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16th August 2015
I had weight loss surgery 16 months ago and I’ve had many requests from friends, twitter followers and pragmatic listeners for an update to how it’s going. How I’m doing. If it was worth it, where this flight of stairs has taken me and if that was a good destination.
To answer in that order:
- It’s going okay so far
- I’m doing fine
- It was totally worth it so far
Consider that the TL;DR and stop reading there if that’s all you want to know. Otherwise…let’s talk.
This article is broken down into the NEGATIVES and the POSITIVES. Do yourself a big favour and read through the whole lot to understand the trade-offs. It’s not as simple as you’d think.
Note: Some on this was discussed on Episode 57 of Pragmatic
Like being a parent explaining parenthood to a non-parent there will be a limit to what I can convey to you, the reader, the potential patient even, about what this surgery will do to you. It’s not for my inability to annunciate that which I have experienced, nor is it a judgement of your inability to comprehend it. Rather the language and the feelings are difficult to fully convey in this medium.
Beyond that dilemma we also have the consideration that my experiences are my own, and whilst some of the symptoms I have experienced are common and shared amongst those that have had the same or similar surgeries, there is no way I can possibly know all of the permutations and combinations of experiences of everyone that has undergone this or a similar procedure.
Noting the above points we’ll do the best we can with what we have.
I had a Gastric Sleeve (technically referred to as a Laparoscopic Sleeve Gastrectomy) which has elements in common with the older Gastric Bypass procedure but nothing to do with a Gastric Band. And yes, the Band probably should be banned…but I digress.
What A Sleeve Is
The sleeve is essentially a staple-line along the major length of the stomach and between 75-80% of the stomach (lower-back) is physically removed below the staple line. This heals and then forms a sleeve-like, tubular stomach. No other modifications to the intenstines are performed. Titanium staples are most commonly used (and were in my case) and most surgeons will use either 2 or 3 rows of staples to ensure there are no leaks.
The sleeve performs two functions: It reduces the total volume that the stomach can hold and because the food in the stomach stays in the stomach for significantly less time, less is absorbed by the body. Beyond this many patients lose their sense of hunger (more on that shortly) and the taste of certain foods change. That’s probably the next part to mention.
Everything About Food Changes
Well maybe not everything, but forget what you knew, what you thought you knew about food and start again. I used to enjoy sweet food, fatty food, lots of carbohydrates and lots of spicy food with few side-effects but now, after only small quantities (maybe 3-5 mouthfuls of carbohydrates mostly) within 2-30 minutes I feel nauseas, faint, my heart races, I feel drained and sometimes even shake and break into a cold sweat with shallow breathing.
The gotchas I’ve learned and the way I eat and what I eat is a daily relearning that I’m continuing to struggle with. What follows are some of the changes I’ve had to make in my eating habits to give you an idea of the consequences of this type of surgery.
Only Eat (don’t drink) and Eat Very, Very Slowly
That’s the age old advice: chew your food, don’t "guts" your food, don’t rush it or you’ll get a tummy-ache. The sleeve puts that "ache" part to shame. Rush it and it won’t just ache. It will HURT and HURT and HURT. I’ve learned that moment of bracing myself, if I swallow something I haven’t chewed well enough. Holding your arms up above your head helps a bit. Standing up and walking around with your arms stretched high above your head also helps a bit more.
I try to face it by pretending I’m doing an extended arm-stretch but it’s obvious after the first minute of doing it, that your arms as stretched as they’re ever going to get without deploying a torturing rack. I must just look odd to other people when I do that, but it helps with the pain.
Due to the lack of pliability of the stomach in the first few years following the surgery each mouthful of food tends to pack the air in front of it behind it like a plug. The increasing pressure exerted by this gas build-up after the first 2-4 swallows of food starts to get painful if you don’t carefully burp to let that gas build-up out. I’ve gotten a lot better at quiet-burping as secretly as possible but sometimes you just risk the embarrassment rather than take the more painful route. It’s become easier after 12 months post-op but it’s still a problem.
The other point is to only eat: meaning don’t drink a liquid at the same time as you’re eating. The liquid takes up valuable real-estate down there and can create painful pressure as the food is compacted after each swallow.
Fear Eating In Public
I’ve grown to greatly dislike eating in public. I have to take a long time to eat my food and when you’re a big surly looking bloke like me (5’11" and solidly built) and you’re surrounded by other similar people at the table, you all get the meal at the same time but you’re barely on your 4th mouthful when everyone else has finished.
But it gets worse. Many places serve food and drink together.
It’s bad enough when the others at the table (that don’t know you’ve had this surgery) look at you, your plate, back at you again and ask if there’s something wrong with it or "not hungry?" they’ll ask. What’s worse though is when the table-staff or even owner comes over and asks you how your meal was. For so many years I nodded and said fine, they’d see a cleared plate, nod, smile and move on to the next table. Now they stop, pause and look concerned.
Usually they ask if something’s wrong with your meal, if you’re feeling well, but the one that took the cake was a waitress in Miles where they don’t pull any punches: "If there’s something wrong with your meal you should tell me sooner, and I’ll just bring you something else mate…" she said to me somewhat impatiently.
Whatever you may think of customer service out West, on that occasion I explained the situation, got them to box up the food that was left and slowly ate it over the next two days for lunch. It’s not so bad the first few times, but after two or three dozen times, it wears just a teeny, weeny bit fucking thin.
It’s far easier for me to ask for a starter and say, "I’m not that hungry today…"
Also I’ve given up asking for a mains without any carbs. Good god they look at you like you’re a freaking nutcase.
Me: "No rice please." Server: "I’m sorry?" Me: "I can’t eat the carbohydrates. No rice please." Server: "Can you say that again? You don’t want rice??" Me: "That’s right. No rice." Server: "The meal comes served with rice. We can’t NOT give you rice with your meal." Me: "A glass of water then."
For the record, the dish in question had been served to me in the past at other restaurants with the rice in a separate bowl and sometimes not at all. But I’ve become so tired of asking for things like that, I just don’t bother any more. It’s not worth wasting my time trying to explain it.
Eating out? Here’s the sales pitch post-sleeve:
- Be charged a fortune for a meal that you can only eat a quarter of at most and the rest will usually be thrown away
- Be grilled by service staff about what was wrong with you or the meal they served you
- Be grilled by your friends or family about the previous item for good measure
- Take 4 times longer than anyone else at the table and feel guilty because they’re all waiting for you to finish before they order dessert
Get Used To Reheating Your Food
Because you eat slowly by the time you’ve nearly finished any hot food, it has long since gone cold. I’ve been reheating hot meals sometimes partway through eating them but that’s not always practical and in many cases it’s never quite the same after that anyway. Doesn’t seem to be any way around that one.
I wrote recently about how I’ve decided that it’s just better for everyone if I gave up Alcohol altogether. It’s simply impossible to pace yourself and be responsible behind the wheel of a vehicle post-surgery. Read that article if you want the details.
I no longer feel hungry. I can walk into a food court at a shopping center (mall) and smell the delights of a dozen of my previously favourite cuisines and feel absolutely nothing. My mouth doesn’t water. I just don’t care. I don’t feel hunger. Although recently I’ve noticed having a feeling of emptyness when I haven’t eaten for several hours but it’s nothing at all like hunger used to be. It’s more of a niggling sub-note rather than a craving starvation.
I’ve read extensively on the subject and many sleevers report hunger returning between 6 months to even 5 years post-op however for me at least, it’s nowhere to be seen.
The problem is that hunger is the bodys way of reminding you it’s time to eat. If you forget to eat you feel faint and can pass out. I nearly passed out on two separate occasions before I learned that I had to remind myself to eat by the clock. Sometimes it gets annoying.
Other items of note
- Buffets become completely pointless
- Other people talking about food becomes incessantly annoying
- Chewing becomes a chore
- You’re just ‘over’ food, cooking shows, etc.
My heaviest recorded weight was 145kg (320lb) and initial consultation weight was about 136kg (300lbs) and my pre-operative weight was 128kg (280lbs). Keep in mind I lost 8kg on the two-week OptiSlim pre-op diet which was designed to reduce the amount of fat stored in the liver and improve the safety of the operation.
I now weigh 84.5kg (186lb). That’s a total loss of about 60kg (130lbs) from heaviest to now.
I have not felt this good since I was 20 years old and yes, that’s half my current age. If I stick to protein rich foods, stay away from sugar and carbohydrates, keep my fluids up (not too much coffee and plenty of water) I feel like I could run a mile in no time at all. It truly is amazing and eye-opening just how unhealthy I had become carrying around all that weight.
My new ritual: is it time to pull another notch in on my belt today? I’ve had four belts in the last 16 months and I’m fitting in a "Large" Shirt size which is bizarre to me. I’m able to shop at "normal" and even fashionable clothing stores for the first time in my adult life.
I’ve thrown away all of my oversized baggy clothes, updated all of my internet avatars to newer photos, started riding my bike again (now I can do that with the kids!) and occasionally, just…occasionally…breaking out into a sprint.
Because I can.
Kirsten and I are discovering "fine dining" at nice restaurants on our monthly date-night, where previously we would have balked at small serving sizes, meticulous presentation and seemingly poor value for money; now we see a small but amazing tasting steak, perfectly cooked and still a touch more than we can eat actually being spot on and we can enjoy it.
Food is no longer the boss of me. I am in control. Its hold over me is gone. And good riddance.
When all that is said and done though, thinking back over the past 2 years there was one event a few months ago that brought it all home. It was stupid, silly, juvenile even. You’re expecting me to say it was something to do with my kids, my wife, my family or friends. Perhaps a compliment or dozen about how great I looked? Nope.
It was the stairs.
I take the train every day to work and have to climb three flights of stairs to get up and over to the center platform to go to work. A few months ago, without even realising it, I reached the top and I wasn’t panting, wheezing or out of breath. I wasn’t fatigued and I looked back down the stairs and realised I’d just walked up them two steps at a time.
I hadn’t walked up a set of steps like that since I was a teenager. And there it was, the last two decades of my life captured in those steps. I was alive, I was crippled for a time, now I am alive once again.
This weight loss journey I took in steps, one at a time, so now I can enjoy my life two at a time.
11th July 2015
We speak and we hear and we rely on our sense of hearing a great deal for communicating between ourselves and others. In the context of attracting the attention of other people, visually waving or jumping up and down will also work beyond yelling and screaming, but if we want to keep our signals discrete how best to do this?
In the theatre, a restaurant, a lecture, a business meeting, a gentle tap on the shoulder doesn’t disturb other people audibly and is barely visually noticable, but to do that you need to be physically next to that person. What if there was a device that you could wear that allowed other people to inaudibly tap you to get your attention but didn’t have to be in the same room?
The telephone started all of this notification stress. When it rang, large bells were hit by a hammer driven by an eletromagnet to get your attention. You could be on the other side of the house, so it had to be loud. Before long it was mobile devices, mobile phones, and of course the pager. Mobile devices didn’t have to be as loud (since it was always on your person) but bringing them into places where sound-making devices had never been taken before created hostility, frustration and resentment in social or business groups.
Vibrate to the rescue…sort of…
Manufacturers began introducing Microdrives into their mobile devices to provide a vibration when the device was not in sight. Visual indications alone (flashing lights when there is an incoming call/message) only work if the device is visible when not in use and aren’t enough. Relying on our sense of touch seems like the best solution.
Early vibration motors were very subtle but a problem became evident: our mobile devices often sit loosly in our clothes pockets, belt clips, handbags etc. In order to be certain the device got the users attention, they had to vibrate a significant amount and therefore vibration grew to be significant. Adjusting the level of vibration on the fly was technically difficult and became non-adjustable, being either fully on or fully off. That would be fine for discretely getting someones attention except for one problem.
They made noise
The problem is that making a vibration motor that used only small amounts of power, was light and vibrated vigorously enough to overcome the unreliable body contact problem had made the vibration function noticably audible. In order to overcome this, and be able to truly discretely notify someone we need a device that attaches to the body at all times. We need a wearable device. That way, the vibration function could be turned far down to a point at which it was essentially silent.
The Jawbone UP in late 2011 introduce a vibrating alarm notifier, followed by the FitBit One in late 2012. At that point the notification was restricted to alarms with no integration with smartphone notifications.
That came in late 2013 and it wasn’t very reliable. Around this time some Android Wear devices and the Pebble also were starting to integrate haptic notifications with smartphones. I wanted these devices back then. However I was heavily invested in the Apple Ecosystem at that point (still am) and as much as these devices were tempting to me, they did not integrate well with Apple devices.
In order to integrate as reliably and completely as possible with an Apple Smartphone, Apple would need to support those devices at the operating system level, or make their own wearable device. I decided to wait for that, just as I had done with the iPhone before it (I have never owned an iPod).
Finally following rumour after rumour Apple announced the Apple Watch in September 2014, but released it for sale online only in late April. I visited a store to try one at that time as I was most interested in the haptic notifications. I was suitable impressed - it’s what I had been waiting for and once finances aligned on the 21st of June I purchased my 42mm Apple Sport Watch and have been wearing it now for three weeks.
The "Taptic Engine" as Apple calls it, is simply a linear actuator which makes significantly less noise than a traditional vibration motor. It is effectively silent on it’s lowest setting and unless your ear is within an inch of the watch, it’s practically silent even on its maximum setting (so-called Prominent Haptic).
The iFixIt Teardown Step 14 shows the linear actuator in all its glory. Because it’s attached to your wrist (wear your watch so it’s snug and doesn’t slide around and you’ll only need the gentlest intensity setting) and because it’s linear, you can more easily adjust the intensity of the tap sensation to suit your personal preferences.
How I Set Up My Notifications Post-Watch
I downloaded a silent ringtone and set my iPhone volume off. Every other sound in the Settings->Sounds is off, actually. Initially I also turned off Sounds in Notification Center for 3rd party apps like Tweetbot, eBay and so on, however I found out that if you do that the notifications won’t go through to the Apple Watch AT ALL (correct as per v1.0.1 of the watchOS). In the Apple Watch iPhone app I systematically went through every account and App on the watch and set a custom notification setting for it, turning off the "Sound" option for each one. Finally the watch Sound & Haptic settings - audio off and the lightest possible Haptic setting.
Beyond this I also moved all of my alarms from my iPhone to the Watch only, since I’m always wearing it when I’m not charging it. I forward my work mobile and my work desk phone to my iPhone 6+ already, so they never ring either. I’ve muted my iPad and only turn sound up on my Macbook Air when I’m listening to music or watching video.
The big downside of a smart watch is the need to charge it every day or every few days depending on the model. Clearly this is the tradeoff we make over a standard watch for all the additional functionality a smartwatch can provide us. Most people are charging their watches overnight, each and every day. I don’t do that.
I wear my Apple Watch all day and night when I’m working the following day and use the Taptic alarm to wake me in the morning. No longer do I wake up to a loud startling noise. The tapping is enough to rouse me even from a deep sleep and having done it reliably for several weeks now it hasn’t failed me once.
It only takes 90 minutes for a full charge from flat and most mornings the watch still has a residual 20-30% charge which takes only 1 hour to top up. Hence on a work day I come in to work and sit at my desk for the first hour of the day, going through EMails, answering queries, preparing for meetings etc. During that time I’m sitting in front of my laptop and I have all of the notifications in front of me. Discreteness isn’t required when you’re looking at a screen.
On weekends I don’t (generally) need to wake up at 4:30am and thus on those occasions I charge the watch overnight. In future I have no doubt that Apple will add sleep monitoring to the watch. When that happens, that information will be a nice bonus to track my sleeping habits.
Not Exactly Misophonic
Retrospectively I’ve wondered if I was suffering from a mild case of Misophonia but that’s probably an extreme diagnosis. Our brains learn to associate emotions with sounds and when an alarm noise is heard we associate inconvenience and frustration with that noise. It’s especially noticable when the alert sound you’ve used as your alarm clock sound for years is being used by the person sitting next to you as their phone ringtone.
Over the years I’ve built up a learned memory of emotional reactions to the many different alarm and ring tones I’ve used over the years. Like the music we hear at a loved ones funeral, it’s hard to listen to those sounds again without triggering some emotional response. It’s hard to put a dollar value on how much less stressed I feel now that the notification noises are no longer part of my daily life.
Gone are the buzzes, beeps, alarms, noises and musical ringtones. No longer does my heart skip a beat when a notification alert sounds in the next cubicle, someone elses pocket, or from the next room because I know that notification can’t be for me. Ever.
I’ve come to realise that with notifications, it’s not what the Apple Watch adds, it’s what it subtracts that makes the biggest difference.
For me at least, my Apple Watch journey has been a silent journey. One that has made me fall in love with this device so much more than I thought possible.
8th July 2015
Ingest, Process, Expound (IPE) is how I like to think about the process of content creation. We ingest information through our senses, process that which we have ingested and then we have a choice about if and how to expound and express to others our thoughts on those topics.
The extent to which we each proportionate these components varies from person to person and there’s no right or wrong answer in the absolute, but each of us at different times of our lives should be cognisant of the need to balance these activities.
For example my wife and many others I know are content to read and read and read. Absorbing and ingesting so much information but after processing it all, choose to expound that information verbally only to a handful of people close to them. (Nudge nudge to my wife: start a blog please!) That works well for her and many others and that’s fine. Honestly it’s a relatively traditional approach too.
To contrast, I also follow many people on Twitter that read Apple focused articles written by Apple users that don’t use other platforms (Google, Microsoft etc) leading to misleading conclusions and when they expound they create nothing more than republished opinions, rather than processed, refined, original conclusions.
Before the Internet we were mostly stuck with one newspaper, a handful of local radio stations and a more insular selection of information to ingest. Beyond ingestion, if you wanted to expound your thoughts to a wider audience there were even more scarce options available.
Given the former no longer applies why aren’t people seeking out wider, more diverse information to educate themselves and push the boundaries of their knowledge?
Not only that it’s become possible to expound your thoughts in blogs, and podcasts that can potentially reach hundreds, thousands or tens of thousands of people.
More sources, more voices, more choices: but it’s up to you what and how you ingest and expound.
Questions to ask yourself:
- Am I ingesting too much information, and am hence unable to process it well?
- Am I ingesting too much of the same information and losing a broader perspective?
- Am I ingesting enough information to process and expound a useful, independent conclusion?
- Am I taking enough time to parse and process the information to expound a useful conclusion?
- Am I expounding my thoughts in the right way, on the right medium and to the right audience?
For me personally, I’ve taken time away from reading Twitter, Apple, Blogs and the like and I feel better for the break. I needed to rebalance for a while and it’s helped return some badly needed perspective. I’ve reshuffled the sites and blogs I read, the podcasts I listen to and broadened the information I’m ingesting.
That’s great but soon it’ll be time to get back to expounding again, but this time I’ll be focusing on the audience and method that most people care about, at least as it applies to me.
My words of caution are thus: Reading or listening to the same people, the same sources of information year in, year out, then fast-forwarding through the processing stage and expounding hastily via a blog or a podcast feels comfortable; like a warm glove in winter. It’s nice, it slips on easily, it can be popular to a niche crowd, but is it truly balanced? Useful? Interesting? Does it add value?
I can’t tell you what the right balance is though, because you have to find the right balance for you. Balance matters. In fact it matters far more than you might think.