(Long-Awaited?) Update

Green means go.

I got green lights from all the necessary parties. Nutrition, psychiatry, most importantly of all - finance (meaning I've paid my program fee in full).

I am a go all around for my VSG surgery.

My weight is up right now. I just ate half a bag of Cheetos, a handful of Chex Mix, and a slice of ice cream cake for my dad's birthday.

I have to weigh in on Monday. I feel like I should cancel/postpone the appointment. I don't want to fuck this up so hard that everything I've done so far gets pushed aside because I weigh in high on Monday. Because you know what? That's just not fair. Justified, perhaps. But not fair. There's a difference.

It's time for this to continue. It's time for ME to get on with my life. The first year of my 30s is half gone, and I've accomplished very little in it, except a good score on my GRE.

There's nothing deep for me to throw out there into the void, right now. I just thought that my upgrade to greens warranted an update. Stick with me, kids. There'll be more to come. I promise.

VSG

VSG.

The sleeve.

Vertical Sleeve Gastrectomy. Sleeve gastrectomy.

Whatever you want to call it, it's what I've decided.



This is my solution.

In going through the pre-operative program with Geisinger, I was always under the impression that they only offered the full gastric bypass (RNY) or the LAP band. When I attended the informational class, led by one of the head nurses of the program, she mentioned the sleeve... and I suddenly felt committed.

Both the bypass and the band have their pluses and minuses, but in both cases, the negatives almost outweigh the positives. When push came to shove, I was leaning toward the band, but the very slow weight loss combined with the intensive adjustment period involved to add/remove liquid from the band really turned me off to the idea of it. Not to mention that any time I said to a medical professional that I was leaning more toward the band, they would inevitably do that little wince and suck air in through their teeth to make a hissing sound... then bombard me with anecdotes of patients who've failed with the band - especially starting at my size.

The bypass, however, did not appeal to me at ALL. It has the highest risk of complications and death and long-term effects on your health, such as iron deficiency (I'm already borderline), B12 deficiency (I may go vegan some day, I won't need any help with that deficiency), and osteoporosis due to calcium deficiency. Right now, the only thing that's wrong with me is that I'm fat. Why am I going to agree to a surgery that could cause problems I may never have had in the long run, just to be thin? Nuh-uh. Logic.Fail.

The sleeve... it satisfies all of my intellectual desires for a surgery. It has more rapid weight loss than the band (but not quite as rapid as the bypass); it does not induce nutritional deficiencies, because nutrients are all still absorbed as normal. All it does is provide a physical stop sign (where I often feel like I do not have one, now) and an extended feeling of fullness. I feel it is, in a word, perfect. And most of the first-hand accounts I've read seem to support that feeling. It's very rare to run across someone on a message board who has been unhappy with their decision to have the sleeve operation... and when someone IS unhappy, it's more often that they get heartburn more than they used to, but it's under control with over-the-counter medication.

I have another appointment with both the psych team (I got a "yellow light" the first time through) and the dietitian (I was upgraded to a "green light," but they want to do a weigh-in to make sure I'm staying on track) on August 10th - at which point, they may compose the letter to my insurance company to get approval to go-ahead with setting a surgical date.

1) Commence freak-out.
2) Get off caffeine. *sips coffee* Tomorrow.
3) Keep honest, accurate food logs from now until that date (and beyond).
4) Get more active on verticalsleevetalk.com.

Second "Class"

My second class wasn't so much a class as a distribution of materials and an informational "Please pay this amount" session. Which, hey, fine, whatever. At least I didn't have to see the asshole nutritionist. Our materials included the surgical binder full of vital info (like timelines, pre- and post-op nutritional guidelines, surgical specifics, and some psychological newsletters to read and consider) and a book by Barbara Thompson, which I just finished reading yesterday.

The six month preparatory education meetings (and the materials distributed therein) carry a flat rate fee (through my program) of $375 which must be paid in full before a surgical date can be scheduled. We met the lady responsible for the billing at the center and she explained to us how we can opt to pay (all at once, installments, etc.). Insurance will not cover this cost and it does not go toward insurance "out-of-pocket" maximums.

I sent my first payment last week.

As far as I'm concerned, the ball is rolling and the decision is more or less made.

My mother is fighting valiantly to keep her mouth shut about my decision - but I can tell she doesn't want me to have the surgery.

But you know what? She may feel like she's been fat her whole life, but she was a size 8 when she married my dad. She wasn't wearing plus sized clothing until the 90s. Possibly the MID-90s. Do you know when I stepped into my first Lane Bryant? Sixth grade.

1993 was not a great time to be a plus-sized pre-teen. Back then, only old ladies were fat. That's what the clothing makers believed, anyway. There are lots of photos of me wearing clothing that could easily be mistaken for upholstry.

Twenty years of dieting (that's 2/3 of my time on this planet) has made me over-informed and unenthused. I am jaded. Calories in vs. calories out is a terrific theory... in theory.

In reality, it's a bitch of a black hole that just sucks your soul away, and when you finally manage to claw your way out of the crushing gravitational pull of count-count-count-deprive-exercise-count-count-exercise-exercise-refuse-invitations-count-count, you launch yourself head first into an industrial sized bag of potato chips and skid into a tub of Ben & Jerry's. Cackling from the sugar rush, you crack "What a long, strange trip it's been!" and slice open the packing tape on the box of "fat clothes" in the back of the closet.

Or maybe that's just me?

Dieter's cynicism aside, I am trying to get back on track with healthier eating (and living).

I ate something at McDonald's almost every day last week. I honestly don't know why.

Today, I'm trying out a new plan. I'm going to have Slim Fast for my evening meal, as that seems to be when I binge/graze/give up on the day. I'm going to add a salad onto that... maybe even a can of soup, as the warmth will keep me fuller for longer.

First Class

I had my first prep class on March 7th. I intended to post about it then, and join the freight train of weight loss surgery (WLS) bloggers already out here on the interwebz, but you know how it goes. Life interferes; 9,000 strangers you don't even know, but are somehow more dear to your heart than most people you DO know, die; depression hits; PMS comes and goes; Prozac is added to the daily multivitamin regimen in a different sort of attempt to balance one's life - never mind the vitamin D, give me that vitamin P!

Et cetera.

Before my class on the 7th, I had to meet with the doctor I'd met for the initial consultation several weeks earlier. I weighed in (wearing heavy work boots and not removing my coat due to the nurse's rush-rush-rush demeanor) and managed to weigh nine pounds more than I had at my initial consultation. I'm mentally subtracting five pounds from that for various factors - clothes, having just eaten lunch and drunk about a liter of water - and accepting the fact that maybe I weighed four pounds more than I had previously.

But you know what? March 7th was five days after my 30th birthday. Yes, I ate cake. Probably more than I should have. And I had a few drinks here and there. And I ate a burrito the size of my head at Mad Mex and had a damn margarita. You only turn 30 once, right?

My handsome Russian doctor scolded me. "Was it your birthday all week?" Well, yeah, it kind of was. I had different days with different groups of people and different places to go and things to do... it's not like turning 10 and having all of your classmates come to your house and having a once-and-done event. Age complicates things.

"Obviously, you are still eating too much. And not exercising enough. If you can't do this, this won't work."

If I could do this, I wouldn't be contemplating the surgical option, thankyouverymuch.

The visit with the doctor left me dejected, upset, disappointed in myself and angry at the world. Angry at well-meaning coworkers who do nothing but harm in bringing donuts/candy/cookies/snack mixes to the office. Angry at parents who don't seem to get the real consequences of this surgery, should I finally opt to have it, thus continue to load the cupboards and pantry with processed empty calorie crap. Angry at myself for lacking the willpower and motivation to avoid the temptations and drag my ass to work out after particularly busy bank days.

Still, there was a class to attend about "nutrition," so off I went, confident that I already knew everything the class was going to offer.

So far as actual nutritional information goes - I did. So far as post-surgical nutrition goes - I did not. And can I mention that the teacher of the class is the dietitian I have so thoroughly raked across the coals in this blog many times? The one I went to see in high school who was absolutely USELESS and who I abhor to this day? Yeah, let's not forget that.

Post-surgical nutrition goes a little something like this:

- The first two weeks are a strictly liquid diet.
- From then, all solid foods must be chewed to applesauce consistency.
- It will take approximately 10-minutes to consume one ounce of food. Use a timer.
- 5 grams of fat per meal.
- 60 ounces of fluid per day. (I usually drink twice that, now.)
- Liquids may not be consumed during meals. Only 30-minutes before eating or 30-minutes after.
- No caffeine (2-weeks before surgery and 2-months after).
- No straws, carbonated, or sugary drinks.

Then there are the generally accepted post-surgical "side effects" of dumping syndrome, anemia (I'm already borderline for this, surgery exacerbates the problem of iron absorption into the bloodstream), B12 deficiency, and possible protein deficiency leading to hair loss and all sorts of other fun problems.

This surgery invites sickness and ill health as companions to being thin. Of course, there are people who sail through without experiencing these issues. But then again, there are people who don't.

Which am I?

My next class is on April 6th. It's a "behavioral" class. Stay tuned.

Japan

Those of you who have known me the longest... know that I lived in Japan for almost six years. And left it very begrudgingly last April, only because the contract for my job was lost to a lower bidding company.

This disaster has had a profound effect on me. I have found myself on the verge of tears - or even crying - dozens of times over the past five days. It's hard for me to tear myself away from CNN in order to come to work.

All of my friends seem to be ok, so far, though the nuclear threat looms ever larger. My best friend in the country is in an area that was affected by the quake, but not the tsunami, and she tells me that supplies are running out. They've been told that regular supply could be delayed for up to a month, as they are going to be re-directing everything to the hardest hit areas first (of course). She is looking to get out of her area as soon as she can, either to visit friends in other parts of Japan or to spend a few weeks at home (New Zealand) until things calm down.

What most people don't know is that if I had taken the job I was offered when my contract was gobbled up (I had about 2-hours to decide... move within Japan or move back to the US), I would have been in Miyagi Prefecture, one of the most devastated areas.

I have been coping the best I can with what's going on, but it's been extremely difficult. I have fleeting feelings of guilt (I should have been there, and I wasn't... I could be helping because I am young and strong and Japanese-capable, but I can't, because I'm not there...), more guilt because I am relieved that I wasn't there, worry for friends, friends of friends, and friends' families who may yet be in the path of nuclear fallout if it comes to that, and the constant onslaught of information in this oh-so-connected age... new videos cropping up on youtube every hour, streaming Japanese news, email updates and pleas for charity relief...

At this point, I wish I could just curl up in my bed and hide under the covers for a while with my teddy bear. Teddy bears can't heal the world, but they do their best.

More on Surgery and My Fat

This is a conversation I had recently (via e-mail) with a very dear friend, and it's a lot of what I want everyone to know...

Her:
Subject: Interesting?
I haven't decided, because I haven't finished, but I am reading. Words. Lots of words.
http://www.thestranger.com/slog/archives/2011/02/11/hello-i-am-fat
I read down to about 100 in the comments. Now I am eating a sandwich.

So yeah, I sent this to you because it was the original article that spurred some kind of email/comment that ****** posted on FB and I thought I would read the beginning of the saga. Which turns out to be the middle of a saga? I don't know. I want to use the word "saga" more in daily conversation.

I don't know if I should have an opinion or not. I am 30, tired of feeling this way, and tired of worrying about feeling this way.
Have I gained weight? Yep. Have I lost it? Yep. Will I continue to need to eat every day for the rest of my life? Yep.
Can I be troubled to worry about what I will eat every day? No. I just can't care about it right now.
Just like I can't care about "loving my body."
I am a succubus that uses this vessel to eat, sleep, whine about my job, and play Farmville.

You, who have worked your ass off at working off your ass... I admire your ability to care at all at this point.
As someone whose mom died an untimely death as a consequence of "lame" surgery, I can understand the reality of the risk of surgery and how much everyone seems to minimize that risk. It takes colossal gonads, in my opinion, to be willing to consider something that you have truly worked to avoid.

I think some of the sentiment I got from the comments is that there is something more to the mess than every individual someone sitting around on a couch stuffing his pie hole, whether it is gunked up food or whatever. The reality is, genetics and/or genetically altered food (if you aren't a freak that believes in creationism) humans are hunter-gatherers. While the instinct to gather and eat food all day remains, it no longer takes the amount of calories and time to locate, well, calories. Maybe it's time to engineer less nutritional food? The enigmatic futuristic rice cake diet that we can eat and eat forever and never consume any calories?

Yes, the solution does lie in a cake. The end.


Me:
I think I still care just because it's such a deeply ingrained habit. I have been fat forever... I haven't ever experienced a life where I didn't have to care. I've been terrified of my fat flopping onto my airplane neighbor since the very first time I got on a plane (and let's not discuss the fear of having to ask for a seat belt extender... or boycotting Southwest Airline's super cheap flights altogether because they were the first people to ever introduce mandatory 2nd seat purchases for "customers of size"...).

***** is a huge Dan Savage fan. I could care less, though I do know that he makes asshole-ish fat comments on a pretty regular basis... which is hypocritical on a massive scale since his whole gay preaching thing is about acceptance of everyone, regardless (fine print: regardless does not include anyone with a BMI over 22, fuckyouverymuch).

I just got something in an email from the obesityhelp.com forums today that pretty much summed up my thoughts on this whole surgery thing and the huge risk that goes along with it.

"I used to be embarrassed to take a plane or to go out in public. It was difficult to get behind the steering wheel. My lifestyle was very stifling. The consequences of my obesity, and the depression and social isolation it caused, made the risk of the surgery far more acceptable since I had been unsuccessful with every diet imaginable."

See how that's all in past tense? I long for that to be in past tense for me. My BMI is 48. Now, I think the BMI scale is bullshit because it ignores a lot of other factors needed to determine true health, BUT... a BMI of 50 is "super morbidly obese" and that's the highest category there is. That's what category those people on TLC who weigh 800 pounds belong to. "Super morbidly obese" people get transported by crane and weighed by truck scales and sometimes they wind up fused to their furniture because one day they wake up and they're just too fat to get up and go to the bathroom.

Right now, I'm pretty far from that point... BUT, assuming that I am perfectly capable of gaining ANOTHER 60-pounds in six or seven months... I am less than a year away from weighing 400-pounds, barring some drastic intervention.

There will never be a better time for me to take advantage of this surgery and use it as the drastic intervention that I so desperately require. I am SO healthy (aside from my fat) that it's disgusting. My blood pressure is damn near perfect, my blood work all came back perfect, and I am young enough that recovery should be swift and results damn near immediate. If I decided to give it another five years... ten years... lose and re-gain 50-pounds three or four more times... My body will be older, I will be just as fat (if not fatter), and I may have developed some obesity-related complications by then.

Thank you for caring enough to worry about me. Do you know that ***** hasn't said a single word about my thinking about having this surgery? Some support network I have, huh?

This addresses a lot more issues than you brought up in your email, but I know you and you're smart enough to be thinking about this shit, even if you don't say anything.

BRING ON THE FUTURE AND ITS NON-CALORIC RICE CAKES.

mmmm cake....

Support

Some of my closest friends have not offered their opinions (either support or dissention) about my surgical decision.

I wonder if they fear my dropping them like a stone if they disagree with what I want to do. There is precedent for that, so I guess I understand it.

Still, it would be nice to know that they care one way or another.

You know, maybe this is why I have never been able to lose weight and keep it off in the past. My support network is just so small as to be non-existent. Online-only friends, anonymous forum posters/commenters, and friends I've met but who live so far away they are basically online friends now... always supportive, positive, caring. What is it about real life that negates my ability to rally support like that?

I haven't got much else to say... just that I'm still completely uncertain as to which surgerical option I would choose (although the band, as opposed to the bypass, is looking like the better option), and I can't wait for my first pre-op "class."

The Surgical Option

There hasn't been a bigger flip-flop in the history of flip-flops since Janet's boobie flopped out of her malfunctioning wardrobe and the entire country flipped over it.

I am considering the surgical option.

Not only am I considering it, I am favoring it.

That's probably not even truthful.

I'm stalking it. Courting it. Being nice to it in the hopes that it will eventually marry me.

Yes, Angela of the no-surgery-ever-no-way-no-how-I-will-not-die-to-be-thin... has flip-flopped.

Apparently, all it takes to persuade me into an option with which I vocally, loudly, adamantly did not support... is a man in a white coat with a Russian accent telling me that it was the only option for weight loss that would offer me a 70-75% chance of success.

The problem came when we started discussing calories and I started throwing out all of my tips, tricks, tweaks, secrets, and cheats for meeting my daily calorie goal (of which I'm well-aware). If he'd given me a quiz from the hospital's nutrtional weight loss program, I probably would have scored a hundred percent AND gotten extra credit points for excessive elaboration on certain subjects.

He looked at me and said, basically, that I obviously know what to do and how to do it. My problem is continuity and maintenance (aggravated by current and recurring depression). Gaining and losing 50-pounds at least half a dozen times in the past decade is proof enough for him that the non-surgical option is probably not going to be my saving grace - especially since there doesn't seem to be anything more I need to learn on the nutrition/exercise side of things aside from implementation, follow-through, and a pile of therapy that's yet to be scheduled.

In discussing the options, we decided that it would be prudent for me to start the motions of the pre-op classes, if only to educate myself more fully about what is involved with the surgery and to make a more informed decision as to whether or not I want to have it. But, I can tell you, now that I have allowed the possibility to exist, it's all I can think about. I want it done and I want it done now.

I feel like I've done my time as a fattie. I've put the work in, time and time again, only to watch others (who know less and don't try nearly as hard) succeed where I fail.

And I am sick of it.

I turn 30 in two weeks. If I would get the surgery as soon as possible after completing the required classes (September or October, most likely), I would probably be down 60-pounds (plus the 10% I have to lose pre-op for insurance purposes, so make that almost 100-pounds total) by the time I turn 31.

I deserve this.

I deserve not to have my 30s suck.

Confessions?

I have an appointment on February 9th with the Danville clinic for fatties. They have both a weight loss program and a bariatric surgery program. They asked me twice in the process of making the appointment which I wanted. I have chosen the weight loss program, because I know I can lose weight. I have in the past. I also know that I cannot do it in these conditions, so I think I'll be wasting both time and money by going through these motions.

Once I get there, I may start talking to them about surgical options.

I say I don't want it. I want nothing to do with surgery. Even a 1% chance of DEATH just because I'm so fucking desperate to be thin sounds like ridiculous odds. 99% I'll be able to shop in the 'normal' sizes. 1% I'll just be dead. How is that even an OPTION? Fat or thin or dead? Two-thirds of those are undesirable.

I don't NEED the weight loss program. I know nutrition. I know exercise. I know muscle memory and that my body will eventually get used to workouts if I don't change up the activity/frequency/intensity. I know that finding some way to deal with emotion other than shoving food down my throat is a necessary evil skill. I know WHY whole wheat pasta is better than processed.

I KNOW IT ALL.

I don't need an education about weight loss.

I need an intervention. And a therapist.

I need a prescription for independence and my own apartment.

The surgery wouldn't fix my head. I can see myself being one of those people who just eats and eats and eats after going under the knife. I would stretch my stomach back out to its current mammoth proportions and regain anything I had lost.

As long as I am here, under the thumb of parental control, I will be fat.

I have decided that, unless the bank ponies up with promotions and/or raises fairly quickly, my savings account is being built up for the sole purpose of moving back to Japan. Interac would hire me. I want to make sure I have enough money to buy my ticket, pay my key money, and live for two months before that first blasted paycheck, without having to ask anyone for anything in the process.

Barring astronomical advances in my banking career, look for me in Japan, March 2012.