Bariatric surgery to end all this nonsense?

[Suddenly Worn Out]

Ive been on CPAP and compliant since mid 2007. It has helped me a lot. A whole lot. It helped me the most though when "I got on the stick" in mid 2008 and 2009 and worked out a lot, dieted and lost a lot of this nasty fat. I was feeling better after I got down to 204-206 lbs AND continuing to use CPAP. Darned better.

I still had 35 to 40 lbs to lose though, at 204-206 lbs. I stopped losing and gained it all back. I continued to use CPAP and have watched my pressures go up and down over the years on auto CPAPs and bipaps just like my weight fluctuates.

I can take a hint.

Lose the weight PERMANENTLY. And continue using CPAP. And feel better. PERMANENTLY. Or until I die of other natural causes.

Bariatric surgery has a bad name with some folks. Mainly because it is extreme. But hey, I am now back up to 240 or so. And I need to get down to 165-170 and KEEP IT OFF.

Only solution I can think of is bariatric surgery. The thing I dont want to deal with is the recovery. I aint afraid of not eating much anymore.

Rant over.

Eric

[Todzo]

Ive been on CPAP and compliant since mid 2007. It has helped me a lot. A whole lot. It helped me the most though when "I got on the stick" in mid 2008 and 2009 and worked out a lot, dieted and lost a lot of this nasty fat. I was feeling better after I got down to 204-206 lbs AND continuing to use CPAP. Darned better.

I still had 35 to 40 lbs to lose though, at 204-206 lbs. I stopped losing and gained it all back. I continued to use CPAP and have watched my pressures go up and down over the years on auto CPAPs and bipaps just like my weight fluctuates.

I can take a hint.

Lose the weight PERMANENTLY. And continue using CPAP. And feel better. PERMANENTLY. Or until I die of other natural causes.

Bariatric surgery has a bad name with some folks. Mainly because it is extreme. But hey, I am now back up to 240 or so. And I need to get down to 165-170 and KEEP IT OFF.

Only solution I can think of is bariatric surgery. The thing I dont want to deal with is the recovery. I aint afraid of not eating much anymore.

Rant over.

Eric

Hi Eric!

The sound byte (this is from some UW-TV medical series videos) that rings in my ears is that "diet and exercise yeilds a 5% weight loss which 5% of the people can maintain for 5 years". My friend, you are not alone.

If my crude inferrence of your BMI is correct you probably do qualify for the surgery from that perspective.

For me right now - I am at an approximate BMI of 30. I do not know how heavy I got but I do know that by recently replaced belts last notch in was at 41 inches and my new belt starts at 40 inches biggest. I had used many notches larger on my old belt. I think I may well see a BMI of 28 this next year.

Changes that helped a lot:

Learned to manage the unstable breathing aspect of using PAP as well as the AHI
Moved to a city I feel safer in
Did walk a hundred miles a month (70% of 10,000 steps a day) and new city has hills where use of my belt worn pulse oximeter turns them into interval training most days.
Half of my diet is veggies with 20% raw
I do not watch TV (the food commercials do a good job) and try to stay away from violent media.
I take care of my microbiome (yogurt, Kimchi, very few processed foods, no GMOs).

In this crazy world, the surgery may be a good choice. I never thought I would say that!

May we see well as we make decisions!

Todzo

[DavidCarolina]

Hi eric, thanks for the rant, seriously, because it shows thinking out of the box, taking calculated risks, etc. Im having to do that with another medical condition that came alongside apnea- NOT fun.

But the thing thats positive is that you both lost the weight at one time, and found a real-life correlation in direct results. Thats seriously useful personal information----with my other condition, its a lifelong process finding correlations like that and they dont come easy.

Im heavier now because i use to play tennis for 2 hours, or even walk 90 minutes many days and could maintain my weight. With this and my other neurological problem, I cant. A few years ago I lost weight this way; there is a book at barnes and noble called something like the twelve greatest foods. Basically, I chose some of those and just ate those for 3 months. Now with my weight id have to do it for at least 4. And im eating a lot of them:

salmon, lean protein, oatmeal, bananas, oranges, spinach, low carb nuts, and lots of water. You get the idea.

My humble opinion id try a lifestyle of just eating certain foods all the time and never actually "dieting". With the foods you choose you can eat all you want, but the fringe benefit is you WANT less. Its a modified atkins approach but still getting enough carbs to run your body and brain. Im not giving medical advice, just my own experience.

If you think you cant live out that lifestyle (of course with the typical binges and holiday breaks and a bad weekend here or there that we all succomb to, then you've got to find another way. Do your research, get lots of opinions, meet people who have actually done it, and go for it. But I'd exhaust the other possibilities first obviously. For example, my wife leaves "carbs" on the counter--chips, donuts. If she simply keeps them out of my sight i can handle it. Better yet if its not in the house. That approach alone has helped quite a bit----because i know without apnea i could just excercise most of my weight off but thats no longer an option. Good luck.

[xenablue]

As a member of the ADA forums (American Diabetes Association), I just read an article on a study for the pros/cons of bariatric surgery. I'll post the link further on.
Basically it says of the 400+ participants - all those with OSA still have it, regardless of how much weight they lost - that's not to say their pressure wasn't reduced etc.
The study indicated the risks of this surgery, the participants whose blood glucose was much improved or who no longer showed any sign of diabetes, among other things.
In a discussion with my endocronologist on this subject - my take is that it's risky (major) surgery, and comes with a whole new set of eating issues and I'm comfortable with my diabetes control and have become very accustomed to the low-carb lifestyle. Two weeks ago DH and I decided to lose some more weight, and are staying on the same foods, but eating less - basically controlling the calories as well as the carbs.

Here's the link - http://www.foxnews.com/health/2012/09/1 ... z27SezHK7F

Cheers,
xena

xena

[Suddenly Worn Out]

Yep, I lost a lot of weight for about two years. And continued using my APAP during that time. Yep, I have "seen the light" you could say. Things improved so much during that period when I lost a lot of weight WHILE continuing to use my APAP, that I just viciously attack any and all people who make the counter claim that "losing weight does not help OSA." While it is probably true losing weight does not get rid of OSA entirely and I agree that much of it is a genetic, tracheal structure issue (shape and size of your airway), my real world experiences just do not jibe with the "dont bother losing weight it wont help your OSA crowd."

And yeah, keeping it off is the hard part. I have since gone back to eating a lot, eating the worst kinds of foods. Im telling ya, it dont work if you have OSA and these sorts of cardiopulmonary problems. I have found I CAN lose it, but it is the keeping it off longterm that is the hard part.

Im thinking of the bariatric surgery as the "end this crap once and for all." DONE!! kind of deal.

I hope you are able to come to grips with your other medical condition and trust me, losing a lot of weight if you are overweight significantly does help! A lot. A whole, whole lot.

Eric

Hi eric, thanks for the rant, seriously, because it shows thinking out of the box, taking calculated risks, etc. Im having to do that with another medical condition that came alongside apnea- NOT fun.

But the thing thats positive is that you both lost the weight at one time, and found a real-life correlation in direct results. Thats seriously useful personal information----with my other condition, its a lifelong process finding correlations like that and they dont come easy.

Im heavier now because i use to play tennis for 2 hours, or even walk 90 minutes many days and could maintain my weight. With this and my other neurological problem, I cant. A few years ago I lost weight this way; there is a book at barnes and noble called something like the twelve greatest foods. Basically, I chose some of those and just ate those for 3 months. Now with my weight id have to do it for at least 4. And im eating a lot of them:

salmon, lean protein, oatmeal, bananas, oranges, spinach, low carb nuts, and lots of water. You get the idea.

My humble opinion id try a lifestyle of just eating certain foods all the time and never actually "dieting". With the foods you choose you can eat all you want, but the fringe benefit is you WANT less. Its a modified atkins approach but still getting enough carbs to run your body and brain. Im not giving medical advice, just my own experience.

If you think you cant live out that lifestyle (of course with the typical binges and holiday breaks and a bad weekend here or there that we all succomb to, then you've got to find another way. Do your research, get lots of opinions, meet people who have actually done it, and go for it. But I'd exhaust the other possibilities first obviously. For example, my wife leaves "carbs" on the counter--chips, donuts. If she simply keeps them out of my sight i can handle it. Better yet if its not in the house. That approach alone has helped quite a bit----because i know without apnea i could just excercise most of my weight off but thats no longer an option. Good luck.

[Suddenly Worn Out]

I dont have diabetes, but if I dont lose this weight and KEEP IT OFF, Im heading towards type II diabetes. That is one of the reasons Im considering the bariatric surgery. I have read other stuff about bariatric. I have read real world people describe their bariatric surgery. And it is the physicians as well as the patients who are absolutely amazed at the results it brings. Severe drop in blood pressure and in blood sugar (if you have diabetes). They claim the results are fast and dramatic.

In type I diabetes, bariatric surgery I would think would not make much of a difference. Because you are born that way or become that way very early on, usually in childhood. With type II diabetes though, its a lifestyle thing...normally you simply become too obese and you suddenly get a call from your doctor, "wow your blood sugar is elevated, Im referring you to an endocrinologist, you have type II diabetes. You need to work hard at losing as much weight as possible."

I can take a hint. It has not happened to me...yet.

Eric

As a member of the ADA forums (American Diabetes Association), I just read an article on a study for the pros/cons of bariatric surgery. I'll post the link further on.
Basically it says of the 400+ participants - all those with OSA still have it, regardless of how much weight they lost - that's not to say their pressure wasn't reduced etc.
The study indicated the risks of this surgery, the participants whose blood glucose was much improved or who no longer showed any sign of diabetes, among other things.
In a discussion with my endocronologist on this subject - my take is that it's risky (major) surgery, and comes with a whole new set of eating issues and I'm comfortable with my diabetes control and have become very accustomed to the low-carb lifestyle. Two weeks ago DH and I decided to lose some more weight, and are staying on the same foods, but eating less - basically controlling the calories as well as the carbs.

Here's the link - http://www.foxnews.com/health/2012/09/1 ... z27SezHK7F

Cheers,
xena

xena

[Suddenly Worn Out]

I do qualify for it. My waist is over 40 inches and Im sick of it. I used to be an athlete. Now Im a fat piece of lard and sick of it. Not only that, it is costing me a lot of $$$ and destroying the quality of my life.

Im looking for a permanent solution. I gotta be honest, Im a man who likes to eat. I also like to work out hard, believe it or not. I will go out and backpack 5 miles still. At my weight I probably should be doing easier exercise. I also will still go out and swim a mile nonstop freestyle. Yet Im obese. I cant do the same running or jogging though because it puts too much strain on my joints. That is screwed up, when you can swim a mile nonstop freestyle or walk fast 5 miles (or more) carrying a pack in the hills, but you cant jog anymore!

Eric

Hi Eric!

The sound byte (this is from some UW-TV medical series videos) that rings in my ears is that "diet and exercise yeilds a 5% weight loss which 5% of the people can maintain for 5 years". My friend, you are not alone.

If my crude inferrence of your BMI is correct you probably do qualify for the surgery from that perspective.

For me right now - I am at an approximate BMI of 30. I do not know how heavy I got but I do know that by recently replaced belts last notch in was at 41 inches and my new belt starts at 40 inches biggest. I had used many notches larger on my old belt. I think I may well see a BMI of 28 this next year.

Changes that helped a lot:

Learned to manage the unstable breathing aspect of using PAP as well as the AHI
Moved to a city I feel safer in
Did walk a hundred miles a month (70% of 10,000 steps a day) and new city has hills where use of my belt worn pulse oximeter turns them into interval training most days.
Half of my diet is veggies with 20% raw
I do not watch TV (the food commercials do a good job) and try to stay away from violent media.
I take care of my microbiome (yogurt, Kimchi, very few processed foods, no GMOs).

In this crazy world, the surgery may be a good choice. I never thought I would say that!

May we see well as we make decisions!

Todzo

[xenablue]

[quote="Suddenly Worn Out"]I dont have diabetes, but if I dont lose this weight and KEEP IT OFF, Im heading towards type II diabetes. That is one of the reasons Im considering the bariatric surgery. I have read other stuff about bariatric. I have read real world people describe their bariatric surgery. And it is the physicians as well as the patients who are absolutely amazed at the results it brings. Severe drop in blood pressure and in blood sugar (if you have diabetes). They claim the results are fast and dramatic.

In type I diabetes, bariatric surgery I would think would not make much of a difference. Because you are born that way or become that way very early on, usually in childhood. With type II diabetes though, its a lifestyle thing...normally you simply become too obese and you suddenly get a call from your doctor, "wow your blood sugar is elevated, Im referring you to an endocrinologist, you have type II diabetes. You need to work hard at losing as much weight as possible."

I can take a hint. It has not happened to me...yet.

Eric

Actually - Type 2 diabetes doesn't quite work like that - it seems to be a genetic condition and if you're going to get it, you will - no matter what. I personally know several T2 diabetics who are in no way overweight, and never have been.

There are many more non-diabetic obese people - who will never develop diabetes, no matter how sedentary they are or how much food they eat. A so-called 'pre-diabetic' may be able to hold off the inevitable for a period of time, but that's a roll of the dice.

Yes, bariatric surgery - circumventing the duodenum - will remove the diabetic condition (T2), but you then have other issues to deal with.

Cheers,
xena

[JohnO]

Im thinking of the bariatric surgery as the "end this crap once and for all." DONE!! kind of deal.

I'd be very concerned about re-gaining weight after surgery. I've known a number of people who looked great for about 24 months after the surgery, but then started to learn how to "cheat" and started to rapidly regain weight.

Here is a snippet from Wikipedia:

To gain the maximum benefit from this physiology, it is important that the patient eat only at mealtimes, 5 to 6 small meals daily, and not graze between meals, which can effectively "bypass the bypass". Concentration on obtaining 80–100 g of daily protein is necessary. Meals after surgery are 1/4–1/2 cup, slowly getting to 1 cup by one year. This requires a change in eating behavior and alteration of long-acquired habits for finding food. In almost every case where weight gain occurs late after surgery, capacity for a meal has not greatly increased. Some assume the cause of regaining weight must be the patient's fault, e.g. eating between meals with high-caloric snack foods, though this has been debated. Others believe it is an unpredictable failure or limitation of the surgery for certain patients (e.g. reactive hypoglycemia). Of course, there may be no operation which can completely counteract the adverse effects of destructive eating behavior. This surgery is only a tool and as with most tools, if not used correctly, it can be of no use.

http://en.wikipedia.org/wiki/Gastric_bypass_surgery

John

[archangle]

It's like people who take trips to Las Vegas. The winners talk, the losers tend to keep quiet about it. Listening to people talk, you'd think everyone wins in Vegas.

You don't hear from the bariatric surgery failures the way you do from the successes. If you have the surgery, but still stay fat, obviously, you're just a lazy glutton, right? Go crawl back in your hole and shun the rest of society.

I had a dear friend die from complications of the surgery. I understand they're now finding out that the "safe" lap band surgery isn't that safe after all.

However, being overweight does have its risks. I just resent the way bariatric surgery seems to be being sold as a sure fire cure for what ails you with no side effects.

[Slartybartfast]

Bariatric surgery is not a panacea.

A friend had the lap band installed. Initially she did well, but it did nothing to address her native physiology. She started craving high carb and high fat foods, which is the worst combination possible. The carbs cause your blood sugar to spike to levels that the body considers toxic. Your body responds by secreting insulin which esterifies the glucose and free fatty acids you obtained from the fat ingested into non-toxic triglycerides which are stored in adipose tissue. The body thereby lowers blood glucose to a safe level, and stores energy away for tough times, which, in a primitive lifestile setting would be a good thing to do.

My friend's body trained her to eat less food, but it caused her to crave a specific combination that circumvented the intent of the lap band.

As I said, bariatric surgery is not a panacea. You can accomplish the same end by simply following the post-lap-band recommended diet.
See: http://www.lapband.com/en/live_healthy_ ... ogression/ which I reprint here:

1-2 Weeks Postsurgery: Liquid Diet
Your stomach will only tolerate liquids at this time.
It’s important to also stay hydrated by drinking lots of water. Drinking small amounts frequently may help you avoid vomiting.

Recommended liquids include:
clear broth or soup (no vegetables, meat, or cream)
skim milk
fruit juice
sugar-free popsicles


3-4 Weeks Postsurgery: Pureed Foods
You can start adding slightly textured foods (the consistency of baby food). You should eat protein-rich foods first, as this helps you maintain muscle while losing weight.
Then move on to fruits and vegetables.

Foods may include:
skinless chicken/fish
mashed potatoes
peas
low-fat yogurt or pudding
Note: In this stage, you may be allowed some foods that might not be permitted in your diet later due to high calorie content.

5 Weeks Postsurgery: Soft Foods
As you progress to soft foods, remember to do so slowly. If they cause nausea, you may return to the liquid diet and introduce these foods again in a few more days.

Meals may include:
tender, cooked fish
ground turkey
moist pork

Some products like bread, red meat, and rice may cause you problems.
If so, stick to softer, more digestible foods.

6 Weeks and Longer
At this point you should be able to tolerate solid food, although in smaller amounts. Always cut your food into small pieces and chew thoroughly. This helps reduce the chance of vomiting, stomach irritation and swelling. It may also help prevent any obstruction of the stomach opening created by the LAP-BAND® System.


So, do you think that by eating that for 6 weeks post-surgery you won't lose weight? Hmmmm . . . looks an awful lot like a simple low-carb high fat (LCHF) diet to me! How 'bout just following the diet and skipping the surgery, with its attendant risk and expense?

Take a look at the video trailers on this site: http://www.fathead-movie.com/index.php/about/ If you see something there that makes sense to you, then order a copy of the complete video, or see it in sections on you-tube.

[BlackSpinner]

Many people have simulated the effects of surgery using the "cookie" diet. A very high fibre, non digestible "cookie" is eaten before each meal. It basically fills the stomach so that you can't eat a lot.

But again, unlike surgery, it requires perseverance and dedication. You actually have to eat the "cookie" with each meal. Having them sitting in you cupboard does no good. That was my oldest. Because they were somewhat expensive, she rationed them.

[Slartybartfast]

There's a thread that's been going on since February and is around 28 pages long. Lots of folks have weighed in on the pros and cons of low-carb dieting, and a significant number of the heavyweights have become lightweights in the process.

I think the thread starts to get interesting about here:

viewtopic.php?f=1&t=75624&st=0&sk=t&sd= ... 15#p691962

[kuda]

As a note - I'm considered obese as well. I'm 6'0 and 235. I just started long distance biking and it's helping with the weight. It's very low impact, lots of fun, and great exercise. I got a heart rate monitor / watch combo and i keep the ticker between 160 and 170 for hours at a time. I just punched out 30 miles last weekend, and feeling great. Something to think about!

[Todzo]

I do qualify for it. My waist is over 40 inches and Im sick of it. I used to be an athlete. Now Im a fat piece of lard and sick of it. Not only that, it is costing me a lot of $$$ and destroying the quality of my life.

Im looking for a permanent solution. I gotta be honest, Im a man who likes to eat. I also like to work out hard, believe it or not. I will go out and backpack 5 miles still. At my weight I probably should be doing easier exercise. I also will still go out and swim a mile nonstop freestyle. Yet Im obese. I cant do the same running or jogging though because it puts too much strain on my joints. That is screwed up, when you can swim a mile nonstop freestyle or walk fast 5 miles (or more) carrying a pack in the hills, but you cant jog anymore!

Eric

Hi Eric!

Your exercise thing is good, very good. It is the greatest predictor of weight loss maintenance known.

I do encourage you, if you have not already, to establish feed back in your PAP use. I believe it will be critical as you loose weight. What I found recently is that weight loss brought on breathing stability problems while using PAP. Actually, I kind of expected this since breathing stability was an area of study regarding my helping on these forums. Problems finding medical help in my new digs led me to do a self titration to reduce pressure which is still in process. Some model our breathing control systems as a servo system whose gain needs to be less than one. If more than one the breathing seems to “take off” resulting in over breathing. The over breathing will likely cause arousals which will also stimulate the central nervous system and so raise the breathing gain (+loop …!). The irritation (drier, colder) caused by the over breathing can cause more AHI which will stimulate the central nervous system and raise the breathing gain (+loop …!). If the gain becomes high enough periodic breathing will result. If the gain goes a bit higher hypocapnic central apneas (such as Cheyne-Stokes respiration) will occur. As all of this occurs many cells will not get O2 when they need it, the heart will strain, the brain is particularly sensitive to the O2 / blood gas issues – well – simply – after reading a lot about what does happen I am more afraid of unstable breathing than I am of Obstructive Sleep Apnea.

The thing is you are making a drastic change in your body, much less out there to move means your breathing “gain” is higher. Your breathing muscles have less work to do but are still as strong. Your PAP pressures are the same (or can go to the same levels – see the scary positive feedback loops above!!) and so unstable breathing becomes very likely.

In March of 2011 my doctor raised my pressure from 14 to 15 in response to a weight and stress increase along with an exercise decrease. I arrived in my new city April. I had made some progress with weight and exercise but some how the severe drop in stress, more sunlight, no TV, and "interval training hills" resulted in rapid weight drop (a pound a week). Near the end of July I reduced my pressure 2 cm/H2O and have been watching my data for a week or so and deciding to drop pressure another 1 cm/H2O with better readings every time. I am now on my fourth day at 8 cm/H2O with my AHI last night being 0.76. The recent drop was the first time I have noted a tendency to snore when first using the CPAP - I am probably very close.

Frankly I think what I am doing now makes a lot more sense than going to the sleep center for one night (a snapshot in time in a very strange place for goodness sakes!!!) and trying to make use of the result for the next couple of years. In your case, you will have rapid weight drop for months!!!!! Again, establish feedback – very – very – very important I really do believe.

I am a bit smaller than you so my 40 inches is still something I would like to see turn into - say - 36 inches (realistic I think). Since I have not a gal but “hope springs eternal” (even at 58!) that will likely help I think!

What happened was that OSA literally stole my carrier in Broadcasting so I retrained as a cook. I do love to cook – and loving food from this different perspective made working with a dietitian for several years productive toward learning some new good eating skills. I love, and will always love food. What I can see now is that our corporate barbarians have trashed our eating skills (produced a lot of trash foods which perpetuate a lust for themselves and advertised them well). So we desire not what we need but what they want us to think we need. It is about getting into yourself what you really do need (and I can make a good educated guess that you are undernourished as I write this). I think cooking classes (from scratch is the best) along with working with a dietitian is a good path.

Carry on good man!

Todzo