Sunday, July 11, 2010

If only bad habits could be edited

I'm taking a professional editing class--it's part of the Technical Writing Certificate I'm working toward in my spare (cough) time. The final project assignment is to edit a piece of writing that's 5-10 pages long, using the different levels of editing we're learning about, etc., etc. It's hard to find pieces of writing on the web that it's okay (read: legal) to edit, so we were steered toward Wikipedia for sources.

I looked up some random stuff I thought I might be able to write about, like 'shabby chic', and there wasn't enough text (or enough interest on my part to make it a final project). Then, a light bulb went on (must have been the Rockstar I just finished--wink wink) and I thought, "I'll look up 'gastric bypass surgery'!" I cut and pasted the whole kit and caboodle into Word and it came up as 17 pages, so even with the random white space where the graphics would have gone, it should be plenty long enough when all is said and done. I emailed my instructor with a couple of questions and now await his reply. Some stuff in the article jumped out at me.

"The long-term mortality rate of gastric bypass patients has been shown to be reduced by up to 40%;however, complications are common and surgery-related death occurs within one month in 2% of patients."

I knew this; in fact, I actually thought the surgery-related death statistic was higher. I think it may have gone down in the 12 or so years I've been reading about it; initially I had the impression that 1 in 4 patients died pretty quickly following surgery, which was one of the reasons I initially refused to get it. I tell people they should know the worst-case scenario(s) and be able to accept them before they undergo bariatric surgery.

"The Consensus Panel of the National Institutes of Health (NIH) recommended the following criteria for consideration of bariatric surgery, including gastric bypass procedures:
1. People who have a body mass index (BMI) of 40 or higher. Or,
2. People with a BMI of 35 or higher with one or more related comorbid conditions.
The Consensus Panel also emphasized the necessity of multidisciplinary care of the bariatric surgical patient, by a team of physicians and therapists, to manage associated co-morbidities, nutrition, physical activity, behavior and psychological needs. The surgical procedure is best regarded as a tool which enables the patient to alter lifestyle and eating habits, and to achieve effective and permanent management of their obesity and eating behavior."

That's what they've been telling me. Tool. It's easier said than done sometimes, but it's the most useful way to think of the surgery.

"In 2004, a Consensus Conference was sponsored by the American Society for Bariatric Surgery (ASBS), which updated the evidence and the conclusions of the NIH panel. This Conference, composed of physicians and scientists of many disciplines, both surgical and non-surgical, reached several conclusions, amongst which were:
• Bariatric surgery is the most effective treatment for morbid obesity
• Gastric bypass is one of four types of operations for morbid obesity.
• Laparoscopic surgery is equally effective and as safe as open surgery.
• Patients should undergo comprehensive pre-operative evaluation, and have multi-disciplinary support, for optimum outcome."

Okay. I agree with this, and it's what I'm getting.

"The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed. It is estimated that 200,000 such operations were performed in the United States in 2008. An increasing number of these operations are now performed by limited access techniques, termed "laparoscopy".

Laparoscopic surgery is performed using several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is also called limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision—with the option of using an incision should the need arise."

My surgery was laproscopic. I had that unusually thick abdominal wall problem, but my incision scars are almost invisible already, not even a year out.

"The gastric bypass procedure consists in essence of: creation of a small, (15–30 mL/1–2 tbsp) thumb-sized pouch from the upper stomach, accompanied by bypass of the remaining stomach (about 400 mL and variable)."

Wow, that's tiny.

"The gastric bypass reduces the size of the stomach by well over 90%. A normal stomach can stretch, sometimes to over 1000 ml, while the pouch of the gastric bypass may be 15 ml in size. The Gastric Bypass pouch is usually formed from the part of the stomach which is least susceptible to stretching. That, and its small original size, prevents any significant long-term change in pouch volume. What does change, over time, is the size of the connection between stomach and bowel, and the ability of the small bowel to hold a greater volume of food. Over time, the functional capacity of the pouch increases; by that time, weight loss has occurred, and the increased capacity serves to allow maintenance of a lower body weight.
When the patient ingests just a small amount of food, the first response is a stretching of the wall of the stomach pouch, stimulating nerves which tell the brain that the stomach is full."

What I heard was that a 'normal' stomach can stretch to the size of a football. (An example like that is easier for me to visualize.)

"In almost every case where weight gain occurs late after surgery, capacity for a meal has not greatly increased. The cause of regaining weight is eating between meals, usually high-caloric snack foods. There is no known operation which can completely counteract the adverse effects of destructive eating behavior."

This is the part that hit me where I lived, particularly the last sentence--because I know how very true it is and live it every day, sometimes much to my own chagrin. It's just another way to say, "This surgery isn't a magic wand"--which is, of course, what I've been saying (and learning, literally) all along.

There were more interesting little factoids on Wikipedia's gastric bypass surgery page, such as that post-surgical folk absorb alcohol faster and take longer to get sober (which would seem logical). The statistics were also kind of fun:

-65-80% of excess body weight is typically lost post-op;
-High cholesterol is corrected over 70% of the time (I'm in the remaining 30%, lucky me);
-Type II diabetes is resolved in over 90% of cases, sometimes within days of surgery (this did happen, yay);
-Sleep apnea is often cured, though no statistic is given;
-acid reflux and joint pain are often gone quickly, although no statistic is given.

The article does stress the importance of having a support system in place due to the psychological ramifications of this surgery. I would definitely, definitely concur.

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This blog focuses largely on a personal journey to and through weight-loss surgery. It's also about reading, writing, animals, photography, love, humor, music, thinking out loud, and memes. In other
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