The Real Deal Living With the Roux-en-Y (RNY)

January 28, 2016

After struggling with my weight since puberty and being super morbidly obese for many years, I had an open Roux-en-Y (RNY) on August 27, 2007. It was the day before my 45th birthday, and it was the day that gave me BACK my life.

After having WLS, I lost 190 pounds. Even more important is that eight years later, I am maintaining a 175-pound loss. (Unfortunately, the slowing metabolism of menopause and the lengthy periods of inactivity following two knee replacement surgeries have resulted in a 15 pound regain over the past 2 years).

Although there have been some drawbacks to living long-term with my RNY, I still believe that it was the best decision of my life. I chose RNY because my surgeon indicated that the Lap-Band wouldn't result in the significant weight loss I needed. I was afraid of the extreme malabsorption and potential side effects of the Duodenal Switch (DS). Back in 2007, the VSG wasn't an option in 2007, but if I were making the decision now, I would probably choose a VSG.

I Miss the Eating Experience

My surgeon's experience is that people have fewer food issues when they don't have an extended period of liquids and purees after surgery. I was eating soft foods on day three post-op before I even left the hospital. Fortunately, eating and drinking were never a physical problem for me, even during the first few weeks post-op. I've never had any food get stuck, I didn't vomit until I was 18 months post-op, and I only dumped twice during that first year.

During the first couple of months after my surgery, my struggles with food were psychological. I deeply mourned food. I clearly remember how difficult it was to watch friends and family members eat "normally". I missed all of the familiar tastes and textures. I struggled emotionally and psychologically because I had lost the ability to use food as a coping mechanism. The fact that I had to lose almost 50 pounds before I dropped a single clothing size, and people started to notice my weight loss, just increased my anxiety and depression.

The Biggest Contributor to My Long-Term Success

I knew this surgery was my only chance to attain, and maintain, a normal weight. I worked hard to find foods that I truly liked that would enable me to stick to my eating plan. I also worked with a counselor on changing my relationship with food and developing healthier coping skills. Many people find that they get a break from their "food demons" while they are so intensely focused on their new eating and drinking habits. When life becomes more normal again, the old issues begin to rear their ugly heads.

The biggest contributor to my long-term success has been addressing the emotional, psychological, and behavioral contributors to my obesity.

The reward for perseverance and diligence has been that -- so far, at least (and I say "so far" very intentionally because the battle is never really "won") -- I have avoided becoming one of the many people I know who have regained significant amounts of weight back. It saddens me to see friends gain 40+ pounds back, but it also serves as a frequent, much-needed reminder that if I allow myself to become lax or complacent, I will be in the same situation.

Many people who are early post-ops don't believe it, but the hard work isn't in losing the weight (when people are offering compliments and motivation is high as the weight quickly drops), but in keeping the weight off after the compliments have long ceased and the only reward for staying on track is that the scale doesn't go up.

Because of my RNY

• I am now a normal sized person who no longer stands out in a crowd
• I no longer hear strangers make rude comments
• I never worry if I will fit in a theater or stadium seat, in a restaurant booth, or, on an amusement park ride
• I routinely walk up the three flights of stairs instead of using the elevator at work
• People no longer make negative assumptions about my intelligence level because of my weight
• I eat like a normal weight, health-conscious person
• I live my life without being constantly aware of my weight
• Tying my shoes is once again a simple, almost mindless task instead of a major effort
• I am now a normal sized person who no longer stands out in a crowd
• I no longer hear strangers make rude comments

Life With RNY Hasn't Been a Bed of Roses

Living with RNY has not been a journey lined with rose petals! I developed an incisional hernia from the open surgery (and had complications from the surgery and the mesh used to repair the hernia). I have had multiple incidents of kidney stones, and I have bone loss in one hip and in my lower spine despite taking 2000mg of calcium per day. The mild hypoglycemia I had before my RNY has worsened significantly, but is managed by eating a combination of protein, carbs, and a little bit of fat every 3 hours. (Unfortunately, most surgeons still don't warn RNY patients about the increased risks of kidney stones, hypoglycemia, or reactive hypoglycemia.)

Initially, taking vitamins four times throughout the day seemed like a very small price to pay to finally lose the weight. After about the sixth year post-op, it became quite tiresome not only to take the vitamins and get the lab work done, but constantly concerned about how quickly vitamin levels can drop and maintain levels of any problematic vitamins. The restriction on taking NSAIDs has also been more difficult to live with than I expected.

My Body Improved but Still a Mess

The body I ended up with after losing 190 pounds was a mess. I had been heavy for a long time, so I knew it wasn't going to be pretty, but I had no idea how bad it would be. I had no idea that I would hate the smaller body as much as, if not more than, I hated my super morbidly obese body. The amount of extra, low hanging skin on my belly and mons area made me feel like a freak.

Even with plastic surgery to address those areas (and my arms), my body doesn't look like someone who never had a weight problem. I look like someone who lost a lot of weight and had plastic surgery. I still wear only knee length shorts in order to hide the excess skin on my thighs. After years of not wearing shorts at all, and wearing only sleeved tops, I love now being able to feel comfortable in those knee-length shorts and sleeveless shirts!

Life is about choices and trade-offs, and about ups and downs, and living long-term with RNY is no different. Just about the time I start to worry that I have somehow lost the restriction of my pouch, I eat "just one more bite" of beef or chicken and my pouch immediately reassures me (via pain) that it is still doing its job.

When I remain consistent with my eating, my scale remains consistent as well. When I allow too many carbs into my diet, the scale number creeps up. RNY has done what I expected it to do: it has given me the ability to control my weight. Although I sometimes lament that VSG was not available eight years ago, signing the surgical consent for RNY was still the best decision of my life.

ABOUT THE AUTHOR Lora Williams had RNY in 2007 and lost 190 pounds. She used her increased energy level after her weight loss to complete a PhD in Psychology and now has a second, part-time job doing pre-op psychological evaluations for weight loss surgery hopefuls.

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