Confessions of a Fat Cardiologist: What happens in Vegas…

John P Erwin III MD FACC FAHA FACP

On February 9th, I’ll be one month post op from my sleeve gastrectomy[ .  During my planning for surgery, I made a conscious decision to accept a trip from a friend to go to Las Vegas for Super Bowl weekend with my wife and several other couples.  I thought that it would be a good assessment as to whether I could continue to be a normally functioning, socially interactive human-being surrounded by the excess of Vegas while adhering to the necessary limitations in which “post-sleeve people” operate.  I also knew that my wife would need this for some restored “normalcy” after centering her life for the last month around the regimented approach to diet and hydration that she’s arduously assisted me with since my surgery.

Before I delve further into the taboo subject of telling the tale of Vegas, I have to say that I’ve truly been feeling great since my surgery.  As anyone who has lost weight by any means knows, it feels good to feel tight-fitting clothes get looser and being able to pull out some clothes from the “lower weight section” of one’s closet.  The regimen of constant fluid intake while having to plan for breaks to eat mainly pureed-consistency foods is certainly a bit tougher to do while now back at work, but I’ve been following my bariatric team’s instructions to a “t”.  I have learned through my orthopedic experiences in the past, that for optimal results with surgery, one truly must follow the post-op rehab prescription to achieve the ideal outcome of any operation. 

Suzi and I went to Vegas fully prepared to do battle with “Sin City”…

What does this look like for a fat cardiologist who is less than one-month post gastric sleeve?  I really hate to admit this, but I’m determined to keep full transparency and throw my pride to the side during this journey.  Part of those preparations for Vegas included packing some baby food and stool softener!  No- there is nothing devious or twisted in this! Since we didn’t want to take a blender with us to whip up some of the “gourmet puree” that my wife has created for me in this dietary phase and it was unclear that we would be able to find something that would fit my current dietary restrictions at the restaurants that we’d be visiting, I needed to have that along as a semi-solid form of protein and vegetable intake.  I’m getting tired of protein shakes, but we also picked up several Muscle Milks as soon as we landed in Vegas to have for “just in case” purposes.  The stool softener part?  Well, that’s the only post-op complication I’ve had during this phase, in which protein shakes are the primary source of my nutrition.  That’s all I have to say about that!

The flight to Vegas late that Friday night was eventful. I had just finally settled into a nap when the flight attendant called for assistance from medical personnel on board.  I rushed to the front galley to find a middle-aged man unconscious on the floor- diaphoretic and with a thready pulse. I kicked myself for not having my AliveCor Kardia with me this one time, but after some IV fluid and some glucose,  he perked up and my initial working diagnosis of vagally-mediated syncope with some component of super-imposed volume depletion seemed confirmed.  His BP rose from a systolic nadir of 78mmHg up to 102mmHg systolic by the time we landed with additional fluids. I gave report to the medics that were waiting on the flight and waited for them to do an ecg and review it before leaving them to their work and transport.  I kept this part of my trip story in this blog because it points to a harbinger of things to come.  The airline “rewarded” me with 5 mini-bottles of liquor, but I’m not partaking currently, and by the early morning hour that we arrived in our hotel room, my wife was also too tired to enjoy them.  These bottles also made the trip home with us fully intact!  I have frequently been called upon on flights to handle medical situations of many types but will speak more about that in future blogs.

With my Offensive Line teammate and roommate during the 1985 Conference Championship Season at Stephen F Austin State University, Buddy Blair (#66), at the Sports Book at The Palms Resort
My wife, Suzi, waiting to welcome me back from the 1985 Conference Championship game in front of Buddy’s and my room at the Lumberjack Football Athletic Dorm

The weekend was fantastic! We met some new couples, but our host also surprised me by inviting two of my college football teammates and their wives- each of whom I had not seen in over 25 years!  We had a great time catching up and the fact that I was not eating and drinking with them really did not seem to matter.  My brother and sister-in-law were also great company.  It was fun being on a trip with them for the first time since my sister-in-law had completed her breast cancer surgery and adjuvant treatment.  While there was a lot of eating, drinking, and celebrating going on, the conversations were great and my water and protein drinks didn’t seem to be a distraction to them at allOut of pride, I most certainly didn’t eat baby food in front of them, ‘though.  I snuck away to our hotel room for that unappetizing part of my regimen!

Joe Manuel (George Strait’s Ace in the Hole Band’s acoustic guitarist), Suzi, and I after the George Strait show at T-Mobile Arena in Las Vegas

It helped some that Suzi and I had also built-in some alone social time after a friend of ours, who plays in George Strait’s Ace in the Hole Band, hooked us up with the best tickets to “King George’s” concert that a person could ever have dreamed to have.  George Strait has been one of our favorite artists for many years and he played a role in our early courtship (more on this on a future blog), but we’d not been able to catch one of his concerts in over 15 years.  Interestingly, I did security for a few of his shows back in my college football playing days and he still sounds as good as he ever did.  One of George’s songs, “The Fireman”, also became one of my college nicknames (besides the “Big John” moniker), but I can assure you that it wasn’t related to the same reason they call George that.  I’ve had a knack for “putting out fires” for a long time…it’s still one of the key elements to my current job!

Palms Super Bowl Party

Sunday was spent seeing how much I could reasonably remove from the coffers of The Palms on the craps and blackjack tables as well as via the Sports Book on the Super Bowl.  I’m not a big gambler, but was pleased that I did come home with some extra capital courtesy of the gaming industry.  The super bowl turned out to be a “punt-fest” punctuated by a poor half-time show, but I did enjoy listening to Aretha Franklin’s National Anthem and won the “over -under” on how long it would take her to sing it!  For those not familiar with Super Bowl betting, besides the scores/spread, etc, there are many so-called “prop bets” on things like: 1.  Will the coin toss be heads or tails?  2.  How many times will Tom Brady be sacked? 3.  Who will be the last team to score…and on and on.  It keeps the game interesting for times when the Cowboys are not playing in the Super Bowl and I could care less about the teams that are!  Needless to say, I wasn’t eating typical “Super Bowl foods” or doing any “Vegas drinking”, but we all had a blast together.  I had asked the question on twitter before I left about suggestions of what to do besides the obvious eating, drinking, and gambling in Vegas and got some very good suggestions. We tried a few and we will definitely be back another time to try more. 

Back to “What happens in Vegas stays in Vegas”…

As great as this first mini-vacation since my Sleeve Procedure was, we found a major caveat to this Vegas cliché:  Influenza A caught in Vegas does not stay in Vegas…that sucker follows you right back home!  We flew back to Texas on Monday and I was at work by 0600 on Tuesday morning.  While at Grand Rounds over the noon hour, I suddenly got hit by a ton of bricks with the onset of cough, total body aches, and shaking rigors with a temp spike to 102.8 by Tuesday evening.  One of the drawbacks of the gastric sleeve is the limited quantity that can be pushed by mouth to maintain hydration during illness.  Despite my best efforts, by Wednesday morning, I was orthostatic and very dehydrated.  Thanks to my Chiefs of Hospitalist Medicine and General Ambulatory Internal Medicine (wife and husband dynamic duo at our place!), my wife, and my Bariatrics team, I didn’t wait until Thursday to seek further care.  My crew, headed by the Division Chief of General Medicine, got me tanked up with some IV fluids as an outpatient and I’m currently still contagious but convalescing at home.  We prophylaxed my wife given that she has asthma and she had her onset of symptoms minimized.  Several others who spent time at the same blackjack table from our group all came home with the flu as well.

Long story short (anytime someone say this, they’ve generally gone too long!), even before getting sick, I lost weight in Vegas!  My current weight status is that I am down a total of 54 pounds ( 24.5 kg ) one month out from my gastric sleeve procedure.  I’ve learned first-hand what I had expected: that life changes drastically after this procedure, but that with a few strategic planning initiatives, one can still socialize with only minimal awkwardness.  One must also be very vigilant during illnesses to maintain hydration or get in quickly for some intra-venous “catch up”.  I’ve also learned that, as with many things in my life, difficult times are easier with strong Faith, a loving partner by one’s side, and a listening ear tuned in to concerned friends and colleagues (Thanks, Drs. McNeal!).

If you’re asking, “Did he get his flu shot?”. Yes, I did.  If you’re then asking, “What’s the point of a flu shot?”.  I’ll answer you without hesitation that it is extremely important to do so every flu season.  Sometimes the strain is missed in a particular year.  Sometimes our immune systems don’t respond as vigorously each year to the immunization, but there is no doubt that flu shots: 1.  Save lives 2.  Do NOT cause the flu and 3.  Lessen the severity of the flu when one does contract the virus.  PLEASE get your flu shot if you have not yet done so!

Thanks for reading and for your encouragement.  I enjoy hearing from you and am happy for you all to travel this journey with me. Wish me luck making it to February 23rd on the pureed diet! After that, I get to progress to real food again!

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