Adventures in Bariatric Surgery

So nine weeks ago I had a Roux-en-Y Gastric Bypass. Thought it might be worth writing a bit about the experience and a few of the things I would have done in preparation knowing what I know now.

Disclaimer: I am not a medical professional. This article is opinion from a lay person. Advice here may or may not work for you.

The story so far: A bit over four years ago I had a Lapband installed. It had the attraction of being reversible whereas the bypass is permanent. While it was effective and I lost about thirty kilograms, after four years weight loss had completely stalled and I started having other issues with it – mainly reflux and heartburn. It turns out in the four years since I got my lapband the prevailing wisdom on the subject has decided lapbands generally last about four years then start having problems, and help the recipient loses about thirty kilograms, but no more. Nice to be inside the curve I guess.

So, still wanting to be alive in twenty years or so, I needed to do something else. The bypass seemed like the logical option to pursue. It’s been around for a fair while and seems to have a pretty good track record (you always hear the horror stories, but they are the exceptions).

So, here’s the rough order of events leading up to and the weeks after the surgery:

  • Two weeks before, you’ll start a very low carbohydrate diet, consisting mainly of protein shakes and soups like Optifast plus a cup or two of veggies per day. The purpose of this is not to enlighten you to the virtues of a Ketogenic diet, but to shrink the size of your liver so it is not in surgeon’s way while they meddle with your other internal organs.

  • Surgery. Don’t be a hero, take the pain medication.

  • All things going well, you’ll spend four or five days in hospital.

  • For the first week after surgery you will be on fluids only. This is basically anything that you could suck through a straw. So soups, shakes… more soups. Expect that you will have a very low tolerance for anything with sugar in it (more on that below).

  • Weeks two and three you upgrade to mush! Anything that can be run through a blender to become puree. This can include casseroles, pasta, risotto and thicker soups. If you can run it through a blender without burning it out, than it is probably fair game.

  • Week four you actually get to use your teeth, kinda. Soft foods. Mostly what you’ve been eating for the last two weeks but without having to blend it first. More casseroles and pasta, but also poached eggs, mince dishes and chunky soups.

  • Week five, all things being well, you’re onto your quote long-term eating plan unquote. Eat sensibly and all that.

Post surgery you want to be pretty kind with yourself. Not only has some of the internal plumbing been rearranged, but the surgery itself is pretty big. Your body will spend a few weeks going, “What the hell just happened?” I found even five weeks later I would be going fine for four or five days then completely conk out and want to sleep for a day, then be fine again. It’s a big adjustment.

Another thing I found post-surgery was a high sensitivity to sugar, called Dumping syndrome. Basically the stomach valve is no longer there to regulate the release of food into the bowel, so the sugar gets dumped into your intestines all at once. Among other things, your body responds by producing an excess of insulin. Symptoms can include a rapid heart beat, sweats, nausea and can even trigger an anxiety attack. Basically you feel like the sky is falling on your head for twenty to sixty minutes.

Initially, even the lactose in milk was enough to make me feel unwell. Even the protein shakes from the pre-surgery low-carb diet had enough sugar in them to trigger episodes, which nixed my plan to use the left over shakes during the first week as part of my fluids.

Fortunately around week four or five, when I started eating substantial food again, the sensitivity started to lessen. While if I were to eat half a family block of chocolate it would make me feel like I was dying, I can enjoy a couple of pieces with only a mild flutter. More importantly, although lactose free milk was okay, I can use regular milk in my coffee again, so life goes on.

For me, this negative buzz if I eat too much sugar was one of the more distressing changes. Not so much because I want to eat more chocolate, but because of how ill I feel if do eat something that disagrees with me. Discovering that peanut butter really does not agree with me any more was a rude surprise that wiped me out for a good hour. On the other hand, as a incentive to eat a bit healthier it is certainly effective. I’ve convinced a bypass is two parts changing the way your body processes food and one part aversion therapy.

With the rearranged internals, you have to get use to different sensations around eating and hunger. Feeling hungry is usually a mild thing that only pops up if I haven’t eaten or drunk anything for half a day. When sitting down to a meal it is also quite easy to eat too much and be over-full. You don’t get the feeling of a full stomach in quite the same way. Also, you’ll be surprised how little food you end up eating at a meal. Having lived with the lapband previously was probably good preparation so I adjusted pretty fast. Looking at the last couple of bites of food on your plate and thinking, “I’ll just polish that off,” can be the difference between thinking, “That was a satisfying meal,” and, “Oh, why did I eat so much?” You adjust in time. When eating out at a restaurant I now take a plastic container in my bag to bring the leftovers home for lunch the next day. Unless you spend the rest of your life ordering entrées you’ll never finish a restaurant meal.

So, things to do in preparation for having a bypass? Figure out as much of the foods you can eat for the first few weeks after surgery in advance. Especially if, like me, you hate soup. Figure out and test the options well beforehand. Assume anything sugary is going to make you feel sick. Even the lactose in milk. Prior preparation will help you resist the temptation to rush the schedule and move onto the next phase sooner. Don’t do that, you might bust a seam.

After the surgery, your body wants lots of protein to help it heal. So beforehand, find a sugar-free, lactose free, maybe even gluten free protein powder that you think you’ll be able to put up with drinking daily for a while. You’ll probably want to avoid anything that tastes sickly sweet. (Pro tip: A drop or two of peppermint essence can really help.) First week home I went down to the local body building supplements store and explained what I needed and why. I wasn’t their first customer in this situation and they were very helpful.

You’ll also have been pumped full of antibiotics for a couple of days, so taking some sort of probiotic is probably a good idea too. Think yoghurt, kombucha, kefir, kvass or other fermented foods. (Flavoured yoghurt usually has too much sugar. A couple of big spoonfuls of plain yoghurt blended up with some almond milk and half a banana or some frozen berries can work well.)

Be prepared to supply your own food while in hospital, in case their idea of a good post-surgery bariatric fluid menu is milk shakes, fruit juice, sustagen and a thin soup that tastes like a doormat. Having not figured out the dumping syndrome thing, and being completely out of it for a couple of days after three hours of surgery, I thought feeling absolutely crap after eating anything was normal. It wasn’t.

Check with your surgeon what medications you may need to be on and for how long after the surgery. In my case I need to be on pariet for about six months to minimise stomach acid production while things heal and the body adjusts. You may need to go back to your GP to get a prescription with repeats.

It is good to find a surgeon that is part of a larger team that does follow-up and looks after you both before and after the surgery. You get to talk to a dietician that will tell you some of what to expect, and make sure you’re set with the proper vitamin supplements and such. Go over the types of food to eat and what can be problematic. You can ring the nurse when the larger laparoscopic incision on your left side starts really hurting after four weeks and they can tell you that is normal and what to do about it. They’ll field weird questions like, “My lips have been really, really dry since the surgery, is that normal?” (It isn’t, but it cleared up after about four weeks, and you can steal the moisturising stick out of your partners handbag to deal with it in the meantime.) They’ll assure you that you’re not being a bother and they would far rather you ring and ask instead of worry.

If all this sounds painful and a hard and a big thing, well it is. But remember the end goal is still being alive in twenty years. I’ll be around too.

Unreasonable People

Listening to Kate Taylor tell stories this morning about how she founded The 2H Project reminded me of something George Bernard Shaw wrote:

The reasonable person adapts themself to the world; the unreasonable one persists in trying to adapt the world to themself. Therefore all progress depends on the unreasonable person.*

I am glad there are unreasonable people like Kate in this world.

* Paraphrased to be gender neutral.

Reading Habits of 2015

So 2015 was very similar to 2014 in terms of book reading, which clocked in at 72 books and a total of 20,909 pages for the year. Or 57 pages per day, or a book every a book every 5 days on average.

There was only one book I gave up on (it was an early novel from an author I usually enjoy, so that was unusual). My average rating was 2.94, against a Goodreads average of 3.89 for the same set of books. Last year my average was 2.79 so perhaps I am getting a bit kinder in my ratings.

I also read a whopping 789 articles and blog entries (most done via my ereader’s integration with Pocket). A word count of about 1.15 million. (Looking at the month by month, there’s a big spike in May when I was doing a lot of bus travel.)

Cover image for Unforgettable

My favourite book for the year is Unforgettable by Eric James Stone. Second place is The Devil’s Only Friend which is a good launch into a second trilogy based on the horror series that started with I Am Not A Serial Killer.

Two books rated with five starts, 18 with four stars, and 28 with three. That’s 60% of books with a three star rating or better (which is a 5% drop from last year). This year all 72 books were read as ebook format on my Aura HD.

Reading Habits of 2014

In 2014 I read 72 books, a total of 20,572 pages for the year. That works out to about 56 pages a day, or a book every 5 days on average. That’s a 14% increase over the previous year, so I’m definitely becoming more of a shut-in, if there was ever any doubt.

This does not include four books that I didn’t finish as I found them not to my taste, or two audio books I listened to this year.

This also does not include 882 various articles and blog entries that I also read via my ereader. This naturally includes a lot of computer programming related articles, as well as the occasional movie review, something about coffee, diversity in tech, stoicism, or anything else that captures my interest.

I’ve been tracking my book reading via Goodreads. My average rating is 2.79, which is about on par with last year. The average community rating of the same books is 3.87, which is also about the same as last year. Interesting to see the consistency there.

All in all my year old reading glasses got a very good workout.

Cover image for The First Fifteen Lives of Harry August

My favourite book for the year would have to be The First Fifteen Lives of Harry August by Catherine Webb under one of her several pen names, Claire North. It’s on my list of books to read again sometime. Special mention would also have to go to Rubbernecker as the second runner. All in all, I rated sixteen books with four stars and the bulk, thirty-one, with three stars. That’s 65% of the books I read with a three star rating or better. Of these books, I read six on paper (pbooks), the rest were ebooks.

I also plowed through a few series, including the four books in Gregg Hurwitz’s Tim Rackley series, and fifteen books in Craig Johnson’s Longmire series.

Special mention also has to go to the audiobook version of Dune that I listened to. It was a very good production. I’ve read Dune at least three or four times previously, but probably hadn’t picked it up in over a decade. Listening to this reminded me how much I enjoyed this book (and loathed the rest of the series).

I started the year with an Icarus Pocket six inch ereader. It was okay, and the firmware had some nice features, but it never really played well with plugging it into my Linux desktop computer and loading stuff with Calibre. Hard restarts were required regularly. Then some of the buttons stopped working, so it was time for an update.

I ended up going with Kobo’s Aura HD and am really happy with it. I always found the six inch e-ink screens a little cramped, so the 6.8 inch gave me the bit extra room I needed. I was also surprised to find the higher resolution screen a big difference to me, and was just that much more comfortable to read with.

With regard to using my ereader to read articles and blog entries, for the last few years I’ve been using a program I wrote called Erudite that downloads articles saved via Instapaper or Pocket, convert them to an appropriate format such as EPUB or MOBI, and add them to my Calibre ebook library.

However, one feature of the Aura HD ereader I purchased this year turned out very handy. It has the ability to synchronise with Pocket. So if I saved all the articles I want to read with Pocket, then they are wirelessly synchronised onto my ereader, saving me having to plug it via USB into by desktop and run through my Erudite → Calibre → ereader pipeline all the time. (I still use this for articles Pocket doesn’t deal with, or that I want to keep a copy of.)

However, I still wanted to track my article reading habits, plus follow up on articles in related forums such as Hacker News after I’d read them and such, so I wrote a litte PHP browser based application that interfaces with the Pocket API to help me manage all that.

Naturally I called it Pocket Lint.

My Sit/Stand Desk

I’ve been interested in having a sit/stand desk in my home office for quite some time. There have been lots of articles in the last few years about the health risks of sitting at a desk all day, and it is something I’ve wanted to put in place for quite some time.

I had a modified desk with a three tonne hydraulic automotive jack under it for a while which made one thing clear. You have to be able to adjust the height very easily, with little fuss, or you wont adjust as often as you would like. To that end, a motorised desk was clearly the order of the day.

After playing around with some electric car jacks as a lift mechanism, and a rocky frame that didn’t travel smoothly, I finally said, “screw it,” to the DIY project and ordered a QDOS desk frame.

Here’s the end result, my new desk, currently set at standing height. (Click on any image to see a larger version.)

Desk at standing height.

I reused the desktop from my old desk, although it was quite wide so I cut it down a bit so it could sit closer to the wall. I also wanted some nicer monitor stands as I was tired of plastic boxes and phone books, and wanted all the monitors at the same height.

I like my monitors sitting quite high above the desk, and pretty much vertical, not tilted back, which became a problem as I found most suitable monitor stands were not tall enough unless I was going to buy one that would mount two monitors vertically. So instead I bought some wall mount brackets and then wandered down to the local hardware store to figure out how I was going to use them. This is what I came up with in the end:

Bracket side-view. Bracket end-view.

A bolt is run though the desk from underneath, screwing into the bottom of the shaft. An angle bracket provides additional stability. Placement was a very fiddly process as you don’t want to go drilling holes in your desk in the wrong spot, but it turned out alright in the end.

Placing the centre bracket. All three brackets done.

Pulling the old desk out also provided an opportunity for a good clean-up, and I think you could agree the final result is a lot neater than before.

Old desktop. New and improved desk.