My Gastric Bypass
answers to some of the questions you were too polite to ask


Julianne Chatelain

last updated 1 October 2003


Executive Summary

I had a roux-en-y gastric bypass on December 21st, 2001. The purpose of this surgery was to help me lose weight. When I wrote this essay on the morning of September 17th, 2003, I weighed 180, so it definitely helped. I am writing this account for the use of other people who are considering the same procedure. Feel free to skip this and read instead the most visited (per the logs) page on my web site, Asking For More Money, which will come in handy when we all figure out what industry we're going to work in next.


A Long List of FAQ

If you had a chance to do it again, would you make the same decision?
How long had you been fat?
(updated) Whose idea was the surgery?
Well then, how long did it take you to decide to have it?
What about fat acceptance issues?
(updated) Where did you have your surgery done?
(updated) Did they do open or laparoscopic?
Did your insurance pay?
What was it like during surgery and recovery?
(new) What are you eating now?
(updated) What side effects have you experienced?
(updated) What long term side effects might you experience in the future?
What are the psychological aspects of all this (in brief)?
How does the procedure work?
What are you concerned about now?
Would you be willing to correspond with other people who are considering this?


The Long Version

If you had a chance to do it again, would you make the same decision?


How long had you been fat?

I crossed the line, the "over 200 lbs" line, in 1983.

That is not to say that my life was trouble-free before. I've struggled with addictions to sugar, carbs, and fats all my life. (And as my sister says, "Don't ever say that word 'metabolism'!") However, during high school, in addition to fighting with my mom about my food, I also did lots of modern dance and backpacking. In college I swung between 150 and 170, but I rowed (well, for my dorm) and ran (long slow distance), both of which activities stressed my knees, although I didn't know that at the time. When I got up to 174 at the end of junior year my parents put me in a drastic protein sparing fast program at Scripps Clinic, which very likely (although we didn't know that at the time) further messed up my set point. In my first year of working full time I got ultra high blood pressure (stress!) and treated it with another bout of long slow running instead of drugs; it's been normal (or almost) ever since.

I clearly remember when I crossed the line: I was grappling with depression, and I figured that any place (in this case, the Country of the Fat) my parents wanted to prevent me from finding so badly might have something interesting hidden within. And I was attracted to women and lots of the most powerful lesbians in my movement were large. And I felt vulnerable, in need of armor. So for all those reasons I remember saying to myself, "what the hell," and eating five Big Macs a day, and letting my weight balloon. I figured it was like an art installation and I could always repaint (slim down) the gallery walls afterwards. Which turned out to be very wrong.

I spent many subsequent years in Weight Watchers and OA and whatnot, but I never saw the underside of 200 again. I got down to around 211 for my wedding in 1986, but people started to treat me differently as a result (not my true friends I hasten to add, but it still bugged me) and I freaked out and went up again. I spent a number of years at around 260 and still more years at 320 and finally several years at 350. I've written another essay about what it's like when people see the fat first and the person second, but if you've been there you don't need to read it. So anyway, I'd been fat since 1983.

Actually, technically, at 180 I'm still fat. But with my weight under 200, people seem to see me as a person first and only later notice that I have a large (and I believe, lovely) bottom and very womanly thighs.

Whose idea was the surgery?

I was seeing a therapist, Dr. Steven N. Broder, for something completely different. He talked to some colleagues and researched what was available for obesity and recommended this particular operation and the specific surgical team I used. He said much later, "I just didn't want you to die."

(I've just checked with Dr. Broder that it's OK to use his name. Many people in my life have expressed gratitude for him telling me something they say they wanted to tell me but didn't know how to express. Dr. Broder has helped me make a lot of life-enhancing, even life-saving, changes but this is the only one that will get a web page! I hope!)

Well then, how long did it take you to decide to have it?

At first I was totally opposed. The most cogent argument for doing it was that my knees were a mess. I'd first messed up the right knee at Yosemite in the early 80's and then smashed the kneecap on some ice in the late 80's, and having been proudly car-free for 12 or so years I'd done a lot of walking, and then when I got pneumonia I hired a trainer to help me recover and we did a lot of hills, which ended up whacking my knees further. I could only go down stairs in this really peculiar fashion, and I still know the location of EVERY escalator on the MBTA.

Even so, it took me a year to get used to the idea, and then the program I wanted had a waiting list and a psychological pre-screening and pre-operative group meetings and a requirement that you lose at least some of the weight beforehand and what with one thing and another it took several years.

I guess I should explain "one thing and another." My then partner (who has loved me at every size) was not initially in favor of me having the surgery (although he has now said that he is happy I am happy) and I couldn't get my primary care physician to refer to the group I wanted to work with and my job was absorbing and somewhat stressful. Ultimately I ended up moving, separating from my partner, changing jobs, and changing doctors before I got all the circumstances lined up so I could do this with the maximum chance of success.

What about fat acceptance issues?

I am totally committed to each of us feeling beautiful and sexy, and to rejecting society's artificial standards of beauty. I believe it's possible to be a healthy large person and except for my knees I actually was one. (All that walking! And I'd been essentially off refined sugar for years.) And I deplore the way J. K. Rowling uses fat as a marker for evil (Harry's Muggle relatives). So, yeah.

I think the thing I miss most now is that there is an informal but strong bond that large women tend to have amongst themselves. (At least here in the U.S.; YMMV.) We tend to be gentle with each other in general, and supportive on the subway with its ghastly narrow seats, and flirty at dances. (OK, I am flirty all the time, but at dances, other large women flirted back.) I'm saying "we" but I'm not in the club anymore, except in my heart. I miss that automatic closeness.

For me this was a personal decision to be able to walk more easily. I am not telling anyone else that s/he "should" have this or any similar procedure. Having said that, I don't like to be dissed for this personal choice, and if you and I are considering dating I will show you my scar right away just to make sure you can deal with it.

(In the early months I had an almost uncontrollable urge to show everyone the scar, even perfect strangers. Fortunately that seems to have passed.)

Where did you have your surgery done?

At New England Medical Center (affiliated with Tufts). The specific group I worked with is called the Obesity Consult Center. My case was initially handled by Dr. Scott Shikora, but he was called out of town, so at the last minute the surgery was done by Dr. Michael Tarnoff. Both have done a LOT of these procedures with an excellent success rate, and the nursing staff is organized to support gastric bypass patients with everything from large blood pressure cuffs and gowns to special beds...

Dr. Shikora gives a lot of credit to the whole team and says that he and Dr. Tarnoff could improve their already outstanding success rate if they refused to operate on people who were really sick (for example, unable to stand or breathe without assistance) but that their Hippocratic Oath and their responsibility as a center for this stuff both incline them to take to take the tough cases.

I like a number of things about the OCC. First of all, once they accept you as a patient, it's a commitment for life, whatever complications arise later. Or you may need to see them if you develop other medical conditions and your regular doctor isn't used to working with a "designer stomach." Secondly, the medical doctors and Registered Dietitians are also amazing and a critical part of the success of the program. I am most grateful to Dr. Edward Saltzman and Phyllis Thomason, R.D., who have done a lot of heavy lifting on my case and consistently treat me carefully and creatively and holistically; if I had a child now I'd be tempted to name it "Edward Phyllis" or "Phyllis Edward" (depending on its gender). Other patients speak very highly of Dr. Richard Siegel (whose areas of special focus include diabetes, endocrinology, metabolism, and the most advanced possible non surgical options) but I never met him because I was not yet diabetic and because by the time I got to the OCC I felt I had already exhausted my non surgical options.

And finally, the existence of some kind of psychological support, both before and after the operation, is critical. That part of my program was founded by Dr. Darrell Vogel, who passed away suddenly not long after my surgery. (Leaving us all in shock and sorrow.) Just before his death Dr. Vogel had hired Dr. Kimberly Smith, from whose leadership I have benefited profoundly. Despite being thin, both of them have (had) profound empathy for program members to the extent that I consider them honorary fat people (this is a major compliment). The program is now augmented by Beth Rontal (LCSW, background in theatre!) and headed by Dr. Izzy Greenberg (formerly of Beth Israel) who has been working with obese patients for years and whom I have found very witty and knowledgeable. People who study this stuff have said that the OCC's psychological programs are what set it apart and allow patients to take advantage of the "edge" that the operation provides. (Not everyone takes advantage of the post op support groups but keeping the weight off long term does seem to be connected somehow with coming to the support groups - and, Dr. G reminded me, exercise, and keeping a food diary. "But we don't know whether that's causative or just correlative.")

Anyway, I highly recommend the OCC at NEMC. If you are considering this procedure, definitely ask whether your surgeon has done this before and whether there is high quality medical support and pre- and post-op psychological and nutritional counseling. You will need all the support you can get.

Did they do open or laparoscopic?

I wanted open, both because I feared long hours of anesthesia more than the surgery itself, and because I wanted the surgeon to be able to see in color. Since I could have had either kind, they did as I requested. However, that was twenty months ago now, and even at the time the open operation was becoming less common. Nowadays almost all the surgeries these two surgeons do are laparoscopic, because the healing afterwards is so much quicker. They reserve the right to open you up if they run into some situation where they can't see properly.

Dr. Shikora came to visit me the next day and said, "Dr. Tarnoff made a nice short scar." True! Because it was open I have one larger scar instead of four small ones. I think it's cool looking, but I no longer show it without prompting; now you have to ask.

One of the factors in how the surgery is handled is whether you have a lot of fat in the area where they're going to operate. I remember Dr. Tarnoff coming in to meet me beforehand and patting the area over my diaphragm to see how much fat he would have to cut through. (I had also written mash notes to the operating team on my arms, which apparently cracked him up.) I have this completely unofficial private theory that they ask you to lose a bit of weight before the surgery because weight one has just put on gets stored around the liver until one's body decides where to put it, but if you've been losing recently then the area under the liver (where they're going to be stitching in a complicated pattern) is cleaner and easier to work in. Again, this is just my theory.

I am sorry that I can't remember the names of my anesthesiologists. I had been most afraid of dealing with them, and they were terrific: knocked me right out and woke me up safely.

Did your insurance pay?

Yes, Blue Cross paid for everything. I choose to pay for the support groups myself ($25 each) because I prefer to use my mental health benefits for my therapist.

What was it like during surgery and recovery?

The worst parts were related to having had general anesthesia: having to get my lungs going again (with the incentive spirometer), and desperately wanting to be free of the catheter. I used minimum morphine (whooo! morphine!) and went home on the third day.

My mom very kindly moved in with me for the first couple of weeks, and made sure I ate my Carnation Instant Breakfasts (No Sugar Added), which were all I could keep down for awhile. Because of my stomach capacity, I had to eat OR drink, not both at the same time, and meals were really slow: one CIB or three ounces of soft protein in 45 minutes. (I used to surf the net while eating.) Mom and I have totally gotten over the fighting-about-food thing and the way she follows her own medical regimen is an inspiration to me. I gave her the bed, and slept sitting up in a reclining chair (half of which was a very sweet gift; thank you Rob!).

Some of the best moments were talking to her in the mornings while she sat up for an hour after taking her Fosamax. (In fact nowadays I still try to call her while she's Fosamaxing as it's a calm time to talk.) One night I'd been talking her ear off until she dropped from exhaustion, but she popped up brightly at five a.m. the next morning and said, "OK, now tell me about John Clute's theory of fantasy." As she's a visual artist herself this was truly heroic.

At two weeks I was OK'd to drive and I returned to work. Some people go back sooner (especially if they're laparoscopy patients), others later.

What are you eating now?

First of all let's talk about what I'm drinking! It's critical to drink lots of water, but I'd been doing that for years because I feel much better when I am properly hydrated. I gave up caffeine in 1980 and I find that large amounts of aspartame make me feel sick, so herbal tea is my comfort drink.

My most important food goal every day is to eat at least 60 grams of protein. (More when I'm hiking or lifting weights.) After the protein is taken care of I eat a balanced but light diet: good fats, vegetables, fruit (or if I must, juice with lots of pulp), complex carbohydrates. I have no problems eating out; I just take some of the entree home for the next day, or order all appetizers (which is where the chefs go craziest anyway). I continue to experiment to try to figure out what makes me feel good.

A recent development is that my current sweetheart told me I was eating too many of the same kinds of vegetables (instead of a variety). Phyllis Thomason agreed and said to try to eat ALL the colors instead of just spinach spinach spinach. (But spinach is so easy!) One long afternoon I cut up a lot of different vegetables and mixed them in one portion bags and put them in the freezer so that when I am not feeling like wrestling with food I can just open the bag and stir-fry them or put them in an egg dish.

The most recent development is that I'm up a pound this morning (181! panic!) and I attribute this to the fact that I had two granola bars last night at 10pm and in addition to being rather empty calories they were sugary and my theory is that this has made me retain some water. (I always like to have a theory! Working late without the right food: this is how I put lots of the weight ON. Argh argh argh, constant vigilance.)

I can drink small amounts of alcohol (and they take effect quickly because my small intestine is higher up). Half a glass of wine is like Mardi Gras. But I also sober up pretty quickly afterwards. One of the tips I got at the post op support group was that if a gastric bypass patient ever gets pulled over for drunk driving, s/he should insist on a blood test. "Because by the time you get to the station you'll be fine." Refined sugar still makes me feel sick (heart pounding and a bit of nausea) but I find I can eat sugar-busters safe chocolate, as an occasional indulgence, if it's 70% cocoa or more.

What side effects have you experienced?

I had two problems during the first month. One of them turned out to be a side effect of the Percocet (I am indebted to my friend Margery Meadow for telling me to get off of those), and the other was that I'd become lactose intolerant. I feel kind of sheepish that it took me so long to realize that the operation was above my waist, but the part of my stomach that hurt so much was below.

It commonly happens that after the operation one's tastes in food, or the foods one can tolerate, change in weird ways. I now basically have to take Lactaid with dairy products, and during the first year I also got sick when I ate sugar, so I had to become even more vigilant about that than I'd been before. (That has receded but I think staying off refined sugar was great for me so I'm trying to stick with that.)

Between three and six months a fair amount of my hair fell out. (Not as dramatic as if I'd had chemo, but big hunks coming out in the shower or when I combed.) This was either because of the shock or because it was hard for me to get enough protein. Then when it came back in I had a whole bunch of very short hair (fuzz!) mixed with the long. I certainly fretted about this, but it wasn't dramatic enough that anyone else really noticed. And then I found a great hairstylist who gave me a multilayered cut so it looked like the odd lengths were on purpose.

Around nine months out I started to have problems keeping food down (vomiting). After a lot of tests (Dr. Saltzman was heroic here, and the most annoying was a barium series in which they kept dragging people in to see the interesting pictures without introducing them to me) we finally figured out that I was just irritating my new stomach by eating too fast. It was September and I'd figured, well, the sabbatical is over, back to eating normally. Well, I can never eat normally again (unless I want to abuse my new stomach and stretch it out).

The scariest moment was when I forgot myself (surfing the internet again, late one night) and ate a lot of dried fruit, which expanded in my stomach. I threw up some of it in time, but not enough. Finally I was in such pain for so long that I called an ambulance, which insisted on taking me to Newton-Wellesley instead of NEMC, but by the time I got there I was so dehydrated that they couldn't get an IV in any vein (and yes they tried them all). I was begging them to pump my stomach, but they weren't comfortable doing that, so they just gave me a bunch of muscle relaxants that made me sloppy for the next couple of days.

At my most recent dental checkup my dentist noticed that my new lifestyle is harder on my teeth. I'd had no new cavities for years, and now five are starting; he thinks that's because I eat small amounts of food more frequently, so there's more sugar in my mouth (especially from the dried fruit). So I'm now brushing what seems to me insanely often, and using super-flouridated toothpaste once a day.

Like many other post-op success stories, I now have interesting flaps of excess skin. Exercise will eventually tone some of it up, but by no means all (I'm 45 and This Is Life). My breasts got super flat and there's an interesting vertical fanfold pattern on my stomach, and a big reverse dimple above each knee, and even through my clothes you can see the baggy bits below the arms. Some post-op patients have (elective, self-funded) surgery to tighten everything up, but I'm just dressing around the problem.

What long term side effects might you experience in the future?

I have to take multivitamins and calcium and have blood tests every year for the rest of my life, to make sure I'm getting enough of the right nutrients. Since I'm about to live abroad I have just gotten a list of what needs to be monitored from Dr. Saltzman so I can give it to my next doctor. He also told me not to exceed 500 mg of Vitamin C a day since there is a slightly increased risk of gallstones. I also seem to recall there's a slightly increased risk of osteoporosis. (Large women have less risk because the weight pulls on their bones and keeps them strong.)

There is a risk that, if I'm not careful in what I eat, I'll mess up my stomach. It's possible, by repeatedly eating too much, to either stretch out the new stomach, or actually rupture the sewing that created it. I'm trying to avoid doing either, but I can tell that my stomach capacity has increased somewhat in the second year. (This is normal, and is why the first year is regarded as sort of magical; it's comparatively easy to lose weight. After the first year it's back to normal, that is, constant vigilance plus exercise is required just to stay at the same weight.)

What are the psychological aspects of all this (in brief, please)?

For years I got my feelings of self-worth from taking care of other people, so initially it felt weird to be taking care of myself for a change. The surgery provided an excuse to do what I now wish I had done earlier. My understanding of the importance of my (and others') feelings and needs owes a lot to my practice of Nonviolent Communication.

The support groups (pre- and post-op), in which OCCers share support and strategies and information with each other, have been amazingly helpful. I am very grateful to my friends Alison Fields and Molly Oldfield Yen who encouraged me to ask for this kind of help, and to everyone I've been in a group with.

It was my experience that when I was at my fattest, some people treated me as if they assumed I was asexual and/or invisible. Those were occasionally useful "special powers" and sometimes I miss them. (Asexuality helped me project confidence in leadership situations and invisibility made me feel safe.) So I am having to develop other strategies to get those needs met.

It's still taking time for my internal self image to catch up to where my body is now. Lots of us report that we still gravitate to the large women's racks.

I'm walking and camping and most importantly dancing again! In addition to their aerobic benefits, those activities provide a major psychological boost.

This only scratches the surface, but I'm not wanting to bore you. Changing any aspect of one's life often starts tremors in related areas and pretty soon there's an avalanche under way.

How does the procedure work?

I've never gotten a definitive answer as to why, during the first year after the operation, the weight loss playing field suddenly seems level, and progress is possible. As far as I can piece this together, the operation is just another way to reduce calories.

Because of the way the surgeons construct the new designer stomach, it fills up faster, and empties more slowly. As a result, one isn't hungry - really isn't - for the first year or so. And there's also supposed to be some decrease in absorption lower down (which may be why the blood tests are necessary).

Eventually the stomach stretches out a bit (more slowly if one is careful) and hunger returns, but before those things happen, one has lost a substantial amount of weight. And one then has an incentive to keep it off using continuing diet and exercise. As the surgeons continually remind us, the operation is just a tool to help us make the lifestyle changes that will improve our health in the long term. I wouldn't call this an "easy" way to lose weight; it's still a lot of work.

The OCC statistics are that 80% of patients manage to keep noticeable amounts of their excess weight off. Twenty percent gain all the excess weight back. As many more people have the operation we'll start to have better statistics (although I personally find statistics infuriate me, which is why I'm de-emphasizing them).

What are you concerned about now?

I very much want to consolidate the changes I've made so far. I've worked too hard to let this slip away.

Would you be willing to correspond with other people who are considering this procedure?




original contents copyleft 2003 Julianne Chatelain