Worry and surrender

I've always worried a lot. I think I've gotten better on this score, and it's something I actively work on. I don't think that worry consumes my life, but I know it is something I fall into far too easily, sort of a default setting from hell. I try to be logical and reason with it. "Will worrying about this change anything? Is anyone going to die? Then relax." Sometimes, this actually works. A friend of mine calls it "perseverating", which sounds like the right word for what it feels like: onomatopoeic, even.

I wonder sometimes if other people are more worried about me having this surgery than I am. They ask me things like, am I scared? And what about this horror story I heard? Do I realize what my loose skin is going to look like after I lose the weight? And what if I have complications? What if I'm sick for the rest of my life? And then, there's the mother of all elephants in the room: what if I die?

I've read about my options. A lot. I've listened to actual people who have been through bariaric surgeries of all types talk about it. A lot. I am a well-informed individual who loves research, is endlessly curious about life in general, and reads just about everything I can get my hands on, because I am interested in just about everything around me. (Except NASCAR.)

I was dead-set against this surgery for myself for so many years. There are a lot of facets to not only that feeling, but the reason that it has changed.

I compare it to the way I used to feel about antidepressant medication. I used to be dead-set against antidepressants for myself, too, but now I have come to realize that they ultimately get me out of bed in the morning. This is my reality; it is a reality that surprises many people who know me quite well. I truly believe antidepressants are a tool to help to correct the medical issue of depression, a medical issue I did not ask for but that I nonetheless have. So be it. (Ultimately, I didn't want to admit I had it; who does? I am grateful for today's increased awareness and decreased stigma regarding mental illness, a great contrast to the cultural climate regarding that issue when I was growing up in the 1970s and 1980s, but we as a society still have a long way to go.) Antidepressants do not solve the problem of depression completely for me or for anyone else I know that takes them--but they can, ideally, make depression manageable, and do for many if not most. Despite the fact that I respect myself less for needing antidepressants (aside to self: sounds like that damn shame again, must obliterate at some point sooner rather than later), I have chosen to view antidepressants as a tool that have improved my quality of life; to continue to work at full acceptance of this; and to move on as best I can.

The way I have come to feel about bariatric surgery parallels the way I feel about antidepressants. I have tried every possible method to lose weight, save many of the flavor-of-the-month diet drugs that have come and gone over the years because I could not afford them (and considering what happened with all of them in retrospect, I'm extremely thankful for that!). Surgery on its own does not solve the problem of obesity; it is a tool that accompanies drastic positive lifestyle changes. It is not 100% effective for 100% of people, and it may not be for me. But the chance that it will affect positive change in my life is enough to convince me that it is a good option--for ME. I don't pretend to know--or want--the responsibility of knowing what is right for other people.

I am already physically sick or impaired on any number of levels and I am certainly tired, bordering on bone-weary. Yes, I am aware that my decision to pursue bariatric surgery as an option is a form of surrender. I am surrendering my own biases, perfectionism, self-loathing, and yes, no small amount of my shame to the chance that the tool of bariatric surgery may serve to help me to feel as though eating well and exercising is pointless because I am still, after all, the f-word. There are already health-related complications in my daily life that even people who have known me for 20 years or more have no idea about.

Am I scared? Certainly. I'm breathing, aren't I? But to my mind, the notion of bariatric surgery is nothing compared to the cancer scare I went through almost ten years ago now, nothing compared to the fact that I had to have a full hysterectomy at age 32 that permanently removed any ability I may have had to ever have children, which has been more profound a loss for me than anything else could be beyond my own death. And seriously? Let's face it, if I die, it's over for me and becomes the problem of the loved ones I would leave behind. I don't fear death, but I don't want to die, either. If deciding to undergo bariatric surgery, subsisting on little bites of rabbit food for the rest of my life and working out (ugh) regularly doesn't prove that I am choosing life, than what in the name of all that is holy would?

I think the worry of other people that care about me is that they know (a) how extremely stubborn I am, (b) how I have continued to fight every aspect of these issues, and (c) how very much I enjoy evil yet delicious food, drink, dessert, etc. They also must know that (d) if I have chosen to do this, I must feel as though there is no other choice. Let the record show: I believe there is no other choice. For ME.

Let's accept this and move on.

Oh, doctors

I am really picky about doctors. I love the joke about the only difference between God and a doctor (God doesn't think he's a doctor). I've "fired" a lot of doctors over the past ten years--most of my life, I didn't have health insurance, so I guess I am just drunk with power. Seriously, if a doctor doesn't listen, I'm gone. But if a doctor is great, I will recommend him or her to everyone I know. I drive three hours one way to stay with a primary care provider I've had for ten years, because she is the best doctor I've ever had, bar none. And who knows how many referrals I've given her--I've lost count!

I remember being a kid on medical coupons, sitting in the waiting room for hours until they got good and ready to see me, even if I had an appointment. That tends to give a person an attitude to begin with (not that I have any shortage of it). I'm sure they still do that every day to poor people, and it makes me furious, but if I start talking about what's wrong with the health care system as a whole, I could be here all day.

A watershed moment for me was when I was sitting on a doctor's table with a broken ankle at the age of sixteen. The bone had not yet been set, and I weighed a great deal less than I do as I write this. This doctor looked at me and told me I needed to lose weight. I snarled as if possessed, "Why don't you set my broken bone first and then we'll talk?" That was the end of my passivity with medical professionals of any stripe.

Let's see. There was the doctor who insisted on giving me a pregnancy test before I was even sexually active, which was highly embarrassing for a kid, but in the shadow of the aforementioned 3 cup sizes in a summer, reason left a lot of people I encountered--male and female. There was the urgent care clinic doctor who griped at me about my weight even though I was just trying to get antibiotics for strep throat and go home. Even my favorite doctor popped off once, saying only "you need to lose weight" before she looked at my chart--I had lost 40 pounds since the previous visit, and I wasn't quiet about it. She never did it again. She has never shined me on about my weight and the problems it can and has caused, but we discuss it like rational human beings. She knows I'm intelligent, I know she's intelligent, there's a two-way street there. (Too many doctors act like you've never looked in a mirror and they are giving you some brand-new insight into yourself, as if a light shone down from above and the angels sang: AAHHHHHHHHHHHHHHH!! You are fat!!! Light bulb!!!!!)

So my favorite doctor recommended gastric-bypass surgery for me when I first started seeing her. I couldn't afford it, and that was my reason for a long time. I had a good job with excellent insurance when I had to have my hysterectomy five years ago, and she suggested I have gastric-bypass surgery done at the same time. I refused; I was just dealing with too much at once, and in retrospect, I still stand by that decision. The recovery from a full abdominal hysterectomy was so long and so difficult for me, even at the young age of 32. I was home for six weeks, and didn't have any stamina at all for about a year. At first, I had to take a nap after walking to the mailbox, I was just so tired.

I knew weight-loss surgery was no walk in the park. I was never going to have gastric-bypass surgery; there were so, so many horror stories. I remember reading once back then that you had a 1 in 4 chance of dying during surgery and a 1 in 4 chance of dying within a year of surgery. I probably misunderstood those numbers (not good odds!), but they scared the stuffing out of me. I knew people that had done the stomach-stapling surgery when I was a kid who had had all kinds of complications. Even five years ago, my understanding was still that they would have to cut you completely open, which is why my doctor suggested that I have it at the same time as the other procedure.

Last year, I had an initial consultation with a sleep doctor who had that tactful technique of so many health professionals I cited above; before we talked about anything else, he blurted out, "You would be a candidate for bariatric surgery." (REALLY? What a shocker. Can I have that in writing?) Annoyed and half-crazed with lack of sleep (my specific sleep issues will play a part later in this blog, to be sure), I feigned patience and told him it was just not in the cards right now, as my current insurance wouldn't cover it, I didn't have five figures in cash lying around, and if I did, I'd pay my student loans off with it. I said something vague about the lap band--that I was looking into it. Needing no further encouragement, he pounced on it like a dime-eyed cat with a catnip mouse.

"Gastric bypass would be better for you," he persisted. "You'd lose more weight in less time."

I don't have a lot of patience to begin with, and what I was faking was completely gone. "Gastric bypass," I replied curtly, "sounds like something some Nazi thought up." I realize that is a rather offensive way to put it, but I was offended, too, and he dropped the subject, which was all I was trying to accomplish.

Gastric bypass, as I understood it at that time, did sound like something some Nazi thought up. Cut a person open, re-route stuff, permanently alter other stuff, it just didn't sound like anything any human being should do to another. It still doesn't sound like the most fun anyone's ever had. I know you can't eat more than a few bites, the food to be thoroughly chewed or it can get stuck, you can throw up a lot, etc. What other people did was their own business, but for me? Never.

Lap band sounded better to me--adjustable, reversible, not so extreme--and I kept reading about other weight-loss surgeries, like the stomach-sleeve gastrectomy. The Realize band started to be advertised on TV a lot recently, and it sounds good. One benefit of dragging my feet all this time is that technology and knowledge keeps improving, and I can continue to learn more and more. There has also been documented medical proof that my weight stays in a certain range despite a number of different eating plans and exercise programs.

How Long Have You Been Fat?

I don't remember not being fat. More precisely, I don't remember not being called fat. Puberty and all its hormones seemed to do a number on me--as it does on everyone, to a greater or lesser extent--but I felt like a science experiment gone awry. 3 cup sizes in one summer, for instance. Men yelling at me out of cars if I wore a shirt that wasn't too big. Boys at school giving me smiles that begged for their mouths to be washed out with soap. It was terrifying to me. There was nowhere to hide. My dearest wish at the time was to be invisible, but between the ages of 12 and 16 felt like the most visible time of my life. I learned to wear baggy clothes, to make jokes, and to grit my teeth.

I lived with one family member who forced me to do situps until I felt sick and ate ice cream in front of me. I was eight years old at the time. I responded by stealing--money to buy food. I learned to hoard food and to stuff myself when I was able to eat, not knowing when I would be allowed to eat again or how much.

Doctors first became involved when I was about thirteen, first to find out if my accelerated cup growth wasn't abnormal. The diets began. Every stupid diet in the '80s, and there were many.

I tried smoking cigarettes to see if that would make me thin. It didn't.

I lived with another family member in my teens who did not allow me to eat with the rest of the family. I had special diet food, most of it frozen and all of it tasteless. He tried to put me on a doctor-supervised diet where I counted calories--1200 a day--and threw a scale at me one day after I got on it at his command and it read 150. It was an old metal scale, and he was a big man, but I ducked and it missed me.

When the bariatric surgeon asked me what my goal weight was two days ago, I said, "180. In my dreams, 150." He told me, matter-of-factly, I could probably weigh 120 after all was said and done, depending on how hard I was willing to work. I don't remember weighing anywhere near 120; it was probably about the fifth grade. I still can't get that number out of my mind; it is like being told, "Oh, yeah. You can go to the moon."

I became bulimic when I was about fifteen. I abused laxatives and diuretics, felt sick all the time, exercised constantly: aerobics, swimming laps, walking. I binged and purged. Calories, fat grams, and numbers on the scale lined my prison walls, and I never got thin. I never even got average. There's nothing quite like starving yourself for days, the loudest sound in the universe the ferocious growl of your echoing stomach. You're dizzy with hunger, and teenage boys are mooing at you anyway.

After about three years, I gave up on bulimia. I had gained 30 or 40 pounds. I was about eighteen years old by this time. I gave up, period, and concentrated on day-to-day survival.

I continued to gain weight through my 20s and 30s. In my 20s, I remember thinking things like, "Well, I'm okay, and if this is as fat as I'm going to get, that's fine." It started to hurt to walk. I couldn't find clothes to fit me without mail order. I didn't care; I was just trying to get through college and find myself in the world. It took me eight years to get a four-year degree. I dropped out four times, but I went back five times. I got the Bachelors degree when I was 28. I started a Masters program a few months later, ten days after marrying my first husband. I dropped out of the Masters after one quarter; it was just not where I wanted to be and I needed to get into the job market.

My first husband and I tried to have a baby, which required fertility drugs because I had PCOS (polycystic ovarian syndrome). With these drugs, I could get pregnant, but not stay pregnant. The body mimics pregnancy on them, so the taker is in for a roller-coaster ride of symptoms. I had an ectopic pregnancy and several miscarriages within a couple of years and was never able to achieve a live birth. I had a myriad of other female problems, including a cancer scare, and ultimately underwent a full abdominal hysterectomy at the age of 32. The first reaction of many people was to say, "Oh, you'll lose weight!" I don't know what planet they were receiving transmissions from or why they thought I even cared about my weight right then, as I was busy grieving, not only the fact that I could never have children, but my eventual divorce and the loss of my closest friend of 25 years. It was hard to find reasons to get out of bed in the morning for a span of time that seemed endless.

My weight never decreased after the hysterectomy. In fact, it shot up another 20 to 40 pounds and has hovered in that range ever since. Once I had my PCOS diagnosis, which came with type II diabetes, high cholesterol, and sleep apnea, I changed my diet drastically--for the better. I did more aerobics, used a treadmill, swam laps, bought a recumbent stationery bicycle. There were times I could lose as much as forty or fifty pounds, but it would not stay off for more than a few months.

I met and married my second husband at the highest weight I have ever been. He sees the person I am, having been blessed with that all-too-rare gift of knowing that people are who they are on the inside--a concept many pay lip service to, but do not really practice. He is an average-size person who is horrified by the actions and comments of other people regarding my weight, many of them strangers. He has seen me struggle, feel physically crappy all the time, and try to sleep normally or even find a comfortable seated position. He has heard me say "I shouldn't eat that" more times than he can count--several times a week. He sits across from me in restaurants; he will order fries and a milkshake, I will order a salad and water. He has seen me struggle with depression when I have so many reasons to be content. He is one of them.

It was not his idea for me to pursue bariatric surgery; I was dead-set against bariatric surgery for many years, but have researched it all along, because I believe in knowing what I'm arguing about. He would like me to live a long time and to be around so we can be together, and he supports whatever I choose. He is the cook in our house, and for the past two years, I have eaten better food than I have ever eaten. Fresh, organic, the works. It has affected my weight not at all.

I recently turned forty. The thing that distressed me about the number 40 was not vanity or the loss of youth--I never really felt young--but the notion that our time on this Earth is limited and I would like to enjoy whatever is left of mine a lot more than I am.

That's how long I have been fat. That's why I am doing this.

Only the Beginning

I recently started the process as a serious candidate for bariatric surgery and it seemed like a good framework to begin a blog. I am going through health insurance to do this, so it is an involved process requiring years of documentation, a physician-supervised and monitored diet and exercise program, a psychological evaluation, and more. People I know have many questions about how it works, what the timelines are, and just about every other imaginable aspect of it, and that I thought perhaps a blog would be the way to go. So I'm giving it a try.

My intention is not to write Only Specifically a Bariatric Surgery Blog, or The Definitive Bariatric Surgery Blog, and I hope that isn't all this one is going to be or sound like. I would like to believe that just about everything about me as a human being and what I have to say is more important than my Body Mass Index. A complicated series of events that took place over decades brought me here, and are only one part of the story, as they are for most people in my current position.

Considering bariatric surgery is a more complicated and involved process than one might imagine who hasn't had the need to investigate it completely. It's not an easy cure or way out, not a magic bullet, as many people with an opinion but not education regarding the topic seem to believe. (I have been researching this topic for about ten years and I learn something new about it every day, in part because it is always changing.) Bariatric surgery is one optional tool to help the obese people who choose to have it manage their weight and health in coordination with healthy lifestyle changes in diet and exercise. It is not an easy thing to decide to have, maintain properly once it has happened, and for many, it is not an easy thing to pay for. There is no guarantee that it will be effective, though it has worked for many people.

I am not going to talk about whether this surgery is right or wrong. Its inherent risks are well-documented and the choice to have or not have this surgery is up to the individual. If you believe bariatric surgery is a cop-out, I very much doubt I can change your mind. (My own mind tends to change when I decide it changes, and not a moment sooner.) Most people who reach the point of having bariatric surgery feel that they have tried every possible measure, both healthy and unhealthy, to lose weight--and I count myself among them. Diets, exercise programs, medications, eating disorders, drinks and pills and bars that taste like cardboard coated in flavor-free goo but that just might be full of that all-important protein are a regular part of our lives, along with the conflict that goes into every bite we take or even think about taking. The world at large feels entitled to have a opinion about our bodies--not just our own families and friends, but doctors, adult strangers, even children we've never laid eyes on before. We cannot go anywhere without thinking, am I going to fit in the seats there? We can't put on our walking shoes without thinking, Is some guy going to yell names at me out of the car today? Before we grocery shop, we wonder how many people are going to stare at what's in our cart this time. We try to be ready for any comment some nimrod throws our way, but the nimrods of Earth come up with some real lulus, usually when you're in a good mood, having managed to forget for a few minutes that you're fat and that your very presence offends the world. Contrary to popular belief, we didn't all get this way from sitting at home eating cheeseburger after cheeseburger. As my husband--whose weighs approximately half what I do--is fond of pointing out, "We have the same diet."

I begin this blog today with the hope of documenting my journey to a healthier life with more purpose. When they asked me why I wanted this surgery, I said, "To feel better." That pretty much says it all.