How to be a Good Weight Loss Surgery Patient

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How to be a good weight loss surgery patient (an excerpt from "I'm Still Hungry" by Carnie Wilson)
1. accept the fact that you are morbidly obese and have a potentially life-threatening disease. No more denial!
2. Admit that if you don't get rid of your excess body weight, you'll develop (if you haven't already) obesity-caused afflictions including high blood pressure, high cholesterol, heart disease, diabetes, certain cancers, sleep apnea, asthma, joint pain, back problems, headaches, qout, gallbladder disease, and circulation problems-including blood clots in your legs that can travel up to your heart and lungs and kill you. ( all of this on top of the tremendous emotional pain being morbidly obese causes)
3. Ask yourself how long you have been overweight. If it's been a long time, then you've probably tried to loose the weight over and over again. Be honest; Have you tried everything in your power, or have you just reached a point where you've given up and feel completely powerless?
4. Get your facts straight; Diet's don't work for morbidly obese people. The cycle works like this: You'll go on a diet, lose some weight, but then gain it back (plus more). On and on it will go-you'll get fatter and fatter, and eventually you'll become seriously ill.
5. Recognize that morbid obesity is the second-most preventable death in the country besides the awful possibilities that can result from smoking. How frickin scary is that? What an eye-opener!
6. Understand that WLS is the only successful weight loss method that results in patients losing between 50 to 75 percent of their excess body weight. Only a small percentage of patients will gain back 25 percent of the weight they've lost. Think of all those people like myself who have lost 98 percent of their excess body weight. I've only gained back five pounds. Sure, I fluctuate with those five pounds, but I've never done that in my entire life. This has been more successful for me than any medical treatment or diet in history.
7. Surrender yourself. Accept that you need help that goes beyond going to a shrink or weekly Weight Watchers meetings.
8. But definitely get psychological help and start working on the issues that contribute to your disease. Address your need to stuff your feelings down with food, and work on self-esteem issues.
9. Research all the facts and information on the different kinds of WLS. Gastric-bypass (which is what I had) is the gold standard and the most successful. Learn about the risks during surgery and right after surgery, as well as the short- and long-term risks and side effects of all types of WLS.
10. Understand that the risks of not having surgery far exceed those of having it. This is a fact.
11. Confront your commitment. This is an extremely important thing to do. You need to ask yourself if you're ready, willing, and able to commit to the responsibilities that come along with surgery. there are several changes that you're going to have to incorporate into your life-are you prepared to do so?
12. Decide if the surgery is for you. If you're afraid of it, ashamed of it, or unwilling to accept it as a new part of your being, then it is not for you. But if you're ready for your body to finally become your friend (instead of the enemy), then you're on the right track.
13. Discuss it with your significant other, family members, and friends. Tell them about the surgery and give them all the facts, while also discussing the benefits and possible side effects. They need to know as much as you do to really understand and support you. However, if they've never had a weight problem, some of them might never understand your making the most important health decision of your life thus far. But I swear, after you've been successful, if they don't change their minds about WLS (I think they will) and notice your power, strength, and success, then they're just angry, negative people with their own problems.
14. Get over the fact that you need surgery to help you. You're weak and not weak at the same time, if that makes any sense. You've admitted that you're powerless and that you need help. You need a tool to get you going and to rid you of the afflictions threatening your health. It's not about giving in or giving up, it's about admitting that you're vulnerable to food and that you feel powerless. That in itself is commendable. Try to ignore the rumor and hearsay about WLS. It's not bad, and you're not a bad person. You're actually a brave, confident, courageous, and smart person, because you're taking control over your health and your life. It's the most precious gift you could ever give yourself. People won't always agree with what you do in life, but you've got to take command of your own life now and forever.
15. Accept that this is a radical thing to do. People close to you may feel excited, nervous, concerned, worried, and scared. That's okay-we have to let people express their take on the surgery too. Letting the people around you express themselves and their opinions is a good thing. They need to feel like they're being heard, too, and that you're not just "jumping into it".
16. Respect other people's reactions, and let it go.
17. Do this for you. It's your life-no one can change you but you. Don't ever do something like WLS for anyone else. I know many people say that they do it for their kids or their loved ones, but I genuinely feel that you've got to do this for you and your health so that you'll be around to live a life with your kids and/or loved ones. Inspiration and influences from others is great, though!
18. Give in to what you've denied yourself in the past-taking care of yourself. Just accept that you need help. After all, if a person with heart disease needed a valve replaced, would anyone even question it?
19. Prepare-this can actually be fun!
20. Research WLS over the Internet. Better yet, talk to people who have already had the surgery. These people are an amazing resource because they've been through it and can help answer some questions you might have. Talk to them and get their feedback when it comes to the whole experience. Learn from them.
21. Realize that everyone is different, from how they react to anesthesia, to how they heal, to how their mind-set is before and after surgery. And ultimately, every one's different in their commitment. But we do have one thing in common: this disease called obesity, and the desire to become healthy.
22. Find a surgeon who's a member of the ASBS (American Society for Bariatric Surgery) Do not have just any gastric intestinal doctor or trauma surgeon operate on you. They might be amazing in their fields, but you want someone who only preforms these surgeries to do your WLS. And make sure that your doctor has done hundreds of them. If you're looking into a laparoscopic procedure, then make sure that your surgeon has preformed this operation at least 100 times. Look at his or her track record: if it takes four to six months to even get an appointment, well, maybe that's because the surgeon only does a limited amount of procedures. You shouldn't have to wait more than a few months for your surgery date.
Your surgeon should be confident, calm, experienced, and enthusiastic about your success, and should love what he or she does for people. You need to feel comfortable with him or her, and be able to ask every single question you can think of. You should feel a connection to your doctor, have confidence in this person, know that he or she feels that this is the best thing in the world for you, and be sure that you'll be taken care of. Tell your doctor that you want him or her to do a good job and to take good care of you. After all, it's your body...
23. Make sure the surgery is covered by your insurance plan. It can be a challenge to get coverage with certain kinds of policies. Don't give up! Many surgeons will even work with you on this. It may take time, but then again, you didn't become morbidly obese overnight. You waited this long to change your life, it will happen.
24. Understand that any surgery is risky. During your WLS, things could go wrong. You could have a reaction to anesthesia; you could go into cardiac arrest (more of a risk for the super-morbidly obese); you could have a bowel obstruction, bowel leakage, or a hernia; you could form a blood clot in your leg and have it travel to your heart or lungs; you could die. Yes, you could die. But keep in mind that you could die having any type of surgery. The good news is that wls is about as risky as having your gallbladder removed. People don't know that, so they think it is much worse.
The actual chance that you'll experience one or more of these problems is small. That's why you need to do research, and make ample preparations with your surgeon and the staff nurses at the hospital. You should receive extensive physical and psychological tests while preparing, which will determine if you qualify in the first place. These tests will help ensure that you'll be safe, and that you're the most prepared you can be. In addition, your doctor needs to know everything about your medical history, while the nurses can help you with more of the emotional and psychological components to the surgery.
25. Remind yourself that you've made a decision to improve your health and life. Accept the possible risks, address them, and then don't dwell on them anymore!
26. Stay positive. Go into surgery with an upbeat, positive vibe. smile and talk to yourself-tell yourself that you'll be fine and you're gonna make this the best experience of your life. Positive people not only heal faster, they also have better results in the long run. So really try to keep your spirits up. It's normal to be scared and nervous, too. I was both.
27. Before the surgery, follow instructions from your surgeon. At the same time, go on with your daily life. Don't stop eating, but don't start pigging out either. Just do what you want. Many people start losing weight right before the surgery because they feel so excited about their decision. It's a relief and a fear all in one. But definitely do stop smoking.
28. Bring comfortable clothes, books, and anything that mellows you out for the recovery period. You'll be tired for a while, and you won't be running around for the first week.
29. Remember to smile and pray. It's a great combo. Good Luck!
30. Know that you might feel uncomfortable and sore when you come out of surgery. It may feel like you've done a thousand sit-ups. You'll probably have a morphine drip, so don't worry too much about the pain. If every thing's normal, you'll move on to Tylenol with codeine or a mild pain reliever for a few days to a week.
31. Walk, walk, walk! Listen to your nurses-if they tell you to get up and walk, then do it! The more you walk, the faster you'll heal. Breathe into the breathing apparatus, too. It's there for a reason. You don't want to develop pneumonia, so get those lungs goin'! This is crucial.
32. Follow all instructions. You might be given a manual or some type of pamphlet before and after surgery-read it and take it's advice. Tell yourself that you want to be a good patient because you know it will make your experience better and more productive. You'll get certain medications, or specific instructions from your surgeon. Don't mess with any of this. The guidelines that have been given to you are there because you need them.
33. When you're allowed, start sipping that water, big time! You'll notice that it's like a little experiment every single time you drink or eat for awhile. That's also part of the fun. Something might feel fine going down, or it might not, so take it easy. Don't gulp your water-sip it like a baby. Don't take big bites of food either. Take a pea-sized (or smaller) bite of anything you put into your mouth.
34. Understand that you probably won't be hungry. I wasn't for three months. I'd actually forget to eat-the biggest miracle ever!
35. If you fantasize about a big plate of mashed potatoes, a juicy steak, or whatever your favorite food is, that's normal. It's okay if you still want it, but remember one thing: You'll have it again. But your daily food plan will be strict and focused for now. This is to ensure your health and start good habits right from the beginning. The first six months after surgery will probably set you up for how you'll be eating for the rest of your life.
36. Realize that you might feel sad or even a little depressed after surgery. Anesthesia can make you feel out of it, tired, and can even change your perception. Also, those painkillers are just terrible. Sometimes they're necessary, but try avoiding them-yuck!
37. Go to support-group meetings, and share everything. You'll find that some people are having an easy time of it, while others are struggling-it's a good thing to experience it all at these group meetings. It will help you (and others) make it through.
38. Know that you won't be feeling like yourself for awhile. you'll be a little off-kilter. Relax, take the time to heal, and know that it gets better every single day.
39. Start doing mental exercises. Envision yourself losing weight: your pants are falling off, and you can run. You look at yourself in the mirror, and you see a difference-you also notice other people's reactions to your progress. You imagine yourself breathing better or not having to take your diabetes medication every day! You're proud of your control when it comes to food and how quickly you become full now.
40. When you eat, don't push it. Take small bites and chew slowly (but don't spend more than 20 minutes eating) Push the plate away as soon as you feel satisfied, but not full. Believe me, you'll understand what I mean-it's like a miracle.
41. Drink at least 64 ounces of water every single day. Remember that we pee out our fat. You should be urinating once an hour-every time you do, say, "I'm losing fat!" The more water you drink, the more you'll lose. However, try not to drink water for a half hour to an hour before and after a meal. You'll be really full from that water, and you need to get your protein in at every meal.
42. Remember that juice, coffee, iced tea, or any other liquid is not a substitute for water. I know that drinking water is a pain in the ass for most of us, but you just have to sip it all day long. Carry it wherever you go. Don't keep refilling your water bottles unless you wash them in hot water with soap first, as bacteria can form in there (gross!)
43. Watch out for your sensitive pouch. Once out of three people will have some difficulty keeping food down, even liquids. Sometimes you'll find out the hard way about food "getting stuck". You might be taking too-big bites, or your tummy might just be really sensitive to whatever you put in it first. It is a healing wound. Believe me, it gets better. If you are having trouble, talk about it with your surgeon or nurse. However, if you're throwing up everything you eat for more than a week, you might have some scar tissue forming. Check with your surgeon immediately.
44. Don't feel like you have to eat three meals a day. You might only want one, or you might want two or three. Whatever you're comfortable with is good. Keep in mind that you need protein the most, and avoid snacking.
45. Take your vitamins (and get used to them, because you'll need to take them every single day for the rest of your life) Taking vitamins is one of the keys to your survival now. Your body isn't absorbing all the nutrients you eat yet, plus you're eating less, so you're getting fewer vitamins and nutrients. You'll probably be supplementing your diet with a multivitamin, and a vitamin B12 (see #46), calcium, and iron pills. Don't take your calcium and your iron at the same time, as they cancel each other out. Take your iron in the morning with breakfast, and your calcium with dinner at bedtime. For additional absorption, taking 500 milligrams of vitamin c is recommended with your iron supplement. (NOTE: there are certain kinds of iron that you won't be able to absorb at all anymore-check with your doctor)
There's a vitamin plan that I follow. I take VistaVitamins, which are the only vitamins formulated for gastric-bypass patients. The only thing I take in addition is a B12 sublingual (which means "under the tongue") from Trader Joe's once a week. I'll chew on a Viactiv once in a while, too. I found that taking my vitamins with food made it easier on my stomach.
don't look at taking your vitamins as a chore-after all, you brush your teeth everyday, right? You'll just need to learn how to work them into your daily life. Don't be embarrassed-be proud! People will be so impressed that you're taking care of yourself. And who knows? They might even follow your lead.
46. Remember your B12-it's very important, especially during the first three months after surgery. This vitamin (along with protein) will help you with potential temporary hair loss/thinning. Don't worry if you loose some hair after three to six months. It's normal, and it will grow back. Understand that you can help this side effect by making sure that you get the exact amount of B12 that your surgeon wants you to have, and by eating tons of protein. But be careful-too much B12 can be very dangerous. Don't just take extra, check with your surgeon.
47. Keep a food journal. You'll be able to chart your progress, as well as which foods you're incorporating into your diet. It's a trip!
48. Weigh yourself at least once a week. You can even weigh yourself once a day if you like. It's fun to see the scale finally becoming your friend. You may even get the urge to kiss it rather than throw it across the room!
49. Don't beat yourself up about things. Progress varies. Try not to compare yourself with others, but I know that's hard. Just remember that everyone eats and loses weight differently.
50. Follow these four rules, and I swear you'll get to your goal (or really close to it): (1) Eat your protein first at every meal. (2) Drink 64 ounces of water everyday. (3) Don't snack between meals- I know it is as hard as hell, but water will help you feel full. If you do snack, have a piece of beef jerky, nuts, cottage cheese, or a teaspoon of peanut butter- in other words, protein only! (4) Finally, exercise at least three to five days a week. You can do 30 minutes on the treadmill, take a nice long walk, join an exercise class, or go swimming. Of course you won't be able to do it all at first, but you can work your way up to it. The bottom line is that your new life will be moving instead of sitting! It's so cool! And here's my bonus tip: Take those vitamins every single day!
51. Get into a routine and make it fun. Experiment with foods and cooking. Try to cook more so you can see exactly what goes into certain dishes. You'll find which foods work best for you. For example, an egg and cheese breakfast works great for me. Sometimes I dip it into a teaspoon of ketchup, but watch the sugar when you're first out of surgery. Even a small amount of ketchup could give you a dumping reaction. Whatever you do, do not make oatmeal, cream of wheat, or any type of carbs for breakfast. It's a bad way to start out the day. You need protein to keep you full-and you'll feel satisfied for hours.
52. Learn the facts about food. You might think that pea soup is a good choice for a meal because it goes down easily and is warm and comforting. But you're wrong-it's not the ultimate source of my favorite capital "p" (protein). Read labels and really know what's in your food.
53. Don't count calories-it's a total waste of time. After your surgery, you won't be eating the same amount of food or even enough calories to be concerned. Later on down the road, if you find that you are snacking more (BAD!), then you'll need to pay closer attention. The simple fact is that if you eat more calories than you burn, you'll gain weight. Also, you probably have calories stored in your body that would last you an entire year, so don't worry about not eating enough.
54. Remember to focus on protein at every meal. Fill up on it first. Try to eat solid protein, but if you are having trouble keeping it down, talk to your surgeon about protein shakes or pureeing some bulk protein. There are many forms of protein you can try, including eggs, fish, chicken, turkey, beef, soy, tofu, cottage cheese, and beans. Oh, and FYI: Taco Bell's beans are refried in water instead of lard!
Remember that you can add salt, pepper, and different seasonings to make things taste good. I was so excited to try food after having the surgery, and it seemed like everything tasted so much better! I really savored and appreciated every bite so much more.
55. If you still crave sugar or certain foods after a few months, that's normal. It's okay to try a few licks of a sucker or hard candy, which you can have at the end of dinner or lunch. Don't feel guilty about this! You should be able to have a bite of any dessert you want (but only at the right time!). Be careful about this, though-don't make the bites too big. Dumping isn't fun-however, it's my lifesaver now because I feel a certain reaction after I eat specific foods. If those foods are high in sugar or fat and I eat too much of them (which might only be two or three bites), I'll have a nasty reaction. The food will "dump" directly into my intestine, and my pancreas will be fooled and will produce a lot of insulin-it's like being a diabetic. I get cold sweats, my heart races, my nose runs and is stuffy, plus I feel like I need to barf, but I just can't. I also feel extremely tired and I have to lie down, no matter where I am. (Some people experience severe cramping and get the runs, too!) But the worst part is this feeling of impending doom that comes along with everything else.
This could go on from 15 to 45 minutes, as the degree of dumping varies. Sometimes I don't even know what caused it. You've got to be ready for the possibility of this happening. Believe me, you'll learn quickly what works and what doesn't for you. That's why I'm happy that I dump. Why would I want to be able to eat a lot of the foods that made me fat in the first place? I love being able to write that!
56. Don't be surprised if you start feeling a little bit different about your identity. If you do all of the things I've been sharing with you, you'll definitely be losing weight-and probably fast, too. You may be feeling really uncomfortable about all of the sudden changes. Don't worry. It's part of the process, and a step forward when it comes to letting a more unhealthy part of you go. You'll also be inviting a happier, healthier self into your being.
57. Use whatever helps you adjust-support-group meetings, therapy, crying, rejoicing, or more exercise! Adjusting to your new self is a process that goes on for a year or two. As I write this, it's been three and a half years since my WLS, and I'm still getting used to the new me.
58. Be prepared for people to react in various ways to your physical and emotional transformation. It might even transform them, too. Remember that it helps totalk about how you're feeling and what the surgery has done for you. Some people might be proud, while others may be intimidated, since seeing someone succeed at something that they've always failed at can be shocking.
No matter how others react, you should be feeling very empowered after losing the weight, and your family and friends should be able to share that joy with you on some level. Remember to support them, too.
59. Have a blast with your new life! Your life will begin to really change now because you'll be able to do things that you've dreamed of doing for maybe forever. Go for it! Get on a bike, go in-line skating, dancing, bowling, skiing, hiking, or scream your lungs out on the highest roller coaster at the ammusement park. Now that you can fit into the seats at concerts or movie theaters, get out of the house. There's so much you can do now that perhaps you felt ashamed of doing in the past or just couldn't physically do before. Celebrate the little things, like being able to run with your children in the park..or tie your shoes!
60. Remember hitting a plateau is normal. If your weightloss starts to slow down after four, six, or eight months to a year after your surgery, then you are doing justfine. Now is when you need to be drinking more water, exercising more, and keeping the snacking down to a minimum. Remember that you're still losing inches, even if the scale is temporarily not moving. Don't let it get you down. Almost everyone goes through this-you'll get through it, too. But don't be in denial: ask yourself, "Did I eat extra bread this week? Did I work out once or five times? Did I drink all my water?" There's always a reason why you've hit a plateau.
61. Eat more food now-it's okay. The "golden year" is over in terms of eating super-small amounts, so it's normal to find your intake increaseing. And don't worry if you notice that it's easier to eat a bigger plate of salad that it is to eat a huge chicken breast. However, the solid, bulk proetein will fill you up faster and keep you satisfied longer.


if you think that you've "stretched out your pouch" because you are eating more, give yourself a little reality check. How much more are you really eating? What are you eating first at a meal? Sit down, eat a chicken breast or a piece of steak, and wait five minutes. I garantee that you'll be totally satisfied.
62. Know that you can't really "stretch your pouch". But you can snack all day lon and drink liquids during a meal-which can make it easier for food to pass through the connection of the stomach and the upper intestine. This means that food won't stay in your tummy long. So don't snack, and don't drink liquids during a meal or shortly thereafter.
63. Don't be threatened by holidays or special occasions. The good news is that your plan stays the same 365 days a year. If you do have more bites of candy, cake, or cookies, don't freak out. Just be careful, because it adds up. Increase your water throughout the day, and do extra exercise-it will really help!
64. Watch your alcohol intake. Two drinks per week is really the most you should have. Drinking isn't a healthy habit, and after you have had WLS, your liver will be more sensitive. Be careful, because you can really feel the effects faster. Just watch it.
65. Call your surgeon if you have any physical problems including severe and persistant gas, nausea, and/or constipation (which usually comes from not drinking enough water); or a hernia. You need to deal with it right away.
66. Continue to follow the four rules I mentioned earlier, and you'll lose your weight and maintain it forever. However, it won't come without serious effort and commitment. Think about how long this list is when people question if WLS is "easy"! The fools.
67. Try to stop and recognize what you are doing ifyou start to revert to old habits. Watch your patterns-are you continuing to eat even though you are full? Whether you're one year of five years post-op, stop and talk to yourself! The worst thing you can do is ignore what's happening, for that's how the pounds will creep back! I was ten pounds up at one point, which was the result of snacking, too much wine, and not enough exercise. This reminded me that WLS is never a cure for our disease-it's just a helpful tool. Follow-up is the key to maintenance. Support-group meetings are also helpful.
68. Weigh yourself every morning at the same time when you reach the one-year post-op period, because it's a good way to see how your body flectuates. You weight depends on your salt and water intake, or that time of the month if you're a woman. Remember that it's easy to lose the weight, but it's easy to gain it back, too. Don't become obsessed with the scale, but keep it a big part of your life. It will keep you aware.
69. Make sure to have your blood work done every six months from now on. You need to keep an eye on your blood levels (especially your iron and calcium)
70. Get help if you're having emotional difficulty being a totally new person or are now addicted to other things such as alcohol or even drugs.
71. When it comes to having children, you should wait at least 12 to 18 months post-op to ensure both your and your baby's health. At this point, you'll be eating enough that your baby can grow healthy and strong. There's no negative effect on pregnancy after having WLS. In fact, you'll probably become more fertile because your hormones aren't out of whack. In addition, there's less of a chance of developing gestational diabetes, and you might experience a more pleasant pregnancy because you're not carrying around that additional weight.
72. Don't worry about your excess skin. It might not bother you at all, or it might totally gross you out. If it does, then it's certainly an option to have it removed. Try to get your insurance to cover some of it. You have rights in this area-fight for them!
73. Be a role model for others. Teach them what you've been through, what you've learned, and how it's changing you for the better. This is what I do, and it feels so good.
74. Take pride in your accomplishments, and don't let envious people get you down. People sometimes like to avoid their own problems by pointing the finger in someone else's direction. Remember how hard you have worked, and ignore negativity from others. I know it's not easy, but look at how far you've come. If you can do this, you can handle anything!
75. Every day, for the rest of your life, thank God and honor your tool forever. Be grateful for this surgery, your willpower, and the strength you've welcomed into your life, because all of the above has made you as successful as you are now. Remember that you saved your life, and in turn, maybe you can help someone else save their life.