VSG Experience

Weight Loss Before and After Gastric Sleeve: Why I Picked Vertical Sleeve Gastrectomy

What a difference a year can make! Getting Gastric Sleeve Weight Loss Surgery has been one of the best things I have ever done for myself! I just want to share my weight loss journey as encouragement for anyone out there thinking about getting Gastric Sleeve, RNY gastric bypass, or any other bariatric procedure.

What Led Me to Get Weight Loss Surgery?

Senior 1996 (130 lbs.)

Choosing to get weight loss surgery is not a decision that is made lightly. For many, it is a last resort before giving up entirely. In my adult life it has been so hard for me to lose and keep my weight off. I graduated high school at 130 lbs. and at 5′ 5″, it was a good weight on my frame. I had never really had to “diet” growing up because my metabolism was extremely fast. I didn’t really work out either, hence I was pretty scrawny. 

We all have bad habits that we learn from a young age, and I guess the bad eating habit I picked up in my youth was how fast I would eat my food. 

I am the oldest of three boys and we all were eating machines! When food landed on the table, it was a race to see who would get food first. I often wonder how we never stabbed each other with a fork, actually it might have happened, I just don’t recall.

When I went to college, I gained the “freshman 15” but it didn’t stop at 15 lbs. It just kept going until 5 years later when I received my bachelors degree I was about 190 lbs.

Graduation May 2000 with my and my brothers. 190 lbs.

When I went to graduate school I met my wife Cynthia and while I was able to still hook a beautiful girl, I was now hitting 210 lbs. (As I’ve said in other blog posts we made a perfect 10!)

My then future wife and her parents.

I remember one the day I started my dieting journey. I don’t know the specific date, but I know it was a spring day in Las Vegas. I was putting on a button-up shirt and it felt so uncomfortable. It was so tight around my stomach, but so big around my shoulders. I remember looking at myself in the mirror and just being so frustrated with myself. How had I let myself get so big? How had I not seen my weight gain before that day? I made a decision that day, that I was going to lose weight especially for my wedding. I was determined and about a little over a year I was able to get down to 160. I remember it was a pretty easy journey to get to 170, but those last 10 pounds were a lot of work. I was happy about it reaching my goal, but I do have to say that it took a lot of dieting to stay there. After awhile it was just too hard, and as I slipped, I felt myself not caring about my health. I would just eat more and more and it felt good and comfortable.

I did this yo-yo two or three times, each time it started with me getting fed-up, then getting serious, losing a lot of weight, getting to 170 lbs., then struggling to get under 170, then hitting 155 lbs. to 160 lbs. and it just being too much work, then gaining it all back and more, until I got to close to 230 by 2018. 

I’m a smart guy, I was fed up again, but I knew what would happen if I tried this again, so I decided I needed to go a different route. 

Me at 228 lbs. in March, 2018

I knew I needed to lose weight and I needed to do it differently. I had tried various different diets that all worked until they didn’t. It wasn’t the diet’s fault, I honestly think I was just fighting my body. This is called “Set Point Theory”, which shows validity amongst researchers. The idea is that your body has a weight that it is comfortable at. As people gain weight and stay at a heavier weight, the set point begins to creep up. The belief is that weight loss surgery helps to reset the set point. 

Besides being heavy, I had other health problems known in the health world as “co-morbidities”.

My Co-morbidities:

  • High Blood Pressure
  • Sleep Apnea
  • Fatty Liver Disease
  • Pre-Diabetic

At this point in my life, I had two beautiful kids and my wife. I had co-founded a non-profit and fairly successful in my profession. I sure didn’t need to be dropping dead anytime soon. My sister-in-law had gone through gastric sleeve surgery and had been getting great results. In fact, several members of her immediate family had gotten the surgery. That inspired me to look into weight loss surgery and if Tricare (military insurance) would cover it.

My Steps to Getting Qualified for Surgery

The very first thing I did was get on Google and typed in “Weight Loss Surgery Procedures” and was presented with several different options:

The stomach is stapled to create a small pouch but the portion of the stomach that releases food into the small intestine is left in place. The remaining portion of the stomach is then removed. Since the remaining portion of the stomach is removed, it no longer produces the hormone Grehlin, which reduces hunger.

A small pouch is made at the top of the stomach, which blocks food from entering into the remaining part of the stomach. The small intestine is then cut past the exit of the remaining stomach and attached to the new pouch. The portion of the intestine that is still attached to the remaining stomach is then attached to the newly rerouted small intestine so that gastric juices mix with the food. Since the pouch is very small, you are unable to eat very much. Also, since you are bypassing the rest of the stomach and a portion of the small intestine, the body doesn’t breakdown calories and absorb the food as well.

With this procedure, a inflatable band is placed at the top portion of the stomach, which creates a small pouch. The band is connected to a tube and port where fluid is injected to inflate the band and restrict food. Only a small amount of food can pass through the opening of the pouch. The food is broken down and absorbed normally.

As I researched through the various different options, I quickly threw out the idea of gastric banding. Patients that received the gastric band lost much less weight than Gastric Sleeve and RNY. It also had a higher rate of gaining the weight back because there was physical maintenance that had to be kept up. Many people wouldn’t keep up with it, which leads to complications and weight gain.

The two most viable options for me were Roux-enY (RnY) gastric bypass and Vertical Sleeve Gastrectomy. While you tend to lose more weight on the RnY overall, there were other things that concerned me, which ultimately led me to picking the Gastric Sleeve. With RnY, there was double the risk for complications within a 30-day period than Gastric Sleeve (5% for RnY and 2.5% for Gastric Sleeve). Even though patients lost more on RnY, there was a 6% difference of weight loss, which is minimal considering the complication risks.

I learned that of the two pretty invasive procedures, Gastric Sleeve did not reroute your intestines which allowed your body to absorb nutrients more normally which reduced dumping syndrome

The decision was made, I’d look into getting Gastric Sleeve. Next I needed to check with my insurance to see if this was even possible. I had heard that Tricare did pay for weight loss surgery, I just didn’t know the ins and outs.

For some reason, I was worried about calling my insurance. Maybe for the fear of finding out that they wouldn’t cover it. So instead, I went to a weight loss seminar with Dr. Clark at the Center for Weight Loss Success.

At the seminar they told me about the different procedures and which procedure we actually had would ultimately be our decision with input from Dr. Clark. Also, they setup a time with me to go over the requirements in order to qualify for surgery under Tricare.

Tricare Requirements

In order to get qualified for surgery under Tricare I needed to meet the following criteria:

I had done Weight Watchers and many other diets that I ended up being unsuccessful, but there hadn’t really been medical records to say I was on a diet. Tricare would allow three months of working with a dietician to qualify for this. So I would have to work with a dietician for three months there at the surgical center. 

  • body-mass index greater than or equal to 40 kilograms per meter squared (kg/m2); or
  • A body-mass index of 35-39.9 kg/m2 with one clinically significant comorbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension.

I had a BMI of 35, but I did have hypertension and obstructive sleep apnea.

Moving Towards Surgery

Now that I was armed with all the information, it was time to move forward, so I decided to make the leap of faith. My surgery center requires patients to enroll in a year-long support course. It was around $500 and there were several classes that we had to attend prior to surgery. After surgery patients have access to support classes and their gym. (Honestly, I only used the gym two or three times and never went to the support sessions.)

In order to satisfy the “non-surgical medical treatments for obesity” I had three meetings over a three month period with a staff nutritionist. (Tricare did not cover this.) I also had one appointment with a psychologist. I didn’t lose weight during those three months, but I didn’t gain either. 

After the three sessions with the dietician, I was scheduled for my surgery and set pre-op appointments with my surgeon. 

At the appointment we decided on the gastric sleeve procedure, was given the opportunity to ask questions, and was told when I needed to start on liquids and fast.

Day of Surgery

Rey Ramirez waiting for his Gastric Sleeve surgery on the day of surgery.

July 20, 2018 – I needed to report to the hospital at 5:00 am. I was prepared for a long day.

While we were expected to get there at 5 am, I didn’t actually go back until about 5:45 am. Here is account of my surgery.

  • Weighed in 224 lbs.
  • Was asked to remove clothes and put on my robe
  • Nurse came in and asked questions and took vitals
  • Anesthesiologist came in and explained that I would be under a general anesthetic and checked again for any allergies.
  • Surgeon came in around 7 am and checked in.

 

I was the first surgery of the day, so things started to move pretty quick once the Doctor left. By 7:30 am, I was given a sedative to keep me calm and then they wheeled me in to the surgery room. I remember being surrounded by beeps and a whole lot of people. One of the nurses asked me to think about something that recently made me laugh and for some odd reason I thought of a lip sync police video that I watched by the Norfolk, VA police department. I remember singing Bruno Mar’s “Up Town Funk” in my head. Before I knew it, my eyes opened. I looked around and wondered what had happened. This all took about 4-5 seconds and then…

I WAS IN A WORLD OF PAIN!!

Sorry for the bold red letters, but that is what was called for. Now, I don’t mention this to scare you, I would do it again if I had the chance, and this is only my experience. I hear of many other folks having no pain at all, so this will be different for everyone. 

It felt like knives being thrusted into my stomach and being twisted. It was by far the most pain I’ve ever been in. I’ve broken bones and sprained muscles, but this..WOW! BUT, keep in mind, I’m a guy and in general, guys get pretty wimpy when we are in pain. (huge overgeneralization) 

To top it off, I felt very nauseous. I remember having to get up almost immediately and running to the bathroom to vomit. As you can imagine, I didn’t have anything in my body to vomit, so I was dry heaving, which hurt a lot. 

I remember the hospital has this pretty nurse that I normally would have wanted to look put together for, but there I was with my butt sticking out of my gown dry heaving and moaning. It wasn’t a pretty picture.

Eventually my wife was brought in and I was just moaning and dry heaving. I was very thirsty, but they weren’t letting me drink anything until I went down and did the “leak test”. About 1.5 hours after I woke up, I was wheeled to an X-ray room and asked to drink this metalic tasting liquid. It was hard for me to swallow, but I got enough down for them to see what they needed to and sent me back to the recovery room. The surgeon eventually came up to see me and I was cleared and discharged with some anti-nausea medicine and some pain killers. I was out of the hospital by 3 pm that day.

I did not want to walk, heck at that point, I did not want to be awake. My wife pulled the car around and I remember just being so nausous. She took me home and I remember basically crawling upstairs to my room and sleeping the rest of the day. I got up to take pain killers and anti-nausea medicine.

My wife let me sleep for that day, but the next day it was time to recover. 

 

Sip and Walk: Post-Op Weeks 1 and 2

Rey is holding his sip cup that he used after gastric sleeve surgery.

During my pre-op classes, the nurses and the doctor stressed that I needed to hydrate and walk after surgery. The most important thing to get into my body, was not necessarily protein (but it was encouraged), it was to stay hydrated. I had been given a metal looking shot glass from the hospital and my job was to sip that much liquid (about an ounce) every 15 minutes. 

My liquid of choice during the first several days was the lemon and the peach tea Crystal Light. I tried to drink water, actually I was craving the taste, but when I tried to drink water it felt very heavy in my new pouch. I have heard this from other people too, I’m not sure of the reason. 

Here are the liquids that I lived on for the first two weeks:

In addition to staying hydrated, I needed to walk a lot in order to allow the gas that was trapped in my chest to work its way out. I started by just walking around the house, then walking up and down the driveway, and eventually walking up and down the street (about 1/4 mile). I found that walking let me expel gas much easier and as soon as I started pushing myself to walk, I began to feel so much better. 

As far as pain medicine went, I only took the prescribed pain meds the very first day. I have never liked how they make me feel, which is somewhat in a daze, and my goal was just to take acetaminophen (Tylenol). Sleeve paitents are not advised to take Nsaids like ibuprofen.  I found that I really didn’t need it, as long as I walked every hour for at least 5-10 minutes. 

I was also given a breathing measurement tool called a spirometer. The purpose was to encourage me to take big breathes. I was able to max out the 4000 ml within several days, but that was probably because I am a brass player and am used to taking big breathes. They use the spirometer to exercise the lungs so no bacteria settles in and causes pneumonia and it also helps push away excess CO2 that is trapped in the body. Now that I look back, the fact that I could do this so well, probably helped me get over my gas pains faster.

Mush!: Post-Op Weeks 3 & 4

The first week was about staying hydrated and the second week was more about getting protein in, but this was starting to get old! So, by the third week I was ready to enter into the mushy food stage.

By now my pouch had some time to rest and let the swelling subside, but it wasn’t ready for solid food yet, so most bariatric patients go through this intermediate phase between liquids and solid food.

Here is what I ate during this period.

  • Mashed potatoes (I did this sparingly since it is a starch but it didn’t take much to fill me up.)
  • Mashed cauliflower
  • Mashed steamed carrots
  • Very fine chicken salad (not chunky)
  • Started leaving the cooked soft chunks in my soups like mushrooms and cooked broccoli. (nothing that couldn’t be mashed with my tongue)

All the while, I was still reverting back to my liquid options too. I still couldn’t eat more than an ounce or so of food at one sitting and that took 15 minutes. I had to pace myself because I didn’t want to eat too much and bust anything. Some would say that I was being too careful, but I had just gone through a huge life-changing surgery. I wasn’t about to do something that was going to jeopardize it. 

Solid Food!

After my 4-week post-op appointment, I was cleared to begin eating small amounts of solid food. I needed to eat very small amounts at a time and chew a lot. At first I was only able to eat the smallest amounts of food, but over the year I was able to work my way towards three small plate meals per day. 

For the first 3-4 months after surgery I did not eat any bread or pasta. I can now eat maybe a slice of bread (I try to keep it to a minimum) and I might eat one or two forkfuls of pasta occasionally. Most of my sustenance effort goes into getting enough protein in my body. My goal is to eat 100 grams of protein and stay between 35-45 grams of carbohydrates. I prioritize proteins, then vegetables, fruits, and lastly starches. (I do love a good taco though!)

New Normal

I have a new normal now. I eat much smaller amounts than I ever have. When I go out to eat, I look at the appetizer or al a carte menu. I bring my lunch with me to work more often than not. It is just so much cheaper!

I do think about my new weight quite a bit. I want to keep my weight in my consciousness, that way I don’t slip back into destructive habits. I am very much aware that gastric sleeve is a tool and having it done does not guarantee that I won’t get bigger again. I have to continue working everyday!

Musician, Educator, Social Entrepreneur, and Blogger Rey started this blog to chronical his Weight Loss Surgery. His surgery date was July 10, 2018

3 Comments

  • Nicky

    Rey you are such an inspiration! I had my VSG in June of 2018, so we’re practically surgery twins! Though, I was much heavier at 428 pounds at my heaviest. This surgery was the best thing I ever did for myself. I live a much fuller life now, and I’m sure you can relate. Keep sharing your story and reaching people. It’s so nice to hear your history!

    • Rey Ramirez

      Twins!!! Sorry for the late reply, work had me pretty busy, but I really appreciate your comment. It is the best thing I have ever done for my health and extension of my life! Thank you for reading! Drop me an email at vsgblog@gmail.com…I’d love to hear about your journey.

Leave a Reply

Your email address will not be published. Required fields are marked *