no more need for self-consciousness, especially when walking into people-filled areas I used to dread, like airplanes. What was never considered a possibility before, or even offered, is suddenly very reasonable. (“Yes, I would like to try on that shirt.” “Parasailing? I’m in.”) And some automatic thoughts need to be changed, like now hoping for a booth at a restaurant instead of a table with chairs.
The effect on the individual of losing so much weight can be profound, and the effect on couples equally so. Dr. Schauer reports that he’s seen couples go one of two ways after one or both lose a significant amount of weight. Some become much closer, and many divide. My wife and I, both of whom were successful patients of Dr. Schauer’s, fell into the latter category. Fat can hide more than cheekbones and abs. It can hide years of fatal flaws in a marriage. It wasn’t long after she and I lost the bulk of our respective weight that we split up.
I recently remarried. My new wife, Rachel, is an intelligent, beautiful, funny, sexy woman of my dreams. Would she have given me the time of day when I was fat? In her words, “Sorry, but no way. I would have said, ‘You’re fat. It’s disgusting. Go for a walk!’ ” (You might think this would bother me, but it doesn’t. It’s the kind of funny, honest, to-the-point remark that’s one of the reasons I love her.)
So, am I where I want to be? Not exactly. When you lose half your body weight, your skin can’t exactly keep pace. I still have double chins plus (are there triple chins?). And while I’m pretty happy with the way I look in clothes, I’m certainly not thrilled with my appearance without them. The shar-pei look for the thighs—not cool. Basically, the bod is droopy, and no amount of gym time can tighten it to satisfaction. Like many who lose more than 100 pounds, I’ll probably be turning to a good plastic surgeon to finish the job.
By itself, losing weight didn’t change who I am. But the fat buffer between me and the public world is gone. To be thinner is to be more approachable, and some formerly fat people have difficulty adjusting to this. Some feel “the world” should have given them a chance even when they were fat. A few become intimidated, longing to have their fat back the way a newly released prisoner wishes to be sent back to the security of the cell.
But I was more affected by the expansion of possibilities in my life. Lying in bed at night, I think of spending more years with my wife; having less fear of heart attacks and strokes; and spending better, more active times with my 11-year-old son, my 6-year-old daughter, and the baby Rachel and I are expecting later this year. That child, unlike Alex and Aviva, will never know what it’s like to have a fat dad. Buying normal-size khakis at the Gap is great. But these are the reasons why, when I meet now with Dr. Schauer, I feel a lump in my throat from gratitude.
Article & Content: http://www.menshealth.com/health/diet-strategies-gastric-bypass-surgery
