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Husband, father, grandfather, friend...a few of the roles acquired in 62 years of living.  I keep an upbeat attitude, loving humor and the singular freedom of a perfect laugh.  I don't let curmudgeons ruin my day; that only gives them power over me.  Having experienced death once, I no longer fear it, although I am still frightened by the process of dying.  I love to write because it allows me the freedom to vent those complex feelings that bounce restlessly off the walls of my mind; and express the beauty that can only be found within the human heart.

Tuesday, February 08, 2011

My Lap Band Life - One Month In

Copyright © 2011 words only by Ralph Couey
A month ago today, I was wheeled into an operating room at Windber Medical Center in Pennsylvania.  About 40 minutes later, I came out, my life changed forever. 
I have always struggled with my weight, essentially since the age of 8.  This is something that seems to run in the family, since I’ve seen pictures of my ancestors from the depression, a solid working class clan, who wore bellies even in the midst of the worst economic disaster in our history. 
Over the years, I began to suffer from the inevitable physical consequences of obesity, including diabetes, bad joints, and heart problems.  I didn’t take retirement seriously because, frankly, I didn’t think I’d live that long.  Finally, after two heart incidents within 10 months, my wife and I decided it was time for some drastic alternatives.
In January 2010, after experiencing chest pain on the way to work, I was taken to the hospital where I received my third cardiac stent (the first two in 2003).  In March, my wife, a Registered Nurse with 30 years surgical experience, brought home some literature on a procedure called a lap band.  I was skeptical, but the stent thing had scared me pretty badly and I was ready to listen.  We went to a seminar for prospective patients put on by Dr. Kim Marley. 
The information provided was a revelation.  In 2002, I almost had a full gastric bypass done.  The operation was derailed when the insurance company pulled the authorization literally as we were on our way to the hospital.  But this was different.  A gastric bypass is a permanent thing, routing the intestine from the bottom of the stomach to a new pouch created at the bottom of the esophagus.  The lap band, conversely, is an adjustable and reversible  device, the size of which is controlled by injecting or withdrawing saline through a port attached to the inside of the patient’s skin.  Being far less complex, recovery time was relatively fast.
The program is structured such that a period of 6 months passes between the time you agree to the procedure and when it is actually done.  This is to allow time for testing and evaluation, dietetic, physical, as well as psychological counseling, giving the patient plenty of time to think.
I was still on the fence, but a second heart incident in October suddenly made the decision a no-brainer.
I finally agreed to have it done, though I had to wait three months to recover from the heart incident..  The date was set for early January (one last food fling over the holidays). 
I had never experienced surgery before, but I have always been haunted by the experience of a friend of ours who went in to have some sinus work done back in the 1980’s.  She metabolized the anesthesia rapidly, except for the paralytic, so was awake and aware during the entire procedure.  She had described in great detail the incredible pain she felt and the fear and despair at not being able to communicate her situation to the folks in the room.
I am possibly the biggest pain wimp there ever was, and for me, this was the stuff of nightmares.  That my wife has been doing surgery for three decades and has never, ever seen this happen was of little comfort to my irrational worries.  In the past few years however, hospitals have added equipment that monitors brain wave and other indicators that will signal when a patient is coming out from under before the patient is even aware of it.  This enables much better control of anesthesia during the surgery as well as reducing recovery time. 
It was only after multiple assurances from all involved that I would be down and out for the time needed, that I could put my fears aside.  Well, mostly anyway. 
For two weeks prior to surgery, the patient is put on a strict dietary regimen consisting of 2 liquid meals and one tiny 350-calorie meal per day.  And no snacks.  In retrospect, that was far and away the toughest part of this entire process.  This is necessary in order to shrink the liver, making it easier for the doctor to get in there and work.  I suspect that there's a little boot camp thing going on there as well, getting one used to smaller portions.  While difficult, I was helped by my own motivation.  I was mentally and emotionally ready to put my old life behind me and if that meant suffering through a period of privation to make that happen, then so be it.
On the morning of surgery, we left our home in Somerset early, arriving in plenty of time.  Over the next hour, I was put in that skimpy hospital gown, given the IV, visited with both Dr. Marley and the anesthesiologist, Dr. Chu.  Following that, I was wheeled into the OR.  Despite my earlier fears, anesthesia was simple and effective, working exactly as advertised.  Seemingly in an instant, I went from the OR to recovery, where the next sound I heard was the Recovery Room nurse telling me to wake up.  There was something soothing and comforting in that sound.  It seems that most of my life I’ve spent lying in bed, hearing female voices yell at me to wake up. 
After a while, I was taken up to the room, where my wife was waiting for me.  She explained that it had gone very smoothly with no complications.  The rest of the day, I spent drifting in and out of sleep, enduring the inevitable pricks, sticks, and pokes attendant to any stay in the hospital.  I was getting pain injections, but truthfully was never in any real discomfort.
My first meal was a revelation.  I was given some Jell-O, very watery cream of wheat, and skim milk.  I ate very carefully and was surprised to discover how little I needed to feel satisfied.
I was discharged on Tuesday afternoon and went home.  All things considered, I felt very good.  I wasn’t in any pain to speak of, although my stomach, decorated by bruises, had the look of a Van Gogh-like portrait.
That first week, I was back on fluids, as the affected parts healed and the swelling went down.  Having been cautioned by the dietician, I was very careful in counting protein content.  I had to consume at least 70 grams of protein each day.  I had no idea how tough that could be on liquids. 
The second week, I graduated to soft foods, which translated means what you could eat if you had no teeth.  By the third week, I was back on solid food, but with a whole new set of rules.  I was finding out that my tummy alarm was going off every 4 hours or so.  This is not a problem at home, sleeping in until 8 o’clock.  Now, back on my usual schedule, this meant eating breakfast at 6:00, lunch at 12, and dinner around 6.  So instead of eating every four hours, I had to go 2 hours longer.  There were days when the alarm would go off and I would have to suffer through extreme hunger pangs waiting for lunch or dinner.  A call to the Doctor’s office eased my suffering. They suggested some small snacks, such as fresh vegetables string cheese, or a protein drink.  That proved to be the answer, although now I find that I don’t need them as much.
I was told that this surgery would put my body through some significant changes, not only dietary, but in areas like hormones and mood.  I realize now that those difficult moments were part of that change. 
So, what is my life like now? 
My perception of food has undergone a huge change.  I was warned to stay away from bread because bread tends to form into dough balls in the stomach that just won’t go down.  And that’s very uncomfortable.  I was afraid that I would miss my comfort foods, the worst being a McDonald’s sausage, egg, and cheese McGriddle.  But truthfully, I haven’t felt the desire for that, and other similar cuisine.  Before this, had I looked at three-quarters of a cup of food, my meal size now, my response would have been a good deal of “What, you kiddin’ me?”  Now, it looks like enough, sometimes too much.  When we go to restaurants, I order off the kiddie menu, and usually end up taking most of that home with me.  We went to a Mexican place in Wexford and I ordered a child’s taco salad.  The waiter took one look at me and brought the regular adult size.  I simply ate what I needed, had the rest boxed up, which provided me lunch for the next four days. 
I take small bites and chew them thoroughly.  I take my time, making that small amount last 20 to 30 minutes.  I don’t drink anything 30 minutes before and after eating, mainly because fluid takes up space.  On those rare occasions when I do need a snack, I find that a very little goes a long, long way.  Because of the carbonation, I don’t drink sodas anymore, although I once had a passionate love affair with Diet Coke.  Surprisingly though, I don’t miss it. 

I stopped taking my diabetes meds the day of surgery and haven't needed them since.   There is a size limit to the pills I can take, so I've gone to chewable forms on a few.
The big payoff has been in my health.  Before surgery, I had ballooned up to 296 pounds at one point.  As of this morning, I weighed 265, and the weight loss has stabilized at about 3-4 pounds per week. 
This, of course has had wardrobe consequences.  I’ve had to make frequent visits to the attic to pull down my “skinny” clothes, and even they are beginning to feel baggy.  One Sunday, I put on my suit, only to discover that when I hung my smart phone on my belt, the pants fell down around my ankles.  Time for suspenders, I guess.
My blood sugars, which had been testing in the 170’s before surgery are now consistently around 110, with frequent excursions into the 90’s.  I am still sensitive to carbohydrates, which can cause those numbers to spike, so I have to read labels carefully.  And most amazingly, I have been experiencing some dizziness that my doctor thinks might be an indication that my heart meds may need to be adjusted downward. 
When I walk now, instead of plodding, I feel a spring in my step.  My knees and hips, once sources of consistent aches, feel much better.  I’m easing my way back into an exercise regimen, which has helped my mood considerably.  If I feel this good only one month post-surgery, I can only imagine how great life will be six months or a year from now.
My life is better now, and the future has a gleam to it that just wasn’t there before.  I realized that I had resigned myself to the expectation that I would pass from this life before I had a chance to enjoy retirement.  Now, I’m thinking life has no limits; that if I depart this mortal coil before age 95, it will probably be on the back of a motorcycle. I’m setting aside money for my dream a year from now, a shopping spree at Brooks Brothers, who sell only beautiful, fashionable, but skinny clothes.

And, oh yes, I'm now taking retirement planning very seriously.
 I’m ready for a vigorous and exciting life, one where I can not only keep up, but even step out ahead.  And as far as my attitude towards the future?
Bring it on.
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