September 14, 2020
So here I am in the home-stretch. Seven more days till surgery. This time next week I’ll be in my room recovering from it all.
I have decided that I’m not going to have a food-fest in these days leading up to the surgery. I just don’t want to put my body through that. I ate so much crap on Friday and Saturday and I really felt it. It’s stupid to do that to myself because it only makes me miserable in the long run. I’m going to be starting liquids on Wednesday just to try and clean my body out. I’ll have protein drinks and I’ll make sure I’m getting my nutrients. No starvation or anything. Protein drinks for breakfast and lunch and then lean protein/veggies for dinner. I’m working on my 64 oz of water and I’m still hating that but I’ll keep going. I want to be prepared for life after next Monday.
How am I feeling? Absolutely fine. I have done some panic-induced online research to find out that death on the operating table is really very rare if the patient is healthy and cleared for surgery (which I am). While I know deep-down that I’m going to be fine, there are still those fleeting thoughts “But what if I die?” I actually confirmed that my beneficiaries are set up correctly at work too . Although I’m not worried, it gives me just a little more peace of mind knowing that my shit is in order. Call me crazy. Yeah mentally, I’m fine. Emotionally, I’m fine. Physically, I’m fine. So what else is there?
Now that we’ve got that out of the way, let’s talk about depression.
I have suffered from depression most of my life and I’ve been on meds for around 18 years or so. One of my surgeon’s concerns about me having the RNY (Bypass) rather than VSG (Sleeve) is that bypass affects your body’s ability to absorb whatever you put into it. So that’s a great thing when it comes to calories and fat. It’s not such a great thing when it comes to the medications that are supposed to keep my brain healthy. That could result in some disastrous consequences. The sleeve doesn’t affect absorption because there’s no re-routing of the intestines. Bypass… well… it rearranges your intestines to “bypass” the first stretch of intestines where most of the absorption happens. So that left me with a potential problem.
It’s weird because I just assumed doctors know everything there is to know about all stuff related to health, right? No. Not at all. My bariatric surgeon was very upfront about the fact that he has no knowledge of how the malabsorptive results of bypass will affect the body’s ability to absorb antidepressant medication. What do you mean you don’t know? Certainly I am not the first patient in the history of weight loss surgery who is taking antidepressants . But I definitely appreciated his honesty. And the weird part – I talked to the psychologist about this when I had my evaluation. He didn’t know either. He knows a lot about antidepressants but not a lot about how they work after bypass. WHAT? Then I talked to my nutritionist. She didn’t know either. The I talked to my pharmacist. He didn’t know either. HOW IS THIS POSSIBLE?! My bariatric surgeon really wanted me to get a definitive answer on this so that I was making the best possible decision for myself, which I appreciate greatly! But who could answer that for me?
I did some google research on my own and did find quite a bit of information about this topic. It took a while for me to read through all the medical jargon to actually get a semi-reasonable answer. Google says YES, bypass surgery does affect the body’s ability to absorb antidepressants… sometimes. So I decided to throw out the question on some of the message boards and support groups I’m part of. The answers poured in. Some people said “No issues at all.” Others said “It was horrible and I wanted to kill myself.” Still others said “Yes and I now take them twice a day and I’m fine.” So even those answers were all over the place.
I finally talked to my primary care doctor and she referred me to the most amazing psychiatrist (MD) who was a god-send to me. I had several appointments with her and we discussed my medical history, my history with mental illness, my current medications, and my plans for this surgery. She has had experience with patients who have had weight loss surgery and her final answer was “Yes, this surgery MAY affect the levels of medication that make it in to your blood stream, and it may not.” so basically the same answers I got from google and from message boards. Because everyone is different and every brain and chemistry is different, one of the safest ways to know how my body will react is to watch and see. Not the most encouraging solution but basically, now that I’ve started treatment with her, she will be ordering periodic blood tests to measure the amount of medication in my blood stream. We will also be doing monthly check-in appointments to monitor my mental health and how I’m feeling. If I feel like I’m slipping, she’ll work with me to adjust my meds accordingly. That’s reassuring. So with that bit of information, I’m pretty confident that I’ll be able to manage my depression through this process as well. It is something to consider if you’re planning this surgery.
Apparently even if you don’t have a history of depression, after weight loss surgery, there is a period of adjustment. Moods swing all over the place due to hormone fluctuation. That’s going to be FUN! My poor husband! Many people report that they’re crying a lot and overly emotional. From what I understand, this balances itself out after 1-2 months but it’s good to be aware of it. Now I know not to panic. And apparently regret is very common soon after surgery because it SUCKS for the first few weeks. I’ve heard many people talk about this in the support groups. The beginning is tough. So it’s good to know that going in. That should help me keep my head on straight. As long as I know it’s coming, I will be better equipped to handle it.
So much to think about.
And then I got my vitamins out to try and figure out when and how many of these suckers I’ll need to take each day. Everything seems so complicated. Take this one twice a day but never on an empty stomach and only 30 minutes after your last meal and never at the same time as this supplement and don’t forget to drink extra water with this one and remember not to take this one too close to your next meal or you won’t be able to eat… Right. Got it. No Problem. I know. I know. After a couple of days doing it, it’ll all make sense and I’ll be used to it. But wow. It’s a lot to take in.
Yes – people say that this is taking the easy way out. I beg to differ. I know this isn’t a magic cure. I know I’m still going to have to work at managing my food and exercise, just like everyone else. But this procedure will give me a chance to get my head above water so I can function. I consider it to be similar to debt consolidation. I still have to pay that debt back, but it makes it much easier to make that monthly payment without ridiculous credit card interest rates. I still have to do the work but it’s more manageable.
Time will tell. I’m hoping I keep my perspective on all of this. I’m ready to be healthy. I’m ready to RUN!