Last supper syndrome tips

I am asked and hear online about how to avoid the last supper syndrome and or how to work on preop wt loss requirements. Of course it is 90% mindset for me perhaps not others...but the mindset is the goal to lead the lifestyle forever...w/o that the tool is not as helpful as it could be start early and practice often and consider feeling BLESSED for the opportunity for both!!



WT LOSS BEFORE SURGERY/MOTIVATION/AVOIDING THE LAST SUPPER SYNDROME
In our program we are required to loose 10% of our body wt before surgery....
Loosing weight pre-op is required by many surgeons & for many reasons... and I am so happy I did!
1.. to show motivation,
2.. ability to adhere to a plan (as we will need to for life!), if you can't be mindful and able to follow restrictions pre-op how will you do it post-op?
3.. to increase your health even a modest 5-10% wt. loss is very helpful, the National Institute of health has even researched this...(hence why weigh****chers is so focused on the 10% wt loss)
4.. decreases surgical complications (by exercise and decrease wt your heart and lungs are in better shape for surgery, anesthesia and healing!)...
5.. Also psychologically it is tough going from a super-sized big Mac meal to clear liquids for 2 weeks post-op!
6.. ***MAIN ONE FOR PROTEIN SPARING or MEDIFAST DIETING***It helps shrink the liver and this eases their surgical procedure and decreases chance of nicking it....
7.. exercising before helps you continue after!
8..The more you lose pre-op the less you will have to lose post-op and the closer to an ideal body-wt you will attain!

I lost the weight by doing the food pyramid. That's it, I was eating so bad (fast food daily, large portions, consuming every high-fat/sugar thing imaginable and NOT exercising that just cutting down and walking 2 miles a day helped!

For ME, it was "no one" was going to stop me from having this operation, it was my decision and all that was asked of me was to loose 30 lbs, I figured this is a small price for such a wonderful gift I would be given and the opportunity to have a healthier happier longer life....! I was so motivated/psyched; I dropped 30 pounds in 30 days and went on to drop 15 more before surgery! (Although this took me 2 months, as it got harder and I had a few last meals, we all do but you can't let this ruin your opportunity!) I believe it is what allowed me to get to a normal BMI as well! And it is not unheard of for surgeons to postpone or cancel surgeries if one gains weight!!!

Exercise was another key; I faithfully walked 2 miles everyday..it helped that my mom went with me a lot! (a buddy is so helpful!) I followed the food pyramid given to me by clinical nutritionist Dr. Boham...I also wrote everything down (Many find www.fitday.com helpful for this) that went in my MOUTH!!! Or you can get food pyramid/bullseye version at: http://www.xenical.com/hcp/1400_Am_Beye.pdf


I also had to remind myself how BAD I wanted this! Everyday it was/had to be more important to me to change my bad habits and lose weight to have this surgery than to continue to slowly kill myself with food/keep myself from the only hope I had!. I also told everyone about my plans and they helped support me, my friends/family and coworkers! I really can't give you any more guidance than this, it really had to come from within, it was a mindset with me, and I wanted this BAD real bad and I knew it was my last resort/chance! I felt invigorated and motivated by the end results...the long-term had to outweigh the short-term gratification of eating bad choices or overeating! It was a learning opportunity for me to change my habits and practice chewing well, not drinking with meals and eating smaller portions, giving up sugar/caffeine/carbonation/alcohol (if any of those are your issues, carbonation/caffeine/alcohol weren't issues for me)!

So a few weeks/months of healthy habits to lose pre-op wt is not a lot if you frame it right! IT IS NOT FOREVER and it is about starting this journey!

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The single BEST piece of advice I can offer being 5 yrs out is this to anyone:
***Disclaimer some may consider this a no-brainer, others a downer, some a new view, psychobabble, whatever thought it is just my opinion, so take it for what it is worth, and it is meant to be helpful/insightful and thought provoking at a time so many of us are caught up with the right vitamin to take, amount of water to drink, etc.. it is meant to challenge beyond those tasks to see the small stuff matters but that there is a larger and more global view as well to consider!!!***

Establish your mindset to accept that weight loss surgery is not a cure/quick fix for morbid obesity, it's a very effective/powerful/wonderful tool that can be used lifelong to combat the chronic/lifelong disease of morbid obesity that has NO *current* CURE (*So at 1 yr out when many say 100# gone forever I sometimes shudder, it is never gone forever it is gone for now but the work has just started at 1 yr out IMHO). The tool is flawed and can be defeated as well (emotional eating, grazing, drinking calories, eating/drinking together, alcohol use, high calorie dense foods, too many simple carbs, overfilling pouch, carbonation, no consistent exercise routine). Considered WLS as part of a life-long process & commitment to challenge your personal awareness/responsibility/consistency/accountability and that a life-long requirement to follow up with physicians, a regular exercise program, and healthy eating. Accept it will come w/ potential challenges & imperfections (risks, side-effects, complications, challenges such as plateaus, not meeting goal, regain, possible depression, grief over the loss/safety of food/obesity may of offered/invisibility it offered although may of been unwanted at the time/the new attention you get, possible anger or anxiety w/o comfort of food as it used to be/limits it may impose, effort it requires to be healthy etc.) that these frustrations are part of the process to make you healthier see them as challenges not difficulties, positive self talk helps!. Your mindset will be the most important tool for success, as all the challenges of traditional diets/exercise plans for health will be present after WLS as well *Yup so many say I will never diet again, well let me say diets don't work *because people go off them* correct but you will have to be mindful of food and pay attention to intake and exercise for life, so in a sense your dieting for life! Even after WLS.... The surgery won't make a person change, but the beauty is YOU HAVE COMPLETE control over those changes/choices needed after surgery for success, the choices are there and the best use of the mind/psychology will harness those. Surgery is such a drastic choice that so many are successful due to a recommitment to healthy living and choices that is one reason it works and we say it is a 'rebirth'.

Changing habits pre -wls is the mindset that will keep you going, the surgery is a piece, the easiest/smallest IMHO. *It is however the milestone/landmark we set to focuses on. But truly the afterlife is the most challenging, the ever evolving challenges from things like getting in enough liquids to food introduction to vitamin taking, new ways of eating/drinking, introduction of exercise consistently to battling with the scale obsessions & disappointments as well as all the wonderful WOW moments. Have the support system needed to create the healthiest environment as well, willpower fades, the tools robust effects fades as well as the honeymoon closes...Harness your enthusiasm and mind for 6 months doing all you can to influence (not only wt loss) but the healthy lifestyle you want to adopt for maintenance, that elusive animal no one has mastered pre-wls. Exercise can become more routine after 6 months as well. Again the mind is just as/more useful than the pouch...it is the operator of the tool! Stress inevitable, so see each issue/stressful time as an opportunity to use your new tool/mindset! (Like I say use things as excuses or opportunities because holidays come and go each year as do parties, office food/celebrations, hurt feelings, sadness, losses, etc)


I know this isn't one message it is a million crammed into one right! Anyone who knows me knows I am never brief, this is my PASSION (giving back), WLS saved me from myself. It isn't easy or fair, but accepting life is imperfect just as the world we live in, embracing that imperfection and controlling what I can has helped me get thru many issues. There is no perfection, I work on that daily. So what to do about all of this babble?

Get a good journal, start writing today all the reasons you are COMMITTED to this change, what your expectations are (hopefully realistic for wt loss 50-80% of excess not an ideal body wt) and that the goals are not wt related alone, the functional ones how you can integrate into life easier, (clothes fitting, less medical co morbidities or risk of, less meds, less pain (physical/emotional) the benchmarks you are setting, take measurements and photos each month along w/ weights to document the journey. the mind is powerful but may be challenging to change so the photos/measurements help when the HUNKAMETAL doesn't register a loss. We are much more than a number on a scale, free from the numbers and see how much you are more than that as a person, your abilities etc....The journey is full of hills and valleys, some bumps and many more pleasures to see, it can be an awesome ADVENTURE!

The letter you may write/journal entry today may save you from backsliding at your first plateau or at 1 yr out, a recommitment to those thoughts, and how you have grown over time. These are the things I recommend. I think everyone else has you covered w/ the 'physical items you need'. These are the ever-elusive psychological things you need LOL!
OK if you have read this far thanks for hearing me out! I wish you well. <Jamie stepping off her soapbox>

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When The Surgeon Quits
I received an email the other day from a reader *****cently had been taken to surgery only to have the surgeon abort the case before completion of her gastric bypass. She expressed her concern, anger and disappointment and could not understand why the surgeon would abort the case. After a lengthy discussion the reason was quite clear, her liver was so large and diseased that it required the surgeon to make a medical decision, continue the case with possibility of losing the patient or quit. The decision was to abort and allow the patient to recover followed by having a liver specialist become involved in her care.
The patient also revealed to me that when she had last been examined in the surgeon's office four weeks prior to her surgery she was told that she must lose more weight to soften her belly. Instead of following the advice, over the next four weeks she gained an additional 20 lbs. She had eaten every meal after she left the surgeon's office as if it would be her "Last Supper". Had the surgeon lost this patient her meals would have been just that, they would have been the last she would ever eat again. I asked her, "How serious were you about having weight loss surgery?" She never emailed me with a reply. I assumed she was now angry with me.
This was not the first nor will it be the last time a patient would go on an eating frenzy prior to surgery. Sometimes I do not believe we make the point very clear that it is important to lose weight prior to surgery to lessen the weight around the heart and lungs. During any procedure with anesthesia the heart and lungs and kidneys have to work harder during the recovery process. To add more weight around these organs virtually adds insult to an already injured body. Our practice has now established the 'one pound and you're out' rule. It is a rule we make very clear to the patient. The last time the patient is weighed in our office that weight is sent ahead to the surgery department. If the patient weighs one pound more the morning of surgery the procedure can and likely will be postponed. If they gain weight we question how serious is this individual about having weight loss surgery? Will they be compliant after surgery with all of the lifestyle changes they must go through? This is serious life threatening surgery and I commend any surgeon for knowing when to say 'no'. No you cannot go to surgery until you go though medical clearance. No, you cannot have surgery until you attend support group meetings to help educate you for what lies ahead. And no I will not continue with this surgery because you may die.
The lady whose surgery was aborted could only blame the surgeon. I guess that is easy enough for any patient to do if something goes wrong. Actually, come to think about it, if anything goes wrong in our lives it is always easier to blame someone else as opposed to taking responsibility for our own actions. I had to tell her that I would congratulate the surgeon for saving and not taking my life. It was definitely not what the surgeon wanted to do. Surgeons want to operate, they want to save lives or in the case of bariatric surgeons they want to help a life begin.
Sometimes surgeons quit doing surgery altogether. They are tired. Tired of fighting with insurance companies and all of the criteria demands. They are tired of the malpractice crisis that is hovering over the medical profession creating exorbitant malpractice insurance rates. In the January 2005 issue of Beyond Change, Dr. David Greenbaum discussed this very critical problem. He states, "You don't have to commit malpractice to be sued. All you have to do is have a complication. That, along with an unhappy patient and a trial attorney who sees the possibility of a large payout - and viola- a suit begins. Never mind that bariatric patients can develop some of the most challenging problems to care for. Never mind that you spend hours discussing the various risks and potential problems with each and every patient. Never mind that despite giving verbal and written instruction in great detail, some do not follow them. Never mind that your overall results are excellent. All that matters is that one patient had a less than wonderful result and you may find yourself in the middle of a lawsuit. Then, even if you win the lawsuit, your malpractice premiums go up because you had to have the insurance company pay a lot of money to defend you. So, you lose even if you win." Some of these surgeons are paying in excess of $200,000 a year, a sum that is unimaginable for most people to comprehend. It would make surgeons want to quit and many have done just that.
There is nothing more rewarding in our business than to see patients do well. For the few complications that arise, it only takes the success of so many others to reinforce why we stay in business doing what we do. None of us want to quit doing what we do because of the sense of satisfaction we receive from our work but each of us may have to realize our limits one day. If the pressures of the business, financial as well as emotional become so overwhelming, then we may cease being effective to those we treat. If that day comes then we have no other choice then to quit.
For the individuals who have suffered with the disease of morbid obesity for so many years their decision to have surgery is based to a large extent on their diminished quality of life. If they do not lose weight and improve their health they will die or worse yet their quality of life will continue to decline. They have surgery because they refuse to quit. They refuse to give up on life. What they must understand is that surgery is not the easy way out, it requires a lot of work, emotional and physical and that work begins the first time an appointment is made with the surgeon. The woman who was disappointed about not having her surgery may still have surgery one day once she receives clearance from the specialist and after she works to lose the weight her surgeon had originally suggested for her to do. Perhaps she will then become one of the most successful patients the surgeon ever had.
Jacquelyn K. Smiertka, RN
has been a bariatric surgical clinical coordinator for over eighteen years. She is a member of the ASBS Standards Committee and a member of IFSO and has presented at both national and international conferences on obesity.
http://www.beyondchange-obesity.com/editorsNotes/whenTheSurgeonQuits.html