Confessions of a Fat Cardiologist- Part III

John P Erwin III MD, FACC, FAHA, FACP

I’m back to my College Football playing weight!!

Today marks the two-week point since my Gastric Sleeve procedure.  I was on a modified liquid fast diet for two weeks preceding that intervention and since December 26^th (less than a month for those of you doing the math at home), I’ve lost 40 pounds.

What really is frustrating is to have lost 40 pounds and STILL be fat!  While I am at my college playing weight, the composition and distribution of that weight is not nearly the same.  The Dallas Cowboys are still not calling, but my belts are thanking me for reducing their work-load! I can’t assess my bench press, dead lift, squat, or power clean strength at this juncture as my resistance training is limited at present to a 15lb weight limit for a few more weeks.  I no longer run a sub-five-second 40 yard dash, but my walks and slow jogs are feeling easier than they did even one month ago.

To this point, my diet has consisted of protein shakes, plain Greek yogurt, broths, and sugar free gelatin, but today I will start the Stage II diet which allows me to eat pureed food! Yeah!! LOL! This phase of the post-surgical diet will last for 4 weeks and then I’ll be progressed in my diet to “real foods” in small portions.

People are asking me, “How tough has this been?”.  Honestly, things have gone surprisingly easily for having 5 one- to two-inch trans-muscular stab wounds in my abdomen and having more than ¾ of my stomach removed.  I’ve had no nausea (according to my surgical team, nausea is especially common amongst female gastric sleeve patients) and the pain has been quite tolerable…sans the few episodes where I’ve sneezed hard without “splinting” my abdomen or twisted/sat up too quickly in forgetting that I’m post-op.

As I’m starting the re-introduction to “real foods” portion of my diet, I can already tell that my physiological drives regarding hunger and satiety have changed.  In my former life, I recall seeing skinny people who could have “a taste” of some type of food and be satiated.  I was most certainly NOT wired that way, but now notice an earlier satiety response to food which will help me with my number one issue in weight management- portion control.  Much like pain, hunger is also a very individual response.  People who are “wired” differently would be quick to say, “Well, why didn’t you just DO that before and save yourself a surgery?”. To them, I say that you first must walk a mile in a person’s shoes that is wired differently.  As mentioned in the joint blog that my wife and I did in Part II, discipline has typically been my strong suit.  There are physiologic signals that can overwhelm in some obese people, however.  We all have a weakness or two in our individual physiological milieu.

I had a great flurry of well-wishers and prayer partners in my journey thus far.  I’ve also had a great deal of unsolicited advice– much of it well-meaning, some of it clearly with commercially vested interests, and a small portion of it being the expected “internet trolling” type of behavior that has come to be a part of our new social fabric.  All of it has been good for introspection, reflection, and confirmation that this path of action has been exactly right for me- just as it has been for the hundreds of patients that I’ve previously referred for bariatric procedures who have had tremendously positive benefits in their lives.

Is a surgical intervention ideal for everyone?  Absolutely not! For people who fit my demographic or worse, it does have the most evidence to support meaningful weight loss, mortality reduction, and morbidity reduction.  Who is less likely to benefit?  Those people who don’t have as much weight that they need to lose have more conservative ways that they can be successful.  Those who have core psychological issues that drive their eating and other behaviors are also going to be less successful.  I’ve heard a myriad of anecdotes about people who have had bariatric surgery and gained most of their weight back.  In delving deeper into those stories, it is not surprising after hearing about the lady who went straight home on post-op day one and ate fried chicken or about the doctor who “felt so good after surgery” that he ordered an extra-large supreme pizza to eat over the course of the day on post-operative day 3.  As mentioned in my first blog, I’m a veteran of quite a few surgeries.  In only one of them did I not explicitly follow my surgeon’s/physical therapist’s instructions, and that did not turn out well.  I will brag on myself in this one aspect: I am a model patient.  I follow the instructions of my doctors and research the recovery process on my own to ask the right questions when I am with them.  I will also brag on my doctors/clinicians.  I have been very blessed to have a great team of health professional look after me my entire life…sans a couple, but I’ll not dwell on those!

I do not hold any false pretense that my surgery is a cure or an “end-all/be-all” solution to my chronic weight issue.  I understand that it will require continual vigilance and effort to restore and maintain my “temple” in the best possible manner during this mortal life.  With that said, I feel very confident that “I’ll get by with a little help from my friends” – most notably, my best friend (and wife), Suzi, and I thank God for blessing me with these loved ones and the surgical team who are helping me along the way. 

Thank you for following along on my journey.  I’ll continue to dedicate some of my blogs to the ongoing portion of this great adventure.