On the fence about surgery, Advice?

Hi everyone. I've recently been considering surgery again after (briefly flirting with it and) deciding against it several years ago and am having trouble pulling the trigger. FYI I'm 30 and have no children yet. Overweight through pre-adolescence and obese since puberty. I've been reading these forums and have really appreciated how enlightening and supportive you all are to one another and was hoping to get some insights or advice. I don't have anyone other than my husband to talk about this with in person.

I understand the changes that I will have to make to my diet and am actually looking forward to having a tool to help reinforce good decisions (my husband and I currently eat fairly healthily but I would be cutting out refined cards and sweets for the most part). I've done low carb dieting before in attempts to lose weight so I am very familiar with how the protein first, veggies next, carbs to a minimum will go.

I am very lucky to be able to say that my husband is completely supportive of my decision to either have surgery or to not have surgery. He wants me to be healthy and understands there are risks either way but that being a lower weight would significantly improve my health and longevity.

I am excited to have something to help me get down to a comfortable size so that I can start being more rigorous in my physical activity again without the pain of the extra weight.

But... I have some concerns, and I realize they are strange concerns;

I'm wondering about if I will be able to keep up with hydrating and fueling (ei: eating) enough for long bike rides of 100-200km a day or long hikes, or if I'll need to give these things up because I will be at risk for dehydration due to the limitations of the stomach pouch.

I worry that I will lose my enjoyment of cooking when I will be able to get by on such a small amount of food and not able to partake in many of the dishes I would be creating, and there will be a risk then of me turning to convenience foods if I lose the joy in cooking.

I worry about if this would have any negative effects in the long term. What I mean is after having the surgery and losing a lot of excess weight I will possibly live a lot longer so will I be an 80 or 85 year old who has regrets long after the surgery has done what it was supposed to because of something else I didn't think of now. I know the point of the surgery is to permanently change you so that you don't fail like many of us have at other attempts to lose weight but I have some sort of psychological block on the permanence of this and sitting there 50 years from now able to eat 1 scrambled egg and using some new technology I'm too old to adopt to try to track my food intake and make sure I'm getting what I need, when I need to.

And if I figure these other issues out and decide to go with surgery after all, I'm also wrestling with whether to go with an expensive private clinic so that I can have the surgery that I want and have it much sooner (I am interested in the VSG, sleeve), or do I go the provincial waiting list route for the surgery I don't want (RNY bypass), and possibly wait 1-2 years, but have almost no costs.

So if anyone has any advice or insights on the extreme endurance exercise, the cooking hobby, the decision to go private/public or which surgery to choose, or how you came to terms with the permanence of the surgery if that was a stumbling block for anyone else, I would really appreciate it. I've been circling this stuff in my head for months and keep thinking I've decided and am ready to jump in with both feet just to remember my apprehensions about an aspect of it and start all over again. It doesn't help that I am a severe over-thinker sometimes. I just keep finding more and more to research and read. I swear it took me 3 months just to buy a new mattress, and that's only a 5-10 yr commitment, ha. Now that I've found this forum I'm hoping that info from people who have gone through this decision and the surgery will help me sort through some of this.

There are tons of WLS endurance sport athletes, never heard of anyone having problems with hydration and fueling except maybe a friend or two who has to be careful with the sugar content in the gels (but they have found other great alternatives)

I do not think the point of surgery is to permanently change us so that we don't fail. Many many many people "fail" at WLS. I personally regained 90 lbs even with a sleeve because I didn't do the mental work. For me, WLS gives me maybe a 20-30% boost in my chances at being successful because I literally cant eat a whole pizza anymore, but I sure can eat 7-10 cup cakes in a sitting. Cheezits? A whole box. 700 calorie starbucks? Yep. Calorie bombs still go down just as easy. I never thought Id have to work so damn hard at losing and maintaining weight 5 years out of surgery but it's not "easy" - its easier than being 420 lbs though by a long stretch.

Im not sure what info you have gotten that makes you think you will be eating 1 scrambled egg years down the road. I can eat a smallish-normal meal. I don't feel super restricted in my intake like you might think.

My only real advice is never ever get a surgery you aren't comfortable with and you don't want 100% because there are no take backs....There are a lot more consequences to getting a RNY and if you cant live with them, don't do it.

I am glad to hear that endurance sports are not necessarily off the table. I know that as I would lose weight, I would want endurance riding to be a big part of my exercise routine.

I appreciate what you're saying about it not being a guarantee to not fail. I certainly don't think of WLS as the magic pill but as a tool to enforce restrictions and good choices and to make it easier to get to a new lower normal. Kind of like a handholding to a fresh start. And I do like that part of the permanence of it, that it should help you in maintaining a new normal weight assuming you're making the right food choices. (It's the weird image of a frail old woman struggling to eat enough that keeps coming back to mind.) 

And I had no idea a pouch or sleeve could hold so much. I had read accounts of people being able to eat barely more than an egg which probably contributed to the image of the frail old lady in my head and the worry of not being able to drink enough to stay hydrated.

I'm certainly not decided yet but I think I really needed to read what you wrote about not getting a surgery you're not 100% comfortable with because there is no going back. I am fairly sure that with what I know now, I would not be happy with the bypass and could be very happy with the sleeve. That could change with more research of course, I'm always open to learning more, but because of the altered digestive tract and the absorption issues I am just not comfortable with the RnY . 

Where I live in Ontario, as I understand it, if approved for surgery, the RnY is the standard and the sleeve is only chosen by the surgeon for those with a medical need not to have RnY. I think this means if I am against the RnY I will likely need to go to a private clinic to be guaranteed the sleeve. An expensive consideration.

Thanks for your response.

The things you're worried about are short-term post-op issues.  Yes, right out of surgery, you might have issues staying hydrated.  But as swelling goes down, you can drink more and more normally.  Food might not be enjoyable at the beginning, but I still love food - I've just focused on good food that meets my nutritional needs.  And, yes, you should be able to keep hydrating and be able to consume enough to do your bike rides.  You'll have to do a bit of planning, but you probably do that already.

Ha, yea I don't plan to do anything more strenuous than walking for the first several weeks. I don't want to cause any complications from being too active too quickly. I am glad to hear that hydration shouldn't be an issue.

I've seen than many ppl are not as hung up on food after surgery and I think that would be somewhat of a big benefit. A chance to only put in the good foods and hopefully lose the taste for the less good-for-you foods. Although like I said I hope I still have a desire or at least a willingness to cook. Even if that comes back some time down the road when I'm well into recovery.

Cyclist here!

Hydration was a bit more of a problem until the 6 month mar****il that point, I could only really sip water, I couldn't take good long drinks. I ended up taking quick breaks very often, every 5 minutes or so, to sip-- mostly because I'm not coordinated enough to grab a water bottle from the bike cage and put it back without tipping over! You can drink "normally" once you're healed up quite a bit, so no worries there. And it's totally possible to fuel for long rides-- some folks (myself included) might break the "no carbs" rule before a long ride. 

I'm doing 30-, 47-, and 60-mile rides in the coming months. I hope to do the STP (Seattle to Portland, 200 mi in 2 days) next summer. I've got a Camelbak and peanut butter pouches, and I'm not worried about that aspect at all.

There is ~40 years of data on the RNY. The ASMBS has made some changes in recommendations in regards to things like supplementation based on their observations, but there's enough data out there that any significant issues have already been identified. From a research POV, I think there's enough info out there that things are solid-- unlike as there was with the gastric band.

Worth noting: the sleeve will NOT physically prevent you from eating carbs and sweets. You won't feel restriction when eating carbs-- only protein-- and it's absolutely possible to graze on an entire bag of M&Ms post-op.

I am so glad to hear this from a fellow cyclist! If fairly normal drinking might resume by 6 months or so, that sounds good to me, I likely wouldn't be doing very long rides the first several months anyway. Those are some nice distances. I don't have trouble sipping while riding but I do take breaks fairly frequently to rest my behind and stretch and when I was riding on the low carb diet I would often have nuts on those breaks as my carbs to fuel the ride. Though I never liked the idea of "carb loading" and of swinging in and out of ketosis, too rough on me. Easier to stay on track if I don't flirt too much with temptation.

That being said, with regard to the sleeve, I do have a sweet tooth and like the idea that I will be able to share desserts with my husband on dates sometimes or indulge in a bite or two of something I'm craving when PM****s especially hard. Even though I'm fine with giving up most carbs and sweets otherwise I like the idea that it won't be a physical problem for me to eat a certain type of food.

I didn't really start on my bike until the 6-month mark anyway, honestly I was too low energy to do much until then. I think the important bit is to do as much as you can, but not feel guilty because you "should" be doing more. Our bodies go through a LOT post-op!

Search around on the forum for posts from a guy named Jubjub. He does uber-endurance-distance cycling, the "see how many miles you can ride in 12 hours" stuff, and has given some great advice!

I've read from several post-ops that they have had very little energy for awhile afterwards, sometimes quite a long time. I only know the types of foods that a few of those saying this have been eating but it makes me wonder if part of it might be too many carbs for some people causing them to keep hitting the wall again and again. I'm not nutritionally trained by any means but I have wondered about that because of my experience with very low carb and cycling and I've been hoping to find some data on it before I have surgery to see if there's anything that can be done to help with it.

And I will definitely look up Jubjub. Thanks for your comments!

I very much doubt that low energy is due to low carbs. Ideally, you should be eating NO CARBS AT ALL immediately post-op-- almost nothing but protein.

I felt like I'd been hit by a bus for the first few months after surgery, and I was under 20g carbs per day as my surgeon recommended.