Stuffed
I have just spent the last half hour listening to my lovely Kim writhing in agony after having eaten some tuna fish with low-fat mayonnaise. Kim is trying to get back on her feed, so to speak, after gastric bypass surgery. I know it is still early days (her surgery was three weeks ago today), but she seems to be having a tough time of getting her GI system back into some semblance of comfort. This seems like it should more or less be expected since the whole purpose of the procedure is to reroute a system that evolution has put into place for the proper management of ingested food and the passage of that food through the various stages of digestion and absorption of nutrients as necessary for the body’s proper functioning. The gastric bypass gives the food the equivalent of the “Not so fast Abernathy” moment by sliding it past the stomach and duodenum, where the majority of digestion previously occurred, and puts it straight into the small intestine. The portion of the system that is being bypassed is where the hepatobilliary system feeds in the enzymes from the liver, pancreas and gall bladder that are used to complete the primary digestion of food. While the small intestine does do some food breakdown, it mostly serves as a place for absorption of food that has been largely processed by the stomach and those enzymes. The water and electrolytes in the food get absorbed in the large intestines and their function is only somewhat disrupted by the bypass. But those poor small intestines are undergoing severe shock in figuring out what in hell is going on. Kim has been on a liquid diet of broth and sugar-free jell-o for the past four weeks. That alone must be a shock to that small intestine, and now it is starting to get food that’s coming at it with full force.
Of course the good part of all of this is that a gastric bypass (even more so than the gastric sleeve or my old friend, the lapband) causes Kim to feel full more quickly and, importantly, to absorb much less of the calories and nutrients in the food. So, think of this all as a slap in the face for the small intestine. He can either say, “thanks, I needed that” or he can say, “WTF!” Right now, Kim’s small intestine seems to be less appreciative of her new program and wants to scream WTF as often as it can. This can take the form of extreme cramping, or, if its feeling particularly feisty, a rapid exiting of its contents in a manner that can only be classified as highly inconvenient. Pooping your pants was fun when you were a toddler, but is much less fun as an adult. Al Roker, the NBC weatherman, who, like Kim, had first a lapband and then a gastric bypass had a rather well-documented case of “dumping”, which is the medical term for what leads directly to pooping your pants. This Al did in the halls of the White House and helped educate a nation about the side effects of bariatric surgery.
So, there is the irony of all of this, the operation makes you feel stuffed after very little food and the reality of a little food sends you rushing to the bathroom since your system wants to get rid if it as quickly as it can. That is a proverbial one-two punch to the gut. There has been a degree of perfection in the whole bariatric field, angling for exactly this outcome. They chart their success in lost pounds and non-reversions and issues like comfort and dignity are merely collateral damage. When I look at the surgical drawings of the sleeve and bypass procedures, I find myself wondering if these things are really as revolutionary as they are being touted. I seem to remember hearing about stomach stapling as a severe correction for the obese. When you look at what happens in a sleeve procedure, it looks for all intents like a version of stomach stapling, albeit done arthroscopically. And bypass surgery has its roots in total stomach removal surgery, but became a weight loss prescriptive almost sixty years ago. The new procedure with the new technology was lapband surgery like I had fifteen years ago.
But alas, while the lapband has worked well and continues to work well for me, it never was very good for Kim or many other patients. I think it was a case of individual physiology. As for the feeling full or stuffed part of the equation, it does that quite well for me. Most of the time it is manageable and while noticeable, not extremely uncomfortable. Once in a while, some combination of factors makes it very uncomfortable. Perhaps it’s what I eat, like bread, white meat chicken or beef. Sometimes it’s the spiciness of the food (I imagine that little restricted gastric rosette puckering up and enflaming under the duress of Mexican or Indian cuisine). I believe my eating patterns affect it, for instance if I haven’t eaten much that day, it tends to object to being overtaxed. When it does happen it lasts for about 20 minutes and while vomiting can be a necessary palliative, it is most often best helped by the simple passage of time. It does put a crimp in the desire to eat, to be sure, but I always manage enough calories to keep from starving.
Actually, the lapband has caused me to be at a stable weight, give or take 3-5 pounds, for fifteen years. Only retirement and increasing my exercise through extreme yard work has taken a 30-pound bite out of my ass of late. I find the inconvenience of the occasional eye-bulging episode a small price to pay for a food consumption governance system that approximates what most normal-sized people have had built into their bodies their whole lives. When I heard about Kim’s surgical complications of removing a lapband that had become enmeshed with her various abdominal organs, I rationalized that her physiology was just not right for a lapband and assumed that my situation was simply different. I don’t know if I would feel my lapband getting twisted up in my innards, but I’m prepared to think that it is not so and that mine continues to more or less work as advertised. I have zero desire to explore the other possibilities since nothing seems to be bothering me.
I hope Kim starts feeling less stuffed soon. She has dropped about 25 pounds so far and with her mostly liquid diet and slow uptake of solid food, I presume she will be losing a lot more before her system settles down. I know it sounds funny to suggest, but for the sake of her weight loss goals, I hope she keeps feeling stuffed for quite some time and maybe forever. As a lifelong weight warrior, I know how much better it feels to conquer one’s subjugation to food even at the expense of some discomfort. I have never had much respect for food (that’s an entire theme I will not pursue here) and I can’t say I am bothered by my current ambivalence towards food. Having been slave to it for so long makes it seem only just that bariatric surgery might finally give us (meaning Kim and me specifically) dominion over our old arch-rival. For all I care, food can go stuff itself somewhere else.