Part I: WLS

Okay, remember a while back, I told you about a project that I was doing for one of the surgeons in our area? Well, I took what I written for him and put it in a document for us.  It has three parts so I am going to post Part I today and in a day or so, I will Post Part II and then finally Part III.  The surgeon wanted me to provide him with a document so that he could understand better what we go through so that's why I begin with Part I.  Part II and III actually contain his and other doctor's research compiled in an easy to read paper.  He knows I'm posting a modification of the paper here and he may even comment.  

So, here's Part I:

Part I: WLS--From Inquiry to Recovery

When I was going through the process to gain approval for my WLS, I read everything I could about WLS, including the stories, both positive and negative, about the rich and famous who had or were alleged to have had WLS. I tried to balance the success stories with the stories of those whose WLS ended in failure, but more importantly, I tried to understand what those who maintained their healthy weight losses were doing differently from those who gained weight. I believe that most of us are in denial about weight gain. Over the last couple of years, I have come to realize that not only is weight gain a real possibility, but weight gain is also inevitable if we have changed the way we view food. More recently, I have read articles, talked to folks who have WLS, and have reflected on my own process before and after surgery and as a result have come to identify some important phases involved with WLS and the steps involved during those phases:

Phase One: Hope

In Phase One, those of us who were hoping to have WLS seek out support groups both online and face-to-face. Our desire to discuss WKS results out of our sheer determination to lose weight so that we can have a longer and better quality of life. Most of us have already tried every type of weight loss program from diets to diet pills and nothing has worked. We still hold out hope for a magic cure of our obesity and that hope lies in our last hope--WLS. I defined the stages of Phase One based on my own experiences and those of members of various groups and these steps manifest themselves based on what motivates us prior to and during the stages and what happens to us--our reality. WLS folks will recognize these because we all go through the same thing.

• Courting WLS: In our desperate attempt to lose the weight, we all start at stage 1. We've tried every diet, taken every diet pill, and have realized that we are too obese to live through another Atkins-eat-all-you-want-meat-diet. By this time, most of us are super, morbidly, obese and many of us can barely walk. We are unable to walk stairs and most of us cannot get into the floor to play with our children, pets, grandchildren. We cannot sit in booths in restaurants; we are unable to use regular stalls in public restrooms; we are unable to wear clothes in regular department stores; we are often so obese that people stop and stare. We are drawn to WLS by the speed of weight loss and the seemingly ease of weight loss, but do realize that in this stage, we are desperate. Most of us read the success stories, but we weren't paying a lot of attention when the medical community told us they were giving us a tool but we still had to change our behaviors. Carnie Wilson and Roseanne Barr did it so damnit, so could we!
• Commitment and Marriage: When we finally commit and a surgeon commits to us, we begin the heavy training in preparation for our journey: 1) at least a year or six month long diet (depending upon the surgeon); 2) visit a psychiatrist/psychologists and take some kind of psych test; 3) get our heart tested to make sure we can withstand the stress of the surgery; 4) get tested for sleep apnea; go to a seminar for WLS; and join a support group. There may be struggles with financing the surgery because insurance companies are not always eager to spend the money for an elective surgery. After all the trials and tests, most of us are able to form a most perfect union with our WLS surgeon. We finally meet our surgeon at the hospital of his choosing, he comes in and says some nice things, we get connected to our IV line, and they roll us down the aisle and into the surgery suit, and after some really good drugs, we are forever changed.
• Buyer's Remorse: Our hospital stays are short and as soon as we can sit up, walk around the nurses station, and hold liquids, we are sent home with some pretty vague instructions that tell us how much to drink and how often to see and when to call the doctor, but there is little or no information about how we will feel or how weak we will become as we both recover from the surgery and learn to survive with our body in total starvation mode. Remember how just putting one foot in front of the other was such an effort. We all panicked and wondered what the hell we had done to our bodies and if we were going to forever feel so weak.

Phase Two: Weight Loss

In Phase Two, we get our strength back and begin to enjoy the abilities that we are gaining every day: the pounds seemingly with little effort fall off of us. We learn to adjust to how people respond to our rapid weight loss, and we learn to respond to those comments about how unhealthy we look. Those who may have had certain prejudices against us when we were very obese suddenly feel more comfortable around us, but our perceived body images have not caught up with our newer images so we all struggle with other's perception of us. Weight loss is imminent, and it seems effortlessly. The stages of this phase are a combination of what we want to happen or our dreams and the reality of the adjustment.

• Honey Moon: Over the first few weeks and for a couple of months after surgery, we begin to recover from being so tired all the time. We also learn to avoid dumping; we avoid the rapid descent to dehydration; and we become experts in how to add previously familiar foods to our diet for the first time. We move from the buyer's remorse stage to the honey moon stage because no matter how damn tired we are, nothing felt so good as watching the scales drop and tossing those clothes we all bought at the tent maker specialty stores. For the first time in our obese lives, our weight loss sometimes happens so fast that we skip entire sizes. The medical community and our support groups remind us that the first year is when we lose the most weight so we should work on changing our eating habits, learn new strategies for handling boredom and emotional eating, and begin exercising so that we maximize our weight loss. These new strategies are designed to not only take the pounds off but to maintain our weight loss, but for many of us, the honey moon seems infinite, so we work on learning how to wear clothes that we could never wear in our obese sizes.
• Infidelity: For some, cheating begins early but, in spite of the cheating, weight loss continues; however, for those who begin cheating, weight loss slows down and stalls happen more frequently and last longer than those who commit to following the plan. Many of us learn there are ways to get around the pesky little pouch such as trying a little sugar here and there until we finally lose that sugar intolerance; we also learn to feed our boredom or emotions with glider foods such as chips or crackers; we also learn that we can drink a little water when we eat. Whether the focus was on pushing the boundaries and trying to make food our friend and comforter again during the honeymoon stage or during the years after surgery, the results are pretty much the same: we are sabotaging ourselves and soon we quit losing and some even start gaining. It's also during this stage of Phase Two where addictive behaviors are traded: for instance, over eating may be replaced by heavy drinking.
• Adjustment to the inevitable: Eventually the infidelity hits us like a ton of bricks, we are gaining weight and people are noticing and saying things like, you are filling out again...we all have been so worried about all that weight loss.... here, have another piece of pie. Sadly we realize that we are upset that we aren't losing weight, so we slip into some of our behaviors of justifying and rationalizing. We even say, okay we aren't losing and we didn't get to goal but we haven't gained a ton of weight. The more we rationalize, the harder it is to accept the fact that our pants are getting tight. We start dreading getting on the scales, and, eventually, we actually reenlist some of our old behaviors of dangerous diets, diet pills, injections, and even trying another WLS.

Phase Three: Killing the Monster

Some people never make it to Phase Three because they are convinced that their pouch is broken and they cannot lose weight or even stop gaining unless they get the pouch fixed. Others know their pouch still works but they are in denial about their relationship with food. For those who do make it to this phase, they realize that the honeymoon is over, but they want to lose the weight they may have gained and they want to attempt to lose more weight to achieve reaching their goal weight.

• Facing the facts: For those of us who want to regain control of our pouches, this stage is crucial because it forces us back to the reality of our failures. We admit that maybe, just maybe, we focused more on the honeymoon stage and all the weight loss without learning those new strategies that our doctor wanted us to work on. Now that our pouch and small intestine has evolved a little and we have picked up some bad habits, working on change is going to take more than waking up on Monday saying, today I am going to get back to basics.
• Counseling: Many of u**** this stage with much resistance. We find we are at a crossroads where we can settle and talk about how we wish we had lost more weight, or we can go back and look at what went wrong. Reflection for us is more about blaming...it was my bad knees; my doctor didn't make my pouch small enough; my pouch never worked right. We think our pouch is broken, and some of us become as hopeless as we were before WLS. We get angry and jealous of those in our support groups who are making positive strides toward maintaining their weight and often our guilt causes us to isolate ourselves from anyone whose goals are contrary to ours and our support groups are the first to go. We struggle with reaching out but if we are to succeed, we do reach out.
• Recovery: Very few of us make it to the recovery stage, and those who do, do so after everything else has failed. In this stage, we must admit that our weight gain isn't due to a broken pouch but is due to our behaviors. For me, it was about reading and learning and applying that knowledge inward so that I could benefit. It's in this stage that we realize that we still have the tool but we have to actually work toward either more weight loss or better maintenance.

Part I has set the stage for what we go through. In Part II of this mini collection, I will provide some valuable information from the medical community that explains why weight gain occurs, the "broken pouch" myth, and how to achieve success and go on the second honeymoon.

You guys are more than welcome to criticize or add to this conversation. I have tried to parse out the information that I have gleaned from my own experience and from conversations we have had on this board and in my face-to-face support group. 

Very nice and so true... 

only one note: you are talking about a general WLS - or RNY only? if general WLS - using "pouch " may confuse sleeved people. Though some call their sleeve a pouch anyway.....

When I began this project, it was for the RNY because it seemed the surgeon wanted the information compiled first for him and the medical folks and then he and I made adjustments so that he could put some of the information into brochures and other instructional materials for patients. But, after I compiled everything for him, he wanted me to create the same information for the other surgeries that he does such as the band and the sleeve.  Since I didn't have either of those surgeries, I am having to do a lot of research. I have been interviewing patients to see what the common phases and steps are for those patients and they are very different from the RNY.  I will include those bits of information when they are developed. I have found that some phases and steps are common between all WLS from doing the initial research to trying to figure out what went wrong.  

That makes sense...

Jeannie,

I can tell you I could relate to all the above despite having the sleeve vs. RNY.

It will be interesting...to me anyhow...to see if your patient interviews turn up some really different stuff.

I think those of us who choose WLS have far more in common than any differences. We chose the type of surgery we had on a number of reasons, but the initial problems are much the same...as is the phases of recovery.

I will stay tuned for your next 'chapter' much in the same way I look forward to Eileen's writing.

Thanks for taking the time to share all that!

Kathy,

So far, it seems that we all have some of the same phases and stages within those phases.  The surgeon that I have been working with has said that it helps for the surgeons to have this information about the phases and stages because they know what the medical side is but they are far removed from the mental issues that we have...He believes as do his partners that this information will help their new patients.  I hope so.  I will get the next installment out soon.  I think everyone can relate to this next installment and some will be surprised as I was when I found the information.