Part 1 – September 6, 2001 – I’ve been overweight as long as I can remember. When I was a child, my mother put me on all sorts of diets. High protein, fruit, calories don’t count – you name it, she tried it. I saw myself as heavy and ungainly. When she wanted to hike, I found ways to stay home. When I graduated from high school, I was a little under six feet tall and weighed about 212 pounds. By my standards of forty-five years later, I was svelte and conditioned then. When I married at age twenty-four, I weighed in at a beefy 241 pounds. My wife, a physical education major in college, didn’t like what I weighed but was certain she could pare me down to an appropriate size. During the next two decades I yo-yoed between 250 and 295 pounds. I went to the Diet Workshop and Weight Watchers. I counted calories, worked out with the Canadian Air Force Exercise Program and Gil Gillett on TV. I climbed mountains in the summer and rode the Nordic Trak in the winter. Every time my weight fell below 250 lbs. I became complacent, began eating “just a little” pie or ice cream and ballooned back up to around 290. When I had my gall bladder removed in 1985 I heard the words “morbid obesity” for the first time. The surgeon didn’t want to operate on me.
One summer I was teaching in a summer program at a local college and noticed a raging thirst, constant urination, and a tingling lack of sensation in my feet. I was a diabetic. I took pills, dieted, exercised…and gained more weight. Slowly I drifted past the dreaded 300-pound mark and began to give up. By the time I retired I had reached 325. We sold our home and moved into an RV, traveling around the country and eating out too much. Many restaurants feature two-for-one specials in the off-season. By the winter of 2001 I weighed around 350 pounds. I could only sleep sitting up supported by four pillows. Many nights I got out of bed and went to sleep in an easy chair where I could maintain an upright position. I napped after each meal, sometimes sleeping for a couple of hours at a time trying to catch up for last night’s loss of sleep. I arrived in our summer home in the Adirondacks in early June and went to the Town Dump where the only scale I could weigh myself on usually weighed garbage. I topped out at 352 pounds.
Where did the weight come from? Lassitude, genes, stuffing, weakness of character, and eating my own food, leading a sedentary life, eating out…all these and more contributed to my getting myself to this point. People try to be helpful. “Just push yourself away from the table,” they say. “Cut out starches.” “Ignore food!” “Try harder.” From a fifth of a ton, none of the advice carries much force. All I can do is look down a long tunnel of meals and snacks toward an ever-vanishing goal of 192 pounds, the ideal weight I set for myself as a nineteen year old.
For several years, my doctor had been suggesting to me that I consider being tested for sleep apnea and that I consider bariatric surgery. I was resistant to both. To reduce the effects of sleep apnea I would have to wear a mask feeding air down my nose while I slept. The bariatric surgery would involve major abdominal surgery and then highly restricted eating for the rest of my life. I resisted both for several years, knowing and hoping beyond knowledge and hope that a chemical solution for my overweight would certainly emerge. The removal of Phen-Fen from the market reduced my enthusiasm for chemical solutions. It seems that every medicine that reduces appetite has other risks and nothing works very well. Obesity is too complex to be cured with a pill. Most obese people cannot sustain a regimen of diet and exercise for a lifetime in order to control their weight. Perhaps character alone leads a person to become fat. But the research seems to indicate that obesity defies simple characterization. Controlling intake involves mind-body interactions, which overpower will power. Moving oneself from chair to exercise becomes increasingly difficult and unpleasant as the weight piles on.
In the spring of 2001 we found ourselves camped in Indiana while we had a series of repairs made to our RV. Because my weight had begun breaking down the recliners in the rig, we went shopping at an RV furniture store up the road a piece. A man came in to try out the same chairs we liked, a chair designed for napping. We chatted, and he mentioned having had the sleep apnea study done and beginning to wear the mask. He said he’d begun sleeping better at night than he had in years, was napping less, and had increased energy. I listened enthusiastically.
Several weeks later, at a trailer hitch dealer, we chatted with a man who was in the waiting area with us. He sipped constantly on a bottle of water. We chatted, and he mentioned he had lost nearly 200 pounds after bariatric surgery. He looked well. We talked about the surgery. He said he ate very little, sometimes overdid and paid the price of throwing up, but wouldn’t change his decision for anything. He said he felt better than he had in years. I listened.
On returning to the Adirondacks in mid-June I met with my doc and arranged to have a sleep study done for sleep apnea. At the same time I talked to a local woman who had had bariatric surgery. She invited me to attend a support group meeting of post-op and pre-op people in the weight loss program of a local surgeon. I had begun the actual work of doing something about my excess weight.
As I waited for events to begin happening, I began doing some research about bariatric surgery on the Internet. I read a number of web sites and discovered the Association for Morbid Obesity and their website at http://www.obesityhelp.com/morbidobesity. I read the descriptions of various approaches to the surgery and learned that the “gold standard” of weight loss operations is the Roux-N-Y gastric bypass. In this operation, the surgeon staples the patient’s stomach leaving a small pouch at the top. He then uses a piece of intestine to bypass the rest of the stomach and a part of the duodenum. This leaves a very small amount of the stomach to receive food. If the stomach is overfilled, the patient either vomits or gets diarrhea, either of which is uncomfortable and unpleasant. Typically, patients undergoing this procedure lose a significant amount of their excess weight within a year, then settle down to slower weight loss for a period before their capacity increases somewhat and they gain a small amount of weight. They then reach a set point and tend to stay there. Patients do not typically seek to have the procedure reversed and they learn to eat within the regimen imposed by the surgery.
I had briefly considered having a local surgeon who was running a bariatric program perform the surgery, but decided against it because the hospital was said to provide questionable post-op care and the surgeons were only doing one bariatric procedure a week. Because we had enjoyed our stay in Florida last winter and had plans for this winter, I used the search facility of the website to identify a board certified bariatric surgeon in Florida. After some research I settled on Dr. Robert T. Marema in Ft. Lauderdale, Florida (http://www.usbariatric.com).
Marema and his associates do over 1000 bariatric procedures annually and run a very comprehensive program. I registered with their on-line service and followed up with a phone call. Within a few days a packet of materials arrived for me to complete and return to their office.
Meanwhile, I was scheduled for a sleep study at Saranac Lake Hospital. I arrived for the study at 8:30 P.M. The technician took me to a small hospital room with a sliding glass door separating it from a room containing a couple of computers. The technician attached electrodes to my head, heart, legs, eyelids, nostrils and other places too numerous to mention. I lay back against the raised bed and two pillows and watched television until I fell asleep. I had my normal fitful night’s sleep accompanied by a couple of trips to the bathroom and awoke for good at about 4:00 A.M. The technician told me that I clearly had sleep apnea; my blood/oxygen saturation had fallen as low as 55% when normal is in the high eighties or nineties. I drove home looking forward to the rest of the study.
Several weeks later, I was scheduled for the second half of the study. This time, I was wired as before, but asked to wear a mask over my nose. Through this mask a continuous column of positive air (CPAP) was directed. The effect of the air column is to keep air going to the lungs through the nose and to assure a good supply of oxygen to the blood. I soon went to sleep, breathing easily against the air coming in through my nose. I woke a couple of times, but slept until after 5:00 and woke up feeling refreshed and rested, the best night’s sleep I had had in some years.
A few weeks later a respiratory technician from a home health agency arrived at the door with my new CPAP machine. She instructed my wife and me on its use, maintenance, and features. She fitted it to me and watched as I tried it out. That night I had a good night’s sleep and during the several weeks since then my ability to sleep well wearing the mask has only increased. I have given up all but my customary afternoon nap. That means I no longer wake up, move to an easy chair and fall asleep again. I no longer fall asleep as soon as I’ve eaten breakfast. I don’t take two naps in the afternoon, nor do I sleep after dinner. This makes me feel better, and I have two or three extra hours a day for reading, writing, playing golf, and more. I scarcely know what to do with the extra time. My wife seems to be beginning to trust my driving again, as I’m much less likely to drift off as I drive. Sleep apnea is a common side effect of obesity. Perhaps, after the bariatric surgery, I’ll need the machine less.
Soon we’ll be leaving for Florida to prepare for the surgery. We hope to schedule the operation itself for early January. Meanwhile, Dr. Marema and his staff have developed a comprehensive pre-op program including meetings with a psychologist, nutritionist, dietician, and attendance at informational meetings and support group meetings. My brighter self recognizes these meetings and appointments as part of an effort to determine the risk factors in my case and help me to prepare for the change in lifestyle, which will inevitably occur as a result of the surgery. I want the meetings to be motivated by a humane caring concern for my welfare and success. My darker side sees the program as devoted to assuring that this important, but elective, surgery gets paid for by my insurance. At best I hope to find that both factors operate in tandem. Meanwhile, I’m scheduled to meet with the psychologist the morning of October 3rd.