Day 25

How did I Get Like THIS?

I always believe pictures say a lot more than words:

At 19 years old

The innocence of 19

Sultry - What can I say? Photographer boyfriend in my life at 19

Made in France - red outfit at 23

19 was a very good year

 

Top two pics are me.

At 21 in Nassau, Bahamas

With brother & sister, I am on the left early 30s

I am about 38 at Deerhurst Resort in Huntsville, Ontario

I was leaving these great ladies who taught me Spanish in 6 months. Taken in San Jose, Costa Rica. I am the tallest one and about 53. Hated this photo of me. Still do.

At - well, OLDER, dressed for Chinese New Year, 2010 This is horrible for me to look at today. See the so called 'Confidence' a FAKE. I knew I just couldn't pull IT off anymore.

I believe at one time, I was a pretty girl. But look at how I was PRE February 26, 2011. Terrible to see the gain in photos. But other than 'baring all' - I am only going to bare my heart here. I think it is a good thing, to show the REVERSE - all that ugliness falling away!

This last photo restores my dignity. Hmm, I am starting to look like my mother . . . when she was younger, of course!

Here is some great info about Bariatric Surgery:

Surgical indications 

info gleaned from  http://en.wikipedia.org/wiki/Gastric_bypass_surgery

Gastric bypass is indicated for the surgical treatment of morbid obesity, a diagnosis which is made when the patient is seriously obese, has been unable to achieve satisfactory and sustained weight loss by dietary efforts, and is suffering from co-morbid conditions which are either life-threatening or a serious impairment to the quality of life.

In the past, serious obesity was interpreted to mean weighing at least 100 pounds (45 kg) more than the "ideal body weight", an actuarial determined body weight at which one was estimated to be likely to live the longest, as determined by the life insurance industry. This criterion failed for persons of short stature.

In 1991, the National Institutes of Health (USA) sponsored a consensus panel whose recommendations have set the current standard for consideration of surgical treatment, the body mass index (BMI). The BMI is defined as the body weight (in kilograms), divided by the square of the height (in meters). The result is expressed as a number usually between 20 and 70, in units of kilograms per square meter.

The Consensus Panel of the National Institutes of Health (NIH) recommended the following criteria for consideration of bariatric surgery, including gastric bypass procedures:

1. People who have a body mass index (BMI) of 40 or higher. Or,
2. People with a BMI of 35 or higher with one or more related comorbid conditions.

The Consensus Panel also emphasized the necessity of multidisciplinary care of the bariatric surgical patient, by a team of physicians and therapists, to manage associated co-morbidities, nutrition, physical activity, behavior and psychological needs. The surgical procedure is best regarded as a tool which enables the patient to alter lifestyle and eating habits, and to achieve effective and permanent management of their obesity and eating behavior.

Since 1991, major developments in the field of bariatric surgery, particularly laparoscopy,  have outdated some of the conclusions of the NIH panel. In 2004, a Consensus Conference was sponsored by the American Society for Bariatric Surgery, which updated the evidence and the conclusions of the NIH panel. This Conference, composed of physicians and scientists of many disciplines, both surgical and non-surgical, reached several conclusions, amongst which were:

• Bariatric surgery is the most effective treatment for morbid obesity
• Gastric bypass is one of four types of operations for morbid obesity.
• Laparoscopic surgery is equally effective and as safe as open surgery.
• Patients undergo comprehensive pre-operative evaluation, and should have multi-disciplinary support, for optimum outcome.

Surgical techniques

The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed. It is estimated that 200,000 such operations were performed in the United States in 2008. An increasing number of these operations are now performed by limited access techniques, termed "laparoscopy".

Laparoscopic surgery is performed using several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is also called limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision—with the option of using an incision should the need arise.
Perhaps these doctors played a lot of video games as children! I had a vertical gastric sleeve procedure, performed laparoscopically by Dr. Allen Okrainec at the Toronto Western Hospital, and I highly recommend him as a kind and skilled surgeon. Wow - personality and surgical skills! One does not often encounter both in surgeons! 

Results and health benefits of gastric bypass

Weight loss of 65 to 80% of excess body weight (the amount by which actual body weight exceeds actuarial ideal body weight) is typical of most large series of Gastric Bypass operations reported. The medically more significant effects are a dramatic reduction in co-morbid conditions: a modifiable risk factor for cardiovascular disease due to their influence on atherosclerosis (or arteriosclerosis). In addition, some forms may predispose some to develop acute pancreatitis.

• Hyperlipidemia is corrected in over 70% of patients. (This is when a large amount of fats are circulating in the blood and become a modifiable risk factor for cardiovascular disease due to their influence on atherosclerosis. In addition, some forms of hyperlipidemia may predispose individuals to acute pancreatitis. Andrea's note) 
• Essential hypertension is relieved in over 70% of patients, and medication requirements are usually reduced in the remainder.
• Obstructive Sleep Apnea is markedly improved with weight loss and bariatric surgery may be curative for sleep apnea. Snoring also improves in most patients. (WOW, did I ever have a bad case of it, once not breathing for 58 seconds when I was sleeping!  Andrea's note)
• Diabetes Mellitus type 2 is reversed in up to 90% of patients usually leading to a normal blood sugar without medication, sometimes within days of surgery.
• Gastroesophageal reflux disease (GERD) is relieved from the time of surgery in almost all patients. This is when you  have chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the eosophagus. A typical symptom is heartburn. (Andrea's Note)
• Venous thromboembolic disease signs such as leg swelling are typically much improved. (Without some kind of treatment, patients who get a clot from this disease can suffer a stroke, transient ischemic attack (series of small strokes) or pulmonary embolism - when the clot migrates to the lungs. Andrea's Note)
• Low back pain and joint pain are typically relieved or improved in nearly all patients.

A recent study in a large comparative series of patients showed an 89% reduction in mortality over the 5 years following surgery, compared to a non-surgically treated group of patients. Concurrently, most patients are able to enjoy greater participation in family and social activities.  
(Not only that, we won't need an extra piece of seat belt when we fly to get there!)

Living with gastric bypass

Gastric bypass surgery has an emotional, as well as a physiological, impact on the individual. Many who have undergone the surgery suffer from depression in the following months. This is a result of a change in the role food plays in their emotional well-being. (I am so happy I don't know what to do with myself!)
Strict limitations on the diet can place great emotional strain on the patient. Energy levels in the period following the surgery will be low. (I am like the Energizer Bunny!) This is due again to the restriction of food intake, but the negative change in emotional state will also have an impact here. It may take as long as three months for emotional levels to rebound.
Muscular weakness in the months following surgery is common. This is caused by a number of factors, including a restriction on protein intake, a resulting loss in muscle mass and decline in energy levels. The weakness may result in balance problems, difficulty climbing stairs or lifting heavy objects, and increased fatigue following simple physical tasks. Many of these issues will pass over time as food intake gradually increases. (I do notice a bit of this. Things just seem heavier to pick up.)

However, the first months following the surgery can be difficult, an issue not often mentioned by physicians suggesting the surgery. The benefits and risks of this surgery are well established; however, the psychological effects are not well understood, and potential patients should ensure a strong support system (THANKS TO ALL OF YOU and the gang at Toronto Western!) before agreeing to the procedure. It is important for people to start changing outlooks on food & diets before surgery to avoid the shock after.
(Should you decide to go for this kind of surgery, be well prepared. Research on the internet, find out as much as you can. Knowledge is POWER!)
Blessings to all!

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Clinical Decision Support Systems: Theory and Practice