Author: Richard Albistegui-DuBois

Had my surgery this morning around 9:30. Woke up in recovery somewhere around 12:30, groggy, and slowly came back to my senses. I’m now in my hospital room. So far, everything has gone pretty well. I have some achy discomfort around the incisions, but it’s easily bearable. Pretty sleepy, though (only got about 5 hours of sleep last night). Will rest.

Pre-op day almost complete. I’ve had nothing but clear fluids today. Took the milk of magnesia this morning; didn’t notice a vast amount of extra poop, so I assume I didn’t have much in there to begin with. Got everything packed, all arrangements made. Even shaved. I haven’t seen my chin in more than 20 years; my kids laughed for a solid 20 seconds.

Only thing left to do is shower and use the antiseptic wipes.

All systems go for tomorrow. Feeling pretty good, a bit anxious. Next post with a new digestive system!

I had my preoperative appointment today down at Scripps Mercy. It was simple: a weight check, confirming all medications I currently take, getting a baseline for my pulmonary function, and giving me info I need for the surgery and aftercare.

I am told that the day before surgery should be a completely clear liquid diet (even broth would need to be strained), and preferably nothing red (as that might look to the doctor like bleeding during the surgery). My surgery is on the morning of January 3; I should have nothing at all by mouth, not even water, starting at midnight before the surgery. The night before, I can take a shower, and then should use chlorhexidine (antiseptic) wipes over my whole body. The morning of the surgery, no shower, but use the wip[es again. And no deodorant after either shower (which makes me feel sad for the folks in the operating room).

I can assume I’ll be in the hospital for three days after surgery, though I am told by others that I might be out after two. While in the hospital, I should be up and walking as much as I can manage (minimizes chance of blood clots, which are the biggest post-surgical risk), and I should use the incentive spirometer to exercise my lungs and minimize chances of pneumonia. It’s a funny gadget which measures both rate and volume of exhaled air; you’re supposed to breathe in slowly but continuously, with the aim of inhaling 2500 mL of air. That’s not a problem right now; typical inspiratory capacity of a person my size is about 3500 mL, and my lung function is good…plus I have vocal music training. Post-surgery, I am supposed to do that 10 times per hour if possible, which seems like a lot, but is easy enough.

I’m feeling excited. I suspect I have some anxiety about it too, but I tend to keep my anxieties subconscious, so I’m not noticing it much on the surface. If this works, I will (hopefully) finally have a good way of making my interactions with food a much more reasonable part of my life.

My surgery is scheduled for three weeks from today.

My main challenge right now is staying with the pre-surgical dietary program. My surgeon recommended replacing 1-2 meals per day with the high-protein shakes I will be relying on post-surgery. However,  I’m finding that the Premier Protein shakes aren’t sitting well with me; they’re nauseatingly sweet (and I *like* sweet!) and leave me feeling icky for hours. My wife found some only-slightly-sweetened whey protein powder which I can flavor on my own which carries a comparable amount of protein, so maybe that will be easier.

However, eating compulsions are still a thing with me, and that has me worried. From what I have read, many–but not all–bypass recipients have significant reductions in cravings and compulsions. I am hoping I’ll be one of those; if not, then following the post-surgery diet strictly will be a challenge. I do understand that the surgery is not magic; it’s a help for undertaking a major lifestyle change, and that the real driver of success will be my own will. I will continue to fight. 🙂

I’m looking forward to the surgery.

I’m not really worried about the surgery itself. From what I’ve read, this is one of the safest significant surgeries, and the risks of diabetes and obesity are significantly greater than the risks of the surgery. The fact that Kaiser pays the full cost (at least on my plan) also suggests that they feel that the overall risk/benefit ratio is heavily in favor of the surgery.

My main concern is willpower. My relationship with food is not very healthy; I eat somewhat compulsively, for emotional comfort and out of boredom. There have been times when I have felt as though it is really not under my control–I have found myself snacking, knowing I should stop, *wanting* to stop, and yet continuing to eat. I’ve spoken to a therapist about it, and I have had success in controlling it for extended periods before…but not long term. Of course, my understanding is that this surgery is meant to help with exactly that problem. Still, long-term success here is going to be absolutely dependent on strict control while establishing a newer, healthy relationship to eating.

That’s one of the reasons I chose the bypass versus the sleeve (the other being its better effects on diabetes). The bigger restriction on stomach volume and the tendency to produce unpleasant side effects when one overeats will (I hope) provide some reinforcement to my learning a new relationship with food.

I mentioned some of this to the psychiatrist I saw as part of the preoperative screening. I explained that I was trying to find a different source of emotional comfort, to replace eating when I am stressed. Interestingly, she said that many people find that that’s less of a concern than they thought; that one of the effects of the surgery is a change in psychological relationship to food. It has deep and profound (and not yet fully understood) effects on appetite, probably via changes in hunger and satiety hormones, among other things. I’ve heard a few similar stories from people who have had this surgery–that they no longer have all the same cravings. I sure hope that’s true.

But of course, food has a much bigger role in our lives than that. It’s a huge social factor; eating together is one of the biggest (and, as far as I can tell, most universal) ways we bond. The advent of hugely individualized dietary restrictions has become a source of humor, and I think it’s partially due to its impact on this fundamental social ritual. Offering one’s guests food is a very deep and basic part of hospitality; how does one do so when this person is on the paleo diet, this person is gluten free, this one is vegan, and this one is on a fifteen day juice cleanse? It’s humorous, and stressful for anyone who has tried to feed a group.
I really don’t want to be one of those people, but after this surgery, I’m going to have some pretty strict dietary limitations. I am worried about finding a way not to be a burden on gatherings. I am fortunate enough to have a super-supportive wife, kids, and immediate family, which will help.

I was contacted by Dr. Rumsey’s office today to schedule my surgery. The soonest they could give me was January 3, at 9:00 am…so that’s what it will be. In case anyone is in a Kaiser class and wondering how long they need to wait, that’s 12 weeks after the last class. I was hoping to schedule it in mid-to-late December so that most of my recovery could happen before my job resumed after the winter break, but it is not to be. Fortunately, my work is extremely accommodating.

I am to eat nothing but clear fluids the day before (but drink lots of water), and nothing at all after midnight.

From what I understand, there’s a reasonably good chance I will be able to leave the hospital on the second day after surgery (January 5), but that’s certainly not guaranteed. In the class, we were told to expect to wait *at least* two weeks before returning to work. Given that my job involves sitting at a desk or walking to meetings, I figure I’ll probably be able to return to it pretty soon. My colleagues have agreed to cover my job through the 16th (and can do more if it’s needed), and I have enough sick days that I should still be paid. My impression is that I can claim disability during this time, but I’d rather not do that if I can avoid it. I’m lucky enough to have a job which allows sick leave; I should use that.

I’m excited about this!

My doctor mentioned the idea of bariatric surgery about two years ago. At the time, I felt that I wasn’t interested in such a radical solution, hoping to eventually manage to lose weight by willpower. However, shortly thereafter I got my diabetes diagnosis, which made me decide that I needed to consider all possibilities. I did some reading about the risks and benefits of bariatric surgery. In May, I began Kaiser Permanente’s OPTIONS program, which is a six-month educational program to prepare for bariatric surgery. It provided an excellent and thorough set of information, and I decided that the surgery was probably the best option for me.

The educational program completed on October 11. On October 24, Kaiser had me give blood for a wide variety of labs (all came out OK). In my area, Kaiser works through Pacific Bariatric, a group of highly experienced surgeons who specialize in bariatric surgery, and who are based at Scripps Mercy hospital. Kaiser patients can either be referred to a Kaiser surgeon working with them, or to one of their own surgeon, and this has a small effect on the next step. Kaiser’s surgeons only require a visit with the surgeon, who determines whether the patient is a good candidate for surgery, which surgery would be best, and any preconditions for approval. Pacific Bariatric requires visits with a psychiatrist (to ensure the patient is capable of understanding the surgery and following the post-surgery requirements), an internal medicine doctor (to provide a thorough checkup and review labs), and the surgeon (to assess for suitability for surgery, provide info, and approve surgery or not).

I was referred to Dr. Rumsey, who is one of the Pacific Bariatric surgeons, and so on November 20 I saw all three of these doctors. All the appointments went well–in fact, all three agreed that I was an ideal candidate for the surgery. Dr. Rumsey strongly recommended the Roux-en-Y bypass, as opposed to the sleeve gastrectomy, due to its better rate of putting diabetes into remission. I’m now waiting on Pacific Bariatric to put together the reports from the three doctors (no, not THOSE three Doctors, Whovians), at which point they should schedule the preoperative appointment and date for surgery. I’m hoping for December 21, as that will be optimal with my work schedule.

I’m Richard Albistegui-DuBois. I’m a 44-year-old cisgendered man, an academic (I teach human physiology at Palomar College), married for 22 years, two teenage sons. I live in north San Diego county. I’m planning on undergoing a Roux-en-Y gastric bypass surgery this December.

Health info: as of today, I am 5’11” and 300 pounds clothed. That puts me well into serious obesity, in BMI terms. I’ve struggled with being overweight for much of my life, at least since late adolescence. I’ve had two significant attempts at weight loss. About ten years ago, I went from about 283 to about 198 pounds over six months or so through a sustained effort of careful calorie counting and regular exercise (mostly long walking, hiking, and some biking). I felt great…and then came Christmas. Between my sweet tooth, the easy availability of candy, and the social pressure to eat, I completely fell off the wagon, and gained all the weight back over the next year or so. I tried again about a year and a half ago, after being diagnosed with depression and prescribed bupropion, I lost about 40 pounds using the same methods…and gained it back the same way. Curse you, holidays! Since then, I’ve varied up and down around a slow upward trend until last May; since then, I’ve hovered right around 300 pounds.

I was diagnosed with diabetes in May 2017, and prescribed metformin and glipizide. With those, diet, and exercise, my blood sugar was well controlled, but my A1C has been slowly climbing. Most recently (October 2018), it was 6.9%. I am not on insulin, and I am hoping to avoid it; one of the main reasons I am planning on the full bypass as opposed to the sleeve surgery is its better record at reducing diabetes issues. No diabetes-related complications so far.

After being diagnosed with diabetes, I was put on atorvastatin as a prophylactic; since then, my cholesterol and triglycerides have been good. Prior to that, my cholesterol was reasonably good, but my triglycerides have always tended to be high.

My blood pressure is on the high side of normal (tends to be around 130/82). Kidneys and liver are normal, no history of gallbladder disease, occasional kidney stones.

I have severe sleep apnea. I actually was first diagnosed with it quite a while ago (15-20 years), was prescribed a CPAP, didn’t tolerate it well, and had throat surgery. My tonsils, uvula, and part of my soft palate were removed. That fixed the apnea quite nicely–until I gained a lot of weight, at which point the snoring and apnea returned. During the educational program for the bypass surgery, we were required to have an apnea assessment; mine came back as severe apnea. I was prescribed a new CPAP, and the newer masks (specifically, nasal pillows) were much better for me; I’ve been on this CPAP for a few months now.

I’m Richard. I’m very overweight, and have been for much of my life. I also have sleep apnea and type 2 diabetes. I’ve decided to have gastric bypass surgery to try and have long-term sustained weight loss and health improvement.

I’m writing this blog to provide an account of the experience, in case anyone else is curious about it or wants to hear what it’s like. I’ll include a health history and status so anyone who wants can compare their status to my own to see how well my experience might compare to theirs.

I’d certainly welcome any questions or comments. If anyone reading is also planning this (or has gone through one of these), I’d be very interested in hearing about your experiences too.