A big milestone: 100lbs

I reached a big milestone last week: I’ve now lost over 100 pounds. It’s been about 1 year and 4 months since I started on this journey, and it’s been nothing short of amazing. I continue to get periodic adjustments to my lap-band. I can definitely say it’s working as designed.

I could make a long list of health-related problems that have either disappeared or been greatly reduced, but the best part about the weight loss has been the improvements to sleep. (Miraculously, I’m able to wake-up feeling like I’ve actually slept.) I rarely fall asleep during the day anymore! Words cannot describe how much better I feel due to the improved sleep alone.

My sleep apnea has not been “cured,” however. According to my BiPAP and oximetry data, I still do have notable episodes of apnea while I sleep. So I still need to use my BiPAP, and I’d say there’s still some room for improvement. True, I’m awake during the day, and not sleepy, but I don’t feel quite as alert and “on the ball” as I think I could be. So I’m still working with a sleep doctor and taking measures to reduce my apnea even further.

In short, my apnea has gone from out-of-control to manageable. My quality of life is remarkably better now for just that reason.

1 year after Lap-band surgery

Today marks one year since I had lap-band surgery. Wow… so much has changed.

I don’t like to place too much emphasis on the exact weight lost; it was never about the number of pounds, but more about my health. But for general reference, I peaked at about 348 pounds in 2008. Let’s just say I’ve lost more than 90 pounds, and not yet 100. I updated my little graph… see for yourself.

The scars have healed quite nicely. I don’t even see them in the mirror unless I’m looking for them. (Having a little bit of belly hair has helped, too.)

Since the surgery, my taste in food has changed somewhat. I used to love fried food. One of my favorite things was a big ol’ cheeseburger with a giant pile of fries. But it just doesn’t have the same allure anymore… I don’t crave that kind of thing these days. I used to eat a lot of bread. Now I can only eat a little bit of bread. (No more bagels, thick sandwiches or buns). I thought I’d really miss it but it hasn’t been a problem at all.

Conversely, I didn’t used to have a sweet tooth… but I now have fairly regular cravings for chocolate. I’m told that after weight loss surgery, many people do experience a shift in their food preferences, but they vary by individual. I guess the important thing is to be aware of these kinds of shifts so you can make the best decisions.

There have been a few downsides. Ok, so I have some excess skin. I’m more gassy than I used to be. And I have to be careful not to eat too fast or too much or I’ll vomit. (Thankfully this has only happened to me twice… hopefully I’ve learned my lesson!)

All of this is a very small price to pay for the benefits. I’m not complaining in the slightest!

Now please allow me to celebrate some victories:

• Last week I fit into a front seat on the "Scream" coaster at Magic Mountain without even trying. (I didn’t even have to use the "big boy" seat. Just last year, I didn’t even fit on the ride at all.)
• I easily fit into my size 38 jeans again. (At my heaviest I wore a size 46.)
• My triglycerides and HDL have gotten a lot better. (They’re not perfect. But they are better.)
• I feel more upbeat these days. I think I’ve been smiling more.

By far the biggest benefit has been the improvements in sleep. Consider:

• Since the surgery I have missed zero work due to daytime sleepiness.
• On the Epworth Sleepiness Index, I jumped from a 14 to a 4.
• I’m sleeping 6, 7 even 8 hours straight through the night, with no tossing and turning.
• When I wake-up, I no longer feel like I’ve been hit by a truck. I feel like I’ve actually slept.
• I don’t get sleepy during the day anymore.

I still have sleep apnea but now it’s manageable. I may always need my CPAP. And you know what? I’m ok with that.

Contrast all this with where I was in 2008:

I’m drained. I’m not motivated. I’m sleepy. My head is fuzzy. I’m moody. I can’t get anything done.

I’ve managed to keep it somewhat hidden from the view of my friends… usually I accomplish this by staying in my cave when it’s really bad. And I’m usually pretty good at putting-on the brave face.

(For a little history, you can read my original lament here, or follow the whole, chronological tale here.)

I’m still paying the bill for the procedure. I’m on a monthly payment plan, and it’ll take another 2 years to pay it off. But it has been completely worth it. My only regret is not doing it sooner.

If you’re considering having weight loss surgery, definitely talk to a doctor. Find out if you’re a candidate. Learn more about it. Make sure you know what you’re getting into.

The lap-band surgery doesn’t always work for everyone:

• Some people don’t lose as much weight as they want to.
• Some people have vomiting problems.
• Some people gain the weight back. (There are ways to cheat the band.)

Some people say that before getting the surgery, you need to change your relationship with food. Others say that the surgery changes it for you. The truth is, it’s a little of both. (As the doctor said repeatedly: the lap-band is a tool, not a cure.)

Even with the lap-band, I still face daily choices about what I eat, and I must make time for physical activity. Not long ago, the mere thought of exercise made me cringe. But now I actually have the energy to do it. A 30-minute walk is now easy for me.

I’ll let you in on a little secret. Since the surgery I haven’t spent a single moment in a gym. Instead I’ve been doing other types of activity: walking, biking, even occasional yoga, kayaking or a volleyball game. (Of course, it helps that I live in a city where I can enjoy these things year-round.)

Whenever I can, I try to bike or walk with a purpose. Whether it’s a trip the grocery store, the dry cleaners, or a restaurant, it makes it feel less like a chore if I have a destination. (Also, thank goodness for iTunes.)

I look back and I’m amazed at the progress that I’ve made. I once wondered if I’d ever be able to escape the vicious cycle of weight loss (every time I lost weight, I’d gain it all back… and then some.) The surgery seems to have been the vital catalyst that allowed me to achieve escape velocity.

Miraculous? Yes. But the surgery is no magic bullet, and it’s not a free pass. It still requires work. I’m still learning every day.

And now comes the hard part (the Mormons like to call it "enduring to the end.") There’s still more work to be tackled, more choices to be made every day.

In the meantime, Mikey’s got his bounce back.

My scars: 8 months after lap-band surgery

The scars from my surgery are healing-up quite nicely.

Click above or here.

So here’s my little report card. It shows, at a glance, how I’m doing since having my lap-band surgery 6 months ago.

The biggest news here is my progress on the Epworth Sleepiness Index. This is a number that helps the doctor know the severity of daytime sleepiness. I leaped from a 14 to a 5… which is simply amazing… and much better than I’d hoped. I no longer require daytime naps… and I haven’t missed work due to tiredness.

Even though I didn’t meet my full goal for O2 desat levels, I’ve done really well! So exciting. I’d like to do a little better, but this is just awesome.

A new BiPAP mask (a full-face model that actually fits me, thank you!) has made a big difference for me as well. Hence the nearly perfect score for BiPAP leak rate.

My triglycerides and HDL have improved as well. As my friend Nick says, there’s only so much you can do about them. (Still, I’d like to improve my score a bit more.)

I wasn’t able to find numbers for blood pressure and neck size, but my blood pressure’s always been good. I think my neck size has gone from about 21-ish to 18-ish. (Reducing neck size is important because it correlates to a more open airway… allowing more oxygen to flow, and decreasing sleep apnea.)

I’ve taken all of my vitamins and supplements every day, and I have not had any caffeine or soda since the surgery. (At first I missed my Diet Pepsi, but I honestly don’t miss it anymore.)

My Apnea/Hypopnea Index (AHI) has improved significantly, which I’m happy about. The doctor says a number under 5 is considered normal… woah. But I want to do even better. I think that with a little work, and maybe some tweaking of my BiPAP settings, I can do it.

During all of this, I have not had a single complication. I’ve never vomited. I’ve had my lap-band filled twice without incident. I barely even know it’s in there.

Now comes the hard part… being persistent, and continuing to get at least 30 to 45 minutes of physical activity every day. (As you can see, my daily compliance was umm, pretty good, but not great. But I have plans up my sleeve!)

Overall, I’m VERY happy with my progress. I only wish I’d done it sooner!

Click above or here.

I’m now past the 6-month mark since my lap-band surgery. Things are going really well!

This chart shows my weight. It doesn’t have any numbers on it because I don’t really give a fuck about how much I weigh. Suffice to say that in terms of weight lost, I’ve safely passed the 75lb mark, most of it in the first few months after surgery. (The notch mark for 2008 represents the middle of the year.)

I’m happy to report that my health is getting much, much better, and most importantly, my sleep apnea is becoming more and more manageable.

Have I “arrived?” Not yet. But I’ve made tremendous progress and I’m sooo happy with the results.

Some recent pics, and an update on my health

I feel a bit self-conscious doing this, but several folks asked me to post some recent “post-surgery” pictures.

I didn’t want to do anything cheesy and I really dislike the idea of a before/after thing. Just kinda lame.

Anyways, so above are some recent pics of me. (Taken by friends Rob, JP and Wayne.)

I dunno, I guess if you want to see a “before” shot, there’s one here.

In three and a half months I’ve dropped over 70 lbs, gone from a 4XL to a 2XL shirt, and from a size 44 (sometimes 46) pants to a size 40. (I can actually wear my 38 jeans but they fit very snugly.)

I’ve been walking or biking every day, and occasionally mixing-in other stuff. Over the next few weeks, it’ll include hiking, kayaking and volleyball.

The weight loss has leveled-off a bit, so now comes the next phase: the goal is to lose about 2-3 lbs a month for the next year.

Meanwhile, my sleep continues to improve, though perhaps more slowly than I’d hoped. I’m definitely over the first “hump” and able to sleep soundly throughout the night. I’m also happy to report that I am alert enough to work a full 40 hours per week at work again. WHEW. But oximeter readings indicate that my blood oxygen is still low and I’m still having some daytime sleepiness. This means I need to keep using my BiPAP*; and I’m working with a sleep specialist to keep finding ways to manage my apnea better.

Things took a giant leap forward when I started using a new BiPAP mask: the Respironics ComfortFull 2. It’s practically a perfect fit… my numbers indicate an amazingly low leak rate every single night since I got it. It’s comfortable, and I don’t get air blasting in my eyes. (This, after experimenting with at least a dozen different kinds of masks over the last few years. Yay!)

So that’s one problem solved. Now onto the next one: getting the right BiPAP pressure settings. I got a new BiPAP machine, it’s smaller and has some nifty electronic reporting features that should give us some clues. Right now the BiPAP pressure is set to 20/16. I told the doctor that I thought 16 was too high, because I couldn’t exhale completely before the BiPAP started making me breathe-in again. He looked at my last sleep study and agreed that my oxygen levels looked better at 20/14. So we’ve adjusted the machine, and we’re tinkering with a few other settings that it has (ramp, cycle, min/max breath time, etc.) to get things better.

So things are progressing!

*A BiPAP is just like a CPAP, only it has two levels of air pressure: one for inhalation, and another (lower one) for exhalation.

Scars, 4 weeks after surgery

They’re healing quickly. (For reference, here are the scars about 1 week after surgery.)

Thanks again to everyone for your encouraging comments and e-mails!

Life = good

Today I’ve noticed a lot of good things are happening for me, healthwise!

• I now have a bunch of clothes that are too big for me. Pants, shirts, belts. Yay!
• The incisions are healing faster than expected. (Pic coming soon.)
• I am getting a good seal on my new CPAP mask… last night I had one of the lowest leak rates yet.
• My energy level is climbing, slowly but surely.
• My feet always used to be kinda puffy. They’re not anymore.
• My left eye used to twitch a lot. The doctor says it was a side effect of the Provigil. I’m not taking it anymore, and the twitch is gone.
• Several folks have commented that my eyes don’t look as baggy anymore.
• I’ve been 100% compliant with my daily supplements, in attending the nutrition support group, and in getting 30 minutes of activity every single day. (Mostly walking, some biking.)
• Remember that sinus surgery I had last year? I actually have been reaping the benefits (finally!) over the last several months. I can breathe freely through my nose now. Not just sometimes, but every single day, and every single night. Which is making the CPAP therapy more effective.

I still have a long way to go, but things are improving even faster than I expected. Yay!

You may have noticed that I’ve not been focusing on my weight (as a number). I don’t think the number is a good way to measure one’s health. However, I suppose it would be good to give a rough idea of how much progress I’ve made; let’s just say I’ll easily surpass the 50lb mark by mid-June.

And I haven’t felt like I’ve been depriving myself of food at all. A small serving of food tames my tummy with no problem.

By the way, I finally did receive a letter from the insurance company, in which they let me know the denial was upheld. I’m not really surprised, and, as I’ve mentioned previously, I don’t blame them. (It was never a question as to whether the procedure was medically necessary; the fact is, the procedure is simply not available through my particular coverage plan.) Ah well, it was worth a shot.

Life = good.

A quick update

It’s been two weeks since the surgery and I’m feeling fine. I’ve had zero pain since the second day after the procedure. I’ve lost weight and my sleep has already improved somewhat. Between that and quitting one of my prescription medications beforehand, I can now sleep about six hours every night with pretty-good consistency. Also, if I wake-up too early, I’m actually able to fall back asleep some of the time now… something I hadn’t been able to do for several years.

I’m still having some daytime sleepiness. It’s hard to know if this is due to insufficient sleep, or insufficient calorie intake. The doctor warned that during the first month or two, there’s a chance of some lethargic tendencies, but this was normal and will eventually go away. In the meantime I just need to follow the prescribed eating plan and make sure I take the vitamins and supplements. Pretty easy.

For the first few weeks, I was only allowed to have a few types of food (water, Propel, broth, sugar-free jello, sugar-free Popsicles, etc.) Soon after, I worked my way up to soupy foods (Cream O’ Wheat, creamy soups etc.) and now I’m up to mushy foods (soft cheese, oatmeal, pureed meats and fruits.) Everything has to be moist and soft or mushy for now. Pretty-soon I’ll actually be able to eat things that can actually be chewed.

I’ve had my first post-operative follow-up and everything looks good. In about three more weeks I’ll have my first Lap-Band “fill.”

I’ve been cleared to drive, and given the green-light to ramp my physical activity back up. So I’m doing 30 minutes of activity every day again now. So far it’s been mostly walking. I’ll introduce biking again soon, then start going to a monthly exercise class, which the doctor requires us to attend. I have some ideas for other stuff, too.

I was just thinking about some of the pleasant “side effects” today:

• I’ll be able to buy clothes at regular clothing stores, instead of just Casual Male XL.
• I’ll be able to fit on some of the roller coasters that I couldn’t fit into before.
• Many asthma sufferers report improvement after weight-loss surgery, and I have mild asthma.
• This may sound weird, but I’m already spending a lot less time sitting on the toilet. (Sorry for the TMI.)
• I’m obviously spending a lot less money on food.

MANY thanks to everyone for your well-wishes. I am really trying to catch-up on all your e-mails… please be patient with me!

So far, things really haven’t been difficult at all. And finally I wake-up feeling like I actually slept (instead of feeling like I’ve been hit by a truck.) I still have a long way to go. But I’m seeing improvement already.

Why weight-loss surgery is more effective than lifestyle changes

One more chart.