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Author Topic: Weight Loss Surgery  (Read 10172 times)
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BMadsen

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« on: Oct 31, 2016, 10:58AM »

Hey All,

So, in my years on the forum, I've seen the topic of weight loss discussed regularly, and I've also seen surgery mentioned a few times, but, as far as I can tell from searches, nobody here has had it. I thought I would share my experience, being I'm now approaching 2 weeks post-op, with it, my current thoughts, etc. I'm happy to answer questions (I don't get on here every day, but I will check this semi-regularly).

First, a little background about myself. I've been heavy since late elementary school. I finally got serious about losing weight in college, and lost 50+ lbs halfway through my 2nd year. I managed to keep that weight off through a 4 month cruise contract (not easy when you consider the food and binge drinking that happens, and being I was an irresponsible 20/21 year old - I turned 21 on the ship - quite impressive). That weight took about 6 - 7 years to come back. I then lost about 15 lbs of that regain, and then, because of multiple injuries, dieting issues, etc, I ended up at my peak in Dec of 2015. Luckily, I was healthy through all of it - no blood pressure issues, no cholesterol issues. My doctor said to me, if I was 100+ lbs lighter, she'd not even worry as everything is "pristine."

I've learned A LOT about weight loss over the years. It's not about "dieting," but lifestyle changes. And, every time I've seen a nutritionist, and bring a food diary (with pictures of what I ate, because if you are going to be honest, you want them to know what you are eating and if you are estimating portions correctly, and pictures go a long way when you don't have a scale to measure with you), they have made suggestions, but they are minor suggestions of changes to my diet - except that I eat too much. Too much meat, too many veggies, cut back on carbs a bit more than the rest, etc. I don't eat a ton of chips, sweets, etc. My drinking is less than one drink a day (and often one or so a week), etc. I generally eat well. Just too much. So, "dieting" for me means cutting calories.

My main issue with cutting calories started about 3 years ago. I've always suffered from migraines to a degree, but not often. As a side note, I'm going to put this out there now - if you've never experienced a migraine, it's not just a headache - mine would render me useless for anywhere from 4-72 hours. Luckily, if I got 4 a year, it was a bad year for migraines for me. Now, for those who don't know about migraines, they have triggers. Some people need one, some need two or more to set them off. I'm a two+ person. The more you suffer them, the easier it is to avoid triggers, and manage them. Since I rarely got them, and need a combination, it's very hard for me to figure mine out. I know high-stress times can feed into them. And, 3 years ago, I found hunger was another trigger. During a time I was cutting calories, I had 3 migraines in one week. Luckily, they were short (longest was 8 hours), so I was still able to work, but it's not a way to live. I also was able to connect it to hunger, rather than weight loss, because 2 years ago I was able to lose about 10 lbs in 3 months by working out a lot (1-2 hours a day for 5 days a week). I didn't eat any more than usual, but didn't experience hunger, and lost the weight. But, my schedule doesn't permit that kind of time normally, so I couldn't keep dropping that way (I did keep it off, however).

So, I was getting stuck. My diet was good, I was working out at least 3 times a week, and couldn't cut calories without significantly harming my quality of life and ability to work. So I made the decision to explore weight loss surgery.

Now, every insurance company is different, but most have some sort of basic requirements to pass before you qualify. Mine required that I went to a center with specific qualifications (only 2 near me), had 6 months of nutrition counseling, and a psychiatric evaluation. My surgeon also required a cardiologist, pulmonologist, and gastroenterologist to sign off on the surgery. So, when I started, I had to wait until September before I could have my surgery because of the requirements (I then chose late October because I'm not typically busy late-october and November, so I knew I wouldn't miss too many gigs if recovery took longer than expected).

I'm not going to go into details about all of those visits, except to say that there are things you expect to hear there (eat more veggies, avoid sugar, etc), that I was already doing, and surprising things because of the way your body works post-op (no carbonated beverages, no straws, because of the possibility of severe gas pain).

I started the pre-op diet October 12th. My surgeon required, based on your BMI, either a one or two week liver shrinking diet to make the surgery safer. I feel into the one week range, thank goodness. I lost a lot of weight then, but it's not a long-term diet solution - you aren't allowed any fat or carbs, which isn't healthy long-term. I didn't get any migraines, thankfully, but I wasn't terribly hungry on it until about 3 days pre-op, so it was manageable at that point.

There are 4 primary types of weight loss surgery. Gastric Band (aka LAP Band), sleeve gastrectomy, gastric bypass, and BPD/DS. Most people have Gastric band or sleeve gastrectomy. I had a sleeve gastrectomy. This entails permanently removing about 80% of your stomach, leaving you with a very small stomach. It stretches a bit after the surgery during recovery, but it will always be significantly smaller than if you didn't remove it. It also removes almost all of the part that produces the hunger hormone.

After surgery, you spend a couple days in the hospital, and start on a liquid diet the day after surgery. After about a week, I was cleared to start eating purees. The first week, I was unable to lift anything more than 5 lbs (I could, but had to avoid it) - I was also told not to play. I was cleared to start playing a week after surgery, and am cleared to lift 15-20 lbs now.

All in all, I'm very happy I did it. I'm down 30 lbs already, and expect to lose at least 60 more over the next year. I am already back on gigs, and only lost a week of income, actually (and only had students and three gigs that I missed, so not a huge amount compared to what it could have been). If you need it, and have been on the fence, I highly recommend it - it's a life changer!
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Bradley Madsen
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BGuttman
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« Reply #1 on: Oct 31, 2016, 11:11AM »

Brad, are you required to eat 6 small meals a day?  Someone else I know had Lap Band and that's what they told her.

As a fat old geezer, my doctor was toying with the idea of surgery, but given my heart problems (coupled with diabetes) we aren't sure it's that good an idea at this point.
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BMadsen

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« Reply #2 on: Oct 31, 2016, 11:36AM »

Nope. Now that I can eat purees, I have 3 small meals and 3 protein shakes. Eventually, I'll eat "normally" - 3 small meals (bigger than what I'm eating right now - I literally only eat about 4-6 tablespoons of food), maybe a couple of snacks. Protein shakes will probably be in my rep for life, as they want me to consume 80-100 grams of protein a day, which is hard with such a limited diet.

I can't speak to your heart issues, but they find that many people (I think it was something like 75%) who have this surgery actually see their diabetes improve or go completely into remission. It didn't apply to me, as I never suffered from it, but it's worth knowing.
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« Reply #3 on: Oct 31, 2016, 11:40AM »

I am no expert on weight loss or this surgery, but I am decently fit and have pretty low body fat. First off, kudos for sharing the story. That takes a lot of guts to get that surgery and try to improve your life.

My thoughts probably mean nothing, but to me the big issue with weight gain comes down to sugar, refined carbs and other processed foods, and fake sugar, plain and simple.

Drinking a lot of juice, soda, diet soda, and beer/alcohol all but guarantees that someone will get fat, and it seems like the surgery wouldn't prevent these poisons from being consumed. Eating ANYTHING out of the frozen prepared foods section of the grocery, and nearly anything out of the main isles of the grocery store will make you fat. Adding sugar to any sauce or recipe will make you fat. The calorie in/out methodology is flawed. 100 calories of soda will always be more than 100 calories of banana or steak, because of what it takes to access those calories. 100 calories of white bread will never equal 100 calories of whole grain sourdough. I totally believe that the many health problems we face today would all but disappear if the central isles of the grocery were closed off and people could only buy raw food from the produce, butcher, staples (bulk rice, bean, flour, oil, spices, etc), and dairy sections (select items only). You could basically eat anything you wanted but you would have to cook or bake it yourself.

Hopefully this surgery does give you many extra decades of life playing the trombone and all is well. I'm kind of curious what limitations it puts on what you can eat. Any complications?
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« Reply #4 on: Oct 31, 2016, 11:57AM »

Maybe if grocery stores were built like IKEA stores you'd burn it all off by the time you reached the checkout.
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BMadsen

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« Reply #5 on: Oct 31, 2016, 12:05PM »

I am no expert on weight loss or this surgery, but I am decently fit and have pretty low body fat. First off, kudos for sharing the story. That takes a lot of guts to get that surgery and try to improve your life.

My thoughts probably mean nothing, but to me the big issue with weight gain comes down to sugar, refined carbs and other processed foods, and fake sugar, plain and simple.

Drinking a lot of juice, soda, diet soda, and beer/alcohol all but guarantees that someone will get fat, and it seems like the surgery wouldn't prevent these poisons from being consumed. Eating ANYTHING out of the frozen prepared foods section of the grocery, and nearly anything out of the main isles of the grocery store will make you fat. Adding sugar to any sauce or recipe will make you fat. The calorie in/out methodology is flawed. 100 calories of soda will always be more than 100 calories of banana or steak, because of what it takes to access those calories. 100 calories of white bread will never equal 100 calories of whole grain sourdough. I totally believe that the many health problems we face today would all but disappear if the central isles of the grocery were closed off and people could only buy raw food from the produce, butcher, staples (bulk rice, bean, flour, oil, spices, etc), and dairy sections (select items only). You could basically eat anything you wanted but you would have to cook or bake it yourself.

Hopefully this surgery does give you many extra decades of life playing the trombone and all is well. I'm kind of curious what limitations it puts on what you can eat. Any complications?

I'll admit to past sins of poor eating - especially in childhood through my teen years. As an adult, I eliminated regular soda from my diet about 15 years ago, and diet about 6 years ago. Before the surgery, I rarely ate white bread - always opting for whole grains. I make a lot of my own sauces with no sugar, cook fresh a lot (or from frozen veggies - which have nothing added to them). I started eating this well in college, when I became a vegetarian (except for drinking WAY too much), and got better and better as I got older. Even after reintroducing meat and fish, I still eat very well. As I stated in my first post, nutritionists had very little advice for me except calorie cutting and eating a few less carbs - not a ton less, however. About 20% less or so. And, by doing that, I lost about 1 lb.

I have to run out to teach, but at some point I will try to link to some of the more recent research on weight loss - you are right that it's more than just calories in and out, but it's so much more than that than you realize. Our biology makes it incredibly difficult to lose and MAINTAIN weight loss. It can be done, but, when I can get that done, you'll see that it takes a level of work that most everyone would feel is extraordinarily difficult for any working adult to do.
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Bradley Madsen
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« Reply #6 on: Oct 31, 2016, 12:48PM »

Thanks for sharing.

I lost 22 pounds this past year and got down to my goal weight(I've since crept up a bit, but I'm still maintaining a healthy weight.  So far.)

I did it on a wellness program we have at work, where they measure body composition and metabolism and give specific guidance. 

And like you, migraines that I'd pretty much got past, down to maybe one a year, came roaring back, daily.  They were milder and shorter, but still no fun, plus I get the optical part where I can't see to read or drive. 

They didn't last.  They were daily for a bit, then weekly, then tapered off. 

I read up on them again and some of the thinking has changed.  They are no longer thought to be vascular, but neurological.  And some of the triggers are not triggers, but symptoms - like that Hershey bar didn't cause it, you were already into prodromal and that included a craving for a Hershey bar.  (that's an example, I pretty much have a craving for a Hershey bar 24/7.)  My occasional extreme irritability is part of the migraine I'm going to get tomorrow.

Well, I've drifted off topic.  Congratulations on a healthier you. 
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Tim Richardson
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« Reply #7 on: Oct 31, 2016, 03:47PM »

I've actually found (60 lbs. down, eight years after losing it), that my life is much EASIER now that I spend, cook and eat less-- not harder.  I focus on food and fitness more than the average person, to be sure, but insofar as I believe that there is nothing more important on which to focus than maintaining one's quantity and quality of life, I don't consider it a hardship at all.  Quite the opposite actually.  PM me if you want some suggestions or a full program.  I have a half-dozen or so trombonist clients who have seen similar results to mine. No extreme dieting required. 
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« Reply #8 on: Oct 31, 2016, 04:09PM »

Thanks for sharing.

I lost 22 pounds this past year and got down to my goal weight(I've since crept up a bit, but I'm still maintaining a healthy weight.  So far.)

I did it on a wellness program we have at work, where they measure body composition and metabolism and give specific guidance. 

And like you, migraines that I'd pretty much got past, down to maybe one a year, came roaring back, daily.  They were milder and shorter, but still no fun, plus I get the optical part where I can't see to read or drive. 

They didn't last.  They were daily for a bit, then weekly, then tapered off. 

I read up on them again and some of the thinking has changed.  They are no longer thought to be vascular, but neurological.  And some of the triggers are not triggers, but symptoms - like that Hershey bar didn't cause it, you were already into prodromal and that included a craving for a Hershey bar.  (that's an example, I pretty much have a craving for a Hershey bar 24/7.)  My occasional extreme irritability is part of the migraine I'm going to get tomorrow.

Well, I've drifted off topic.  Congratulations on a healthier you. 

I wish that the migraines had decreased - the longer I went, the worse I got. Over 3 weeks of calorie cutting, I had 2 migraines the first two weeks, and 3 the 3rd week. I stopped after that because it was clear it was getting worse, because none of my other suspected triggers were present.

I didn't have cravings leading up to my migraines either - beyond desiring to eat more. But I would have been thrilled to have steamed chicken and vegetables at that point, and that desire existed all day at that point, rather than specifically before the migraine.

I've actually found (60 lbs. down, eight years after losing it), that my life is much EASIER now that I spend, cook and eat less-- not harder.  I focus on food and fitness more than the average person, to be sure, but insofar as I believe that there is nothing more important on which to focus than maintaining one's quantity and quality of life, I don't consider it a hardship at all.  Quite the opposite actually.  PM me if you want some suggestions or a full program.  I have a half-dozen or so trombonist clients who have seen similar results to mine. No extreme dieting required. 

I'm glad that your program is working for you. When I get the chance, I'll post the research I mentioned earlier. It's not that you CAN'T lose weight, but it requires a certain level of focus on this stuff that is rather difficult for most people to manage with work and family obligations. It sounds like you are able. I would probably be able to as well, if my migraines weren't such an issue.

As for a program, I'm personally set with a program - I have a pretty scripted diet with my recovery (it won't be until about 12/14 that I can eat anything with little risk), but even after, my nutritionist has already approved my previous diet, just in much smaller amounts (with a few modifications - for instance, I used to make this great black bean filling that I would have on a whole wheat tortilla, and instead I'll add chicken and cut the tortilla because the carbs in the black beans is more than enough to cover my carb needs). But, I'm sure anyone looking to lose weight would be interested, knowing you've lost so much and kept it off for 8 years.
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Bradley Madsen
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« Reply #9 on: Oct 31, 2016, 04:24PM »

I'll be interested to see that research. It's hard for me to ponder the idea that doing less would require additional focus in the long run.
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« Reply #10 on: Oct 31, 2016, 06:25PM »

Here's a starter: http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html

Almost all of the research I've seen since this article has basically deepened the basic ideas that this magazine article talks about. I'll continue pulling up more things I've read in coming days.
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« Reply #11 on: Oct 31, 2016, 07:10PM »

Interesting to read your story. The only other online personality that i've followed who has had weight loss surgery is TV writer Mark Evanier who occasionally writes about it.


Best wishes for your continued weight loss and improved health!



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« Reply #12 on: Nov 01, 2016, 06:34AM »

Here's a new story I just read that's exploring the link between poor memory and weight gain:

http://www.bbc.com/future/story/20161031-why-obesity-damages-your-mind-as-well-as-your-body

Nothing conclusive, yet - it's new - but it does raise interesting ideas and questions. One nutritionist I saw about 5 years ago told me to completely focus on my meal when I was eating, and I did for 2 weeks. I know I ate less, and lost 2 pounds, without changing what I was eating, but my wife wasn't happy that I was ignoring her during meals. When I tried to balance the need to focus on eating and on her, the weight loss stopped - and when I started focusing a lot more on her, I put those 2 lbs back on. Again - the kind of thing that seems to help, but for me, was unrealistic (and I doubt that my experience is unique).
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Bradley Madsen
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« Reply #13 on: Nov 03, 2016, 06:26AM »

More articles citing reliable research into losing weight:

http://www.cbc.ca/news/health/obesity-research-confirms-long-term-weight-loss-almost-impossible-1.2663585

http://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832?pg=2

https://www.hsph.harvard.edu/nutritionsource/best-diet-quality-counts/

http://ajcn.nutrition.org/content/82/1/222S.long

I post these not to discourage trying (some are rather negative on long-term success), but to educate. My feeling is, if you know what you are up against, you can set realistic expectations, and decide if more extreme interventions (such as my surgery) are necessary, based on your health and goals.

The Mayo Clinic's page about weight loss drugs is interesting because my doctor and I considered them, but her concern was long-term dependance on them to keep the weight off. I wanted to not be on medicines long-term if I could avoid it, especially if they could have serious side-effects (because the longer you use them, the better the chance you can develop them).
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Bradley Madsen
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« Reply #14 on: Nov 03, 2016, 06:29AM »

The very best weight-loss diet I ever saw advocated eating anything and everything you like - just smaller amounts. That is a whole lot more sustainable than crazy schemes. If it took 20 years to put the weight on, don't expect it to come off in weeks or months. Think long-term.

...Geezer
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« Reply #15 on: Nov 03, 2016, 06:32AM »

The very best weight-loss diet I ever saw advocated eating anything and everything you like - just smaller amounts. That is a whole lot more sustainable than crazy schemes. If it took 20 years to put the weight on, don't expect it to come off in weeks or months. Think long-term.

...Geezer

 Good!

Sustainability is everything.  It's science!

https://www.sciencedaily.com/releases/2005/01/050111122137.htm
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« Reply #16 on: Nov 03, 2016, 06:57AM »

Bradley, thanks for sharing your journey. No doubt it may help someone reading to make positive changes to their own life. You were right when you said lifestyle changes, and doing what works for you, within job and family obligations. Some people are truly lucky if their healthy lifestyle gives them ample time to invest in their wellness. The rest of us just have to make time, the best we can.

I would like to mention that for me, I always feel better when I exercise daily, and eat a good balance of fruit, vegetables, beans, and nuts and seeds. Plant-based meals are the simplest and work the best for me (and the world 🙂).

Best of all, the ability to continue making music is a gift that some with health problems don't get to continue.
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« Reply #17 on: Nov 03, 2016, 12:14PM »

That is a whole lot more sustainable than crazy schemes. If it took 20 years to put the weight on, don't expect it to come off in weeks or months. Think long-term.

...Geezer

Geezer, I'm not sure how to take this statement. If I take it at face value, then I have to assume you've completely ignored everything I've written and posted here, and believe that this choice I've made in consultation with my doctor over the course of years is a "crazy scheme." (To add to the background, my doctor started suggesting it for me in 2013, but I really didn't come around to the idea until Dec of 2015, and then by the time I got enrolled in the program and started working through the requirements, had to wait until October for everything to line up).

If I take it as a comment on weight loss in general, then you are also ignoring the articles posted. Even the article posted by TromboneMonkey admits to only modest losses, and doesn't look at regain issues. For long-term improvement in health, it's commonly accepted that (if you are overweight or obese) you need to lose at least 10% of your starting body weight and keep it off. Those diets, in the time frame indicated, actually had very few successfully losing at least 10% of the body weight in a year. There is also this caveat mentioned:

"… we found that a variety of popular diets can reduce weight and several cardiac risk factors under realistic clinical conditions, but only for the minority of individuals who can sustain a high dietary adherence level. Despite a substantial percentage of participants who could sustain meaningful adherence levels, no single diet produced satisfactory adherence rates and the progressively decreasing mean adherence scores were practically identical among the 4 diets. The higher discontinuation rates for the Atkins and Ornish diet groups suggest many individuals found these diets to be too extreme. To optimally manage a national epidemic of excess body weight and associated cardiac risk factors, practical techniques to increase dietary adherence rates are urgently needed," the authors write."

While the study admits that there may have been better long-term adherence if the participants got to choose their own diet, society is clear proof that long-term adherence is not actually possible with these diets, because outside of the study, we can all choose our way to weight loss, theoretically.  And, the transition back to regular eating, if you read the NY Times article, is particularly a problem, because our brains trick us into eating more without realizing it, and our bodies actually need significantly less than we realize because of the fact that a large amount of weight has been lost.

If these are wrong, please clarify. If one of these are correct, please take the time to read everything before commenting, so you add something to the discussion, rather than sounding like you are attacking what's being discussed. I intended this discussion to be a positive one, and educate the community on how having this surgery, should you deem it necessary, doesn't end your ability to play (as I remember was mentioned at one point in another thread).
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Bradley Madsen
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« Reply #18 on: Nov 03, 2016, 01:03PM »

It was just a general comment on dieting, etc.

...Geezer
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« Reply #19 on: Nov 03, 2016, 01:21PM »

On long car trips sometimes my wife listens to the radio talk show, Delilah.

Yeah this is a circuitous route but I might be able to connect it up.

The conversation is pretty much the same on every single call:
Caller:  I can't seem to stop nagging my husband, even though I know how much it bothers him.  I've been trying for years and failing, and I'm at my wits end.  I think my marriage is going to fail.  What shall I do?  (nb:  specific example chosen at random from multiple similar scenarios) 

Delilah:  Stop nagging him.

Caller:  Oh, thank you, thank you, you've saved my marriage and my life.  I'll always be grateful, and tell all my friends about you. 

The point is that some things are easy to know how, but hard or impossible to do.  Losing weight is one, quitting smoking is another.  The better studies say only about 5% of people actually succeed in quitting smoking.   
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