the post-op life: things i wish i knew beforehand

This is going to be another long one.

What I'm talking about today are the things I wish I knew, or knew more about, before I had weight loss surgery. I don't mean that I regret having done it--I think it's one of the best things I've ever done for myself.  What is mean is that there are things I didn't know ahead of time that I had to figure out all on my own, either because I didn't think to ask the doctor or it just wasn't part of my pre-op program (every weight loss surgery program is different, which is pretty frustrating and confusing sometimes), or I knew and didn't think it would be a big deal. So, I've thought about it and here's my list of things I wish I knew (or knew more about):


Physical complications are drastically different from person to person, and are sometimes non-existent.

Physical complications or issues can cover a large range of things, such as:  getting certain foods stuck, either because they're dry (like chicken or turkey), or you took too big of a bite, or didn't chew well enough; being unable to eat certain foods because they get stuck, don't digest well, upset the new stomach, or cause reactive hypoglycemia or dumping syndrome; anemia; vitamin deficiencies; excessive hair loss; excessive weight loss (meaning a person is underweight); strictures; ulcers; and other complications.

I'd heard horror stories, both in person and in online forums, from a lot of people about how they can't eat certain foods anymore, like raw veggies, or most meats, or they throw up after every meal. I was nervous going into surgery and truly worried I'd never be able to have steak again. While that can be true for a lot of people, I am one of the lucky ones in that I have virtually no physical/food issues. I've never had food get stuck, there are no foods that upset my stomach, and I don't have any ulcers. I'm sensitive to sugar, just like other gastric bypass patients, but I manage it and am careful to check labels. I don't count that as a "complication," as it's something that is universal for people that have had gastric bypass. Also, I've finally figured out, after almost five years, that I get blood sugar drops when I eat carbs like crackers, Chex Mix, chips, and things like that without eating some protein along side of it. The simple solution is that I either avoid those foods, or I add some protein if I do have them. They're really not foods I need to be eating anyway so I try to limit them, but I've said before that I choose to eat whatever I want as long as it's in moderation. I don't tell myself that I'm "not allowed" to have something, because that just makes me want it more. (The one thing I avoid, though, is soda. I don't ever want to get back into the habit of drinking six cans of diet soda per day.) Sometimes I get acid reflux, but I've figured out that as long as I don't eat close to bedtime, and I limit spicy foods, I don't get it. Again, I don't consider this a "complication," since most people who get reflux, regardless of whether they've had weight loss surgery, have to manage it.


The psychological part is usually much more difficult than any physical complication. 

This was especially true for me. When it comes to the physical part, I feel it was a breeze for me, and it still is. The psychological part, though, is so hard, even after almost five years. It's much better now than it was the first year, but I still struggle with the disappointment of not being able to finish my meal (that sounds ridiculous now that I see it in writing), as I'm someone who lives to eat, rather than eats to live. I wish that changed after surgery, but it didn't.

Although doctors talk about this and how WLS patients need to learn to cope with their emotions without food, learn new habits, think about food differently, etc., I don't feel that doctors do nearly enough to truly help someone to prepare for the reality. Yes, it's on the patient to actually do these things and take the initiative, but part of that is just knowing that these things need to be dealt with. I think more counseling beforehand, and required counseling after surgery, is needed. Obviously I can only speak to the program I went through since every doctor is different, but I can definitely say that I was nowhere near prepared for the psychological part of WLS. I was required to go to only three counseling appointments before surgery, and nothing afterwards. Also, support groups are sometimes lacking. The hospital had a regular support group, but the discussion was dominated by the same two people every month, so I stopped going; I really didn't get anything out of it. My doctor's office had a support group when they felt like it, which I liked, but it wasn't held with any regularity. And those same two people were patients of my doctor, so they went to this same group and again dominated the discussions.

Also, eating will be different. Very different.

I'm not talking about portions, really, but the psychological aspect of it. Before surgery, eating and food was: a job to be completed ("I bought this package of cookies and my job is to eat them all until they're gone"); comfort; happiness; reward; something to do and a fun activity; love; or companionship. After surgery, it's supposed to be a source of survival and we're supposed to find all those things, like comfort, reward, etc. from other things. Often, though, it's just not that simple. For some it is, but not for me. I spent many, many years seeing food as all those things I mentioned. It wasn't easy to have to look at it as simply a means for survival and nourishment. It was so, so hard in the very beginning to take some food and then be full after three bites. Eventually I could eat more--I can now finish half a hamburger and a couple fries, or eat about five ounces of meat--but even after all this time, the act of eating still feels incomplete. The only time I don't feel that way is when I'm actually able to finish my portion, and that only happens when I have a yogurt, or onion soup, and things like that. It's so frustrating and disappointing--STILL, after almost five years!--to sit down to a meal, start to really enjoy it, and then BOOM I'm full. I can slow down, of course, but years of scarfing my food down are hard to undo. This is something I wish someone told me. I wouldn't have decided against surgery, but I would have started BEFORE surgery trying to get comfort or reward in other ways so it wouldn't be so damn hard afterwards.


Once you lose the weight, you'll need to work just as hard as everyone else to maintain it, if not harder.

OK, this one I pretty much assumed, but I didn't realize how much harder it would be than what I originally thought--and this really applies to anyone losing weight, regardless of the method.  Also, I'm including it because I've come across many people who don't realize this when they start talking about having weight loss surgery.  They think it's a magic wand that solves all their eating and weight issues, that they'll never have to work again at losing weight and that the weight will just magically stay off. I've overhead people say, "I'll just get weight loss surgery. It's so much easier and I won't have to work so hard."  Oh, and that they'll get to their goal with no effort. Not true. Well, let's restate that:  it's not true once you're out of the "honeymoon phase." The honeymoon phase is that fabulous first six months (could be longer, but usually about six months) where the weight just melts off with seemingly no effort on your part. You don't exercise? No problem, the weight still comes off. You have a binge day (considerably different than pre-WLS!)? You'll probably still lose a pound or two that week. It's fabulous; you can do no wrong...and that lulls you into a false sense of security and makes you think you'll never have to truly work at it. And then when you truly DO have to work at it, it makes it that much harder to change your mindset. So, losing it is hard, but keeping it off is so much harder.


Having weight loss surgery isn't going to magically turn you into a workout maniac or give you an endless supply of energy.

Yes, lots of people who lose weight, through any means, turn into people who just LOVE to workout and are always going going going; those people really annoy me. Deeply. But if varies from person to person.

So, energy. If you were naturally a low-energy person before weight loss, chances are you'll continue to be a low-energy person afterwards. I would say I had a lot of energy the first year and maybe the second year, too. I think it was because I felt a lot lighter and no longer had to carry around 130 extra pounds. After that, though, I slowed down closer to what I was before surgery. While I no longer feel lethargic and unmotivated--a total slug--like I did before I lost the weight, it does take an effort for me to get myself going sometimes.

In terms of working out, I did not become someone who loves working out and finds every opportunity to do so. It took me until March of 2016, so about 2.5 years, to finally seriously think about exercise.  For 2.5 years it was something that I knew I should do, but I'd lost the weight, so why did I need to do it? I was looking at exercise as a means for further weight loss, not what it actually is:  a means to a healthier, stronger body. Part of what got me seriously thinking about it is that I'd regained about 29 pounds. The other part is that I wanted to get the excess skin removed, which meant I needed to be at my lowest weight possible. I tried a few times to start on my own; however, the only thing that finally got me doing it was to go to a personal trainer. Yes, it's expensive, but there was a Groupon offered for the studio, which gave me five sessions for $100.00, which is insanely cheap. I then signed up to go twice a week (working out three days on my own), and then eventually cut down to once a week (working out four days on my own) once the trainer felt I'd be able to stick with it. It took me two years, but I'm finally at the point where I never miss working out unless I'm sick, in pain, or on vacation (and even then I try to work out at the hotel or wherever I am). That's partially because it's a waste of money to pay a trainer and not work out on my own the other days of the week; you're not going to get very far if you workout once a week. Plus I feel guilty if I skip for no good reason, and I typically don't do that. Also, my trainer knows if I haven't been working out as much as I should. He can tell what I'm doing at home, and how often, based on how I do when he sees me each week. He notices when I'm struggling, or when the things he has me do seem easy for me. Without that accountability, I wouldn't stick with it. I posted  a lot more about it a couple weeks ago. So, yeah, even though I've lost 130+ pounds and have been working out five days a week for two years, I totally have to drag my ass into the gym most days.


Just because you have a tiny stomach after surgery, doesn't mean you can't gain the weight back.

I kind of knew this one, too, and it was only from reading WLS forums online, but maybe not to the extent I should have known.  The doctor mentioned being careful about weight gain, but never said, "Hey, you can still eat six slices of pizza as long as you space them out."

I've heard from lots of people, both people who are considering WLS and those who are simply talking with me about my own surgery. So many people think that tiny stomach=no possible way to overeat. That's true--partially. It's true that it's difficult to overeat in one sitting in a way that you would start to regain the weight. BUT--and it's a big one--all that means is your physical capacity to overeat is limited in ONE sitting. If you order a cheeseburger and eat half now, you'll very likely be able to finish that cheeseburger an hour or two later (timing varies a lot from person to person), then go back in another hour and eat something else, and so on. That could add up to MANY sittings per day. And what you eat matters, too. If you eat a 1/2 cup of cottage cheese, that's about 80 calories and you're full. But if you eat a muffin, that's often anywhere from 300 calories to upwards of 600 calories depending on how big it is. You're still full, but it's way more calories than you should be eating in one meal. (Actually, that's about 1/3 to 1/2 the day's calories for some WLS post-ops.)  So, if you're going back to eat something every hour or two, and it's something loaded with calories, you can very easily gain the weight back. That's why drinking water when you're not eating is important--it keeps you from feeling hungry. Plus, everyone needs water.

Hopefully you've managed to read this far down. If you've made it, thank you! I really wish I knew if anyone who reads my blog wants to have WLS, or has had it. If so and you want to ask me anything, go right ahead. I'm pretty much an open book.