Two roads diverged in a wood

Last week I got the insurance approval for my bariatric surgery which has been scheduled for mid-August. While I hadn’t talked much about it before I started the formal process for approval, I’ve been thinking about and researching bariatric surgery for several years. There is a general attitude that the surgery is the “easy way out”, and lots of people choose not to be public about their choice. While I respect that, I’m a “live out loud” kind of person, so I’ve chosen to share this with anyone who wants to know. (Kinda obvious since I’m posting it on the interwebs, LOL.) I’ll write more about the “easy way out” in later posts.

I’ve been overweight most of my life, certainly since my teen years. I stayed pretty active though, sports and cheer-leading in junior high and activities like square dancing through high school. So while I was pretty healthy, it impacted a lot of things in my life. I always felt like the Ugly Duckling and didn’t get a lot of male interest when I was younger. I never got cast as a lead in a play. I couldn’t wear a lot of the fashion trends because they didn’t make them in my size. I got teased quite a bit for my “thunder thighs”. All in all, it wasn’t as bad as some people have it, but things like that do change who you are as a person and how you see yourself.

My weight has been up and down throughout my adult life. I’ve had good success with diet and exercise for short periods of time – less than two years generally – but it has gotten harder to get the weight off with every lose/gain cycle. The time period after my second divorce and through nursing school is when my weight really got out of hand. I kept thinking that once I was doing nursing and on my feet for 12 hour shifts, the weight would start coming off. I didn’t count on developing an auto-immune condition and the associated pain, or that night shift would make it incredibly hard to eat in a healthy way. I was able to stabilize my weight during that period, but I couldn’t seem to make the changes needed to start pulling it back down. Then after I had to leave bedside nursing, my weight shot up and crossed the “shoot me if I’m ever that heavy” line.

I started thinking about surgery several years ago after a few friends of mine had gastric bypass and had good results. I was worried about such a drastic option – changing the way nutrients are absorbed didn’t seem like a good option to me. I knew several people who had the lapband, their results were dismal and there were some serious complications. I didn’t think much else about it until a few years ago when my sister had the vertical sleeve (VSG) done while she was living overseas. She encouraged me to think about it, but I wasn’t ready for anything that drastic at that time. Every spring for the last two or three years, I’ve promised myself that I am going to change my habits and if I haven’t lost some significant weight by my birthday in October, I would do the surgery. Needless to say, the weight remains. I still wasn’t ready for the permanence of the solution.

Dealing with my auto-immune arthritis had brought the issue to mind again. I started researching it again in earnest after another friend had the sleeve and has had excellent results. I started working with a therapist about my odd food issues, knowing whether I had the surgery or not I would need to address those issues. In April, my diagnosis changed from presumed rheumatoid arthritis to psoriatic arthritis, and Dr. B started talking about biologics. I had done enough research to know that biologics create issues around surgery. Namely that the decreased immune system function caused to mitigate the auto-immune condition causes slower healing and more risk of infection. So I floated the idea to Dr. B, expecting her to say that surgery wasn’t a good idea. She surprised me by being completely *for* the idea. What my research had not revealed is that the hormone changes that accompany the surgery – first with the loss of stomach tissue, then with the loss of fat cells – directly and positively impacts the inflammatory processes that are behind the damage with auto-immune. Later benefits of weight loss are less joint pain, losing the CPAP for sleep apnea, and a reduced risk of diabetes and other conditions that complicate auto-immune. The caveat was that sooner was better than later for the surgery, as once we started biologic treatment I’d have to have a much longer break from treatment in order to have the surgery than if we did it prior to starting.

That knocked me off the fence. I went the next night to a weight loss seminar with the surgeon Dr. B recommended, and started the process to get insurance approval. I’ve spent the intervening time with a series of appointments needed for a supervised diet period, my cardiologist’s clearance, a psychiatric evaluation, and my primary physician’s approval. My blood pressure has been steadily climbing since last year, but I hadn’t considered it high enough to warrant treatment. My primary doc disagreed especially after it was found to be 160/110 in her office. So we had to get that under control before surgery. Being put on two blood pressure meds has only confirmed my choice in my mind. I’ll likely be back off the meds by late fall, and potentially will be able to get off my CPAP this winter or next spring.

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

— Robert Frost