Tuesday, October 22, 2013

Weight Loss Surgery - Six Years Later (NSFW pictures)

(Generalized disclaimed that everything you're about to read are my opinions and my experiences so take them for what you may. Also, no matter how hard I try, I can't get the formatting to be consistent. Any ideas about getting the text "normal" on Blogger, aside from highlighting and then clicking "normal"?)
It’s been six years since I had weight loss surgery. (Seriously, six years! Jesus Christ, how time has flown!) I should start at the beginning, yes?

why I had it (the guest post that went viral) insane nutrition class the idea of "before & after" surgery itself shaving my head how I got to be 550 pounds the two(ish) year update why the hell naked photos of me are public

Before surgery, I was 550 pounds. I’m not positive but my guesstimate is that I got down to around 300. I (as everyone who has wls does) regained and I’m currently at 345. I know this because I get weighed every month at the pain specialist’s office. I actually regained up to 360ish but have been losing again.

It’s amazing to see peoples’ faces when I say I had wls. It’s pure cognitive dissonance. Wait..you had weight loss surgery but are still this fat? You already had wls…aren’t you supposed to be thin? Did it not work? How did you fuck it up? Are you going to get it done again?

I tell them I lost 200 pounds and they look at me differently. I can see their brains calculating and picturing my body expanding, trying to imagine what I’d look like with an addition of 200lbs on my already fat body. Suddenly my body is okay because I’ve done something to fix it. As long as I’m trying to be thin, I’m okay. Because they think I hate my fat body and want it to disappear. So suddenly I’m succeeding. Suddenly I’ve done such a great job. Go Heidi! As long as I loathe the body I’m in, as long as I deny it food, as long as I get my insides sliced up, I’m an acceptable fatty. My current weight is okay only because I’ve been fatter. My body is okay…relatively speaking.

A lot has changed in the past six years. In every single aspect of my life but especially in regards to surgery.


(I’m just going to snag and paste from various places on the internet because why reinvent the wheel?)

The Laparoscopic Roux-en-Y Gastric Bypass is classified as a "combination" weight loss surgery because it is both restrictive and malabsorptive in nature. The surgeon will staple and separate the top portion of the stomach from the bottom portion of the stomach to create a small stomach pouch. This pouch is between the size of a walnut and the size of an egg and functions to restrict food intake. A section of the small intestine is then attached to the small stomach pouch. This allows food to bypass the lower stomach, and the first part of the small intestine, reducing the amount of calories and nutrients absorbed from food.

The Physical


When the new stomach pouch has fully healed from surgery, it will be roughly the size of a tennis ball and an average meal will be about ½ to 1 cup of food. Different foods move through at different rates, depending on their consistency. The amount of food a person can eat a year after surgery varies between individuals, but most people are able to eat a couple of cups of food at a sitting. The new stomach requires several tiny, nutrient-rich meals a day supplemented with additional vitamins and minerals. The food you eat will no longer go into some parts of your stomach and small intestine that break down food. Because of this, your body will not absorb all of the calories from the food you eat.

I'll get into it further but the only restriction I have is serving size.  At six years out my stomach can hold…well, I have no idea what measurement of food I’m able to hold. I mean, let’s just use examples instead of guessing at the ounces. If someone told me their stomach holds three ounces, I wouldn’t really know what that means; I need examples to understand.

I can eat a 6” sub sandwich with a lot of veggies and be full. Other times I end up with a few bites of the sandwich not being eaten. Or being eaten and immediately realizing it was too much food. I can eat part of a chicken breast and maybe a cup or two of one veggie or another.  A yogurt and some string cheese.  A couple of smallish pieces of fish.  Some days I can eat identical things and my body revolts. A bowl of Ramen will be fine one day and have me throwing up the next. It’s beyond frustrating. Same with the aforementioned sandwich; I can’t be positive that eating the entire sandwich will end well. Coincidentally, yesterday was a vomit-y day and most of the food had to come up. We're trained to expect to eat three full meals and a couple of snacks. That’s what normal, non-disordered people eat, right? I mean, that’s what the specialists say; that’s what’s supposed to be healthy, right? But after wls, there is no real “normal.” My meals and my snacks are erratic in terms of size and time so sometimes when I say “snack” I mean “meal” and sometimes I say “meal” and mean “snack.” But it’s all semantics, really.

It’s hard to understand - really understand - that your body, no matter how badly it’s fucked with (and slicing up your organs is pretty goddamn fucked with), knows what it needs. I’ve had an eating disorder for nearly my entire life. Even before surgery, I had no idea how to listen to my body, how to trust my body to tell me what it needed. So when I eat several times throughout the day, I want to berate myself. How dare I eat more than the wls sample diets tell me to eat? I’m awful, I’m failing, I’m fucking up the surgery, how can I be this much of a failure. How dare I eat more than I “need.” And then something was said to me that changed everything.

I work with Michelle, The Fat Nutritionist, and she’s changed my entire life and my entire relationship with food. I was talking to her about hating myself for eating more often than I “should” and my terror over possibly reversing the surgery and failing this too. She said my body requires more calories than I’m able to consume in one sitting . That my 350 pound body requires more calories to function than someone who is, say, 200 pounds. That’s why I eat more often…I need more nutrients and calories than my stomach is capable of holding at any one time. Blew. My. Mind. I just thought, well I’m clearly eating too much, the surgery didn’t work, I’m a horrible person, how do I fuck up my last resort, etc.

We’re told so often that we're supposed to eat 1,200 calories a day. The end. No flexibility. No matter how much you weigh, no matter how hard you work. 1,200 calories. That’s what I learned as a child and I’ve held on to that - even when I know, logically, that it’s complete and utter bullshit. Even dieting sites tell me I should be eating 2,500+ calories just to function. When you’ve believed your entire life that 1,200 calories is your goal, giving yourself permission to eat twice that amount is terrifying. I don’t trust my body. I don’t trust my hunger. How can I? Look where that left me.

What Michelle teaches me is to learn to accept that my body knows best. My body knows what it needs from me. And even after ignoring and disbelieving that for 30 years, I can teach myself to slowly start listening to the things my body tells me. I can permit my body to eat what it needs and wants, whether that’s a candy bar or a bucket of greens. I can give myself permission to eat. I can eat without judgment or fear or shame.

The food mantra I’ve come up with and repeat to myself when I eat: My food choices are valid. I’m allowed to eat this.

But the wls makes this difficult. I don’t always feel hunger. I can wake up at 6am and not realize until 5pm that I never ate. Even then I generally don’t feel hungry; the realization often hits because I get headachey, woozy, and have trouble standing. Sometimes it’s just a matter of noticing the time and realizing, shit, I’ve not eaten in 12+ hours. That’s another thing Michelle and I work on. I set alarms to go off throughout the day to remind me to eat. Eat something, anything, just get calories and nutrients into my body. Just eat.

I’ve always said that wls is surgically induced bulimia. And if you have any kind of disordered eating? This surgery will be difficult. I still throw up several times a week. If you have an eating disorder to start with, vomiting constantly WILL trigger this shit. And hard.  It did for me anyway. For many months every time I ate, I vomited. and every time I vomited, that fucked up part of me thought of it as a success. Because the vomiting wasn’t something I could control. It happened, like it or not. So it being something that happened organically, I could write it off as not my fault, and therefore, not something I needed to deal with. I very rarely feel hunger in my stomach and when I do, it feels like failure.

Everything that happened I anticipated. In my mind, it was this or death. And god knows I have one hell of a survival instinct. Though even the stuff I anticipated ended up harder than I assumed. I knew it would cause issues with my eating disorders but that lasted longer than I thought. Changing a three decades long psychological fuck up is difficult…WHO’D A THUNK IT!?

I know when I’ve taken one bite too many because I can feel it in my chest; like my food is stuck in traffic, and there’s an intense pain in my stomach within seconds of swallowing. Sometimes I’m able to breathe through it and the pain subsides. Other times… I can tell it’s crossed the line into I’m going to vomit, like it or not, get to a fucking receptacle NOW because my mouth fills with saliva. I’d made myself throw up for so many years that I didn’t even know what it felt like to do it unintentionally.

There are some foods that are dangerous for me, in terms of getting sick. The two big ones are rice and pasta. Since they expand, I’m horrible at gauging how much my stomach will allow me to eat comfortably.

The worst thing, though, is not being able to vomit. The pain not hitting fast enough so I have to try to force the food up. But there’s a point of no return. Vomiting will stop the pain but it’s already too late, the food has gone too and I can’t get it out.

When you take medication, the meds depend on your stomach to disintegrate the pills. Your little pouch doesn’t hold enough acid to do so. The other issue is that there’s substantially less surface area in both the stomach and small intestine for it to dissolve into. This means time-release capsules need to be avoided. Also, drug dosages are affected by how quickly and thoroughly your body changes after wls. Not all doctors have knowledge about how wls affects medication absorption so, really, it’s a bit of crap shoot.


Because food bypasses most of the stomach and small intestine, most nutrients aren’t absorbed which makes taking vitamins a necessity. A lifelong necessity. Not taking them will, eventually, leave you malnourished. As Michelle stated, your body can’t eat enough to give you the vitamins it needs. And, as stated above, you can’t absorb the nutrients your food does contain.

The lower part of the stomach and the upper part of the small intestine do not participate in the digestion of food after surgery because these portions are bypassed. These sections play an important part in the absorption of some minerals (iron, calcium, magnesium) and vitamins (B-12 and B6). Patients who have had surgery need to take multivitamin and supplemental calcium (calcium citrate) every day for life. Supplemental B-12 is also required and can be taken sublingually (under the tongue) or by injection.

When you have wls, you are committing to take these vitamins forever. Forever and ever. And they're pricey!  I know many people can't afford all the vitamins necessary but we all do the best we can.

My vitamin regimen is the following:

Morning: Multivitamin, B12, Magnesium

Early Afternoon: Iron, C

 Early Evening: Calcium, D

Late Evening: Multivitamin, Biotin, Zinc

Bedtime: Calcium, D

I’m currently missing some of those but I make sure to, at least, take the multivitamins.

Allow me to point out, trying to get all of those in you in the beginning when you have a fucking walnut sized stomach is impossible. I can do it now but it took time. Especially because it’s preferable that vitamins are taken with food.

It’s called dumping because it occurs when the food “dumps” too quickly from your stomach into the small intestine. Lordy lordy lordy, dumping is not a fun thing. It happens when you eat too much sugar or fried foods, which pulls water out of the bloodstream and into the small intestine.

I almost never eat fried food (I just don’t like the taste) but have experienced dumping after doing so.  Also if the food is especially greasy,  Dumping is viewed as a really painful way to force you to change your diet. In addition to sugars and fried foods, some folks experience dumping after eating dairy and certain kinds of fats.

When I experience dumping it’s in the form of: intense stomach pain, nausea, severe diarrhea, sweating, dizziness, raised heartbeat. It also hits too late to throw up, leaving my stomach so fast that I can’t get the food out of me. All I can do is go fetal, breathe deeply and slowly, and sip water.

See what’s weird about it is how illogical it is. I can eat a candy bar with zero issue while a bowl of Special K with Strawberries causes me to be stuck in the bathroom, in agony. Just like the same amounts of food affecting me differently, the dumping can’t always be predicted. It’s frustrating.


Before surgery, I could barely stand long enough to have a picture taken of my body. A few months ago I walked 1.5 miles. Admittedly it seems to have jacked up my ankles for life but I still did it! I can walk and I can stand in line. I do wish I hadn’t fucked up my ankles because I was really hoping I could do a 5k. Rawr. Maybe I should get back on the track at the gym but take it a lot slower to start with. Because I really do want to do a 5k, damn it!


My mom used to have to help me. The shame so bad I wanted to die when I admitted that I couldn’t go to the bathroom or shower without help. Now I can stand in the shower for as long as I want. I still appreciate that, you know? I can clean myself spotless and it’s an incredible feeling.

Blood Pressure
I didn’t have any issue with it pre-surgery (which always caused the nurse/doctor’s eyebrows to raise in shock) nor do I now (which still causes the nurse/doctor’s eyebrows to raise in shock).

I didn’t have any issue with it pre-surgery (which always caused the nurse/doctor’s eyebrows to raise in shock) nor do I now (which still causes the nurse/doctor’s eyebrows to raise in shock).

Gastroesophageal reflux disease.  I would wake up with vomit in my throat, the bile burning.  I had to sleep sitting up for a long time.  I sleep a lot better now and don't experience any of the symptoms anymore.

Irritable bowel syndrome. Well, when dumping happens, it’s pretty damn close to the same thing. On it’s own, though, I no longer have symptoms.

When I awoke after surgery, my back pain was screamingly bad. So bad that it made other pain I might have been feeling inconsequential. I begged for help, for pain killers, muscle relaxants, anything. They told me to keep pushing the morphine button, ignoring me when I begged to see my doctor to approve something different. I couldn’t stand or even sit up, the pain in my lower back and coccyx being all I could feel. I suspect that lying flat on my back for hours during surgery intensified the pain I already had from a fall and an accident. 

I had to use a walker once I got home. I was still shuffling, hunched over, in agony. It lasted for months and months. I don’t know that the pain would have taken over as it did had I not been on that operating table for so long.  But I can say that having less weight on my joints after so long has had a very positive affect on my pain levels. 

It’s clear that I had surgery for reasons other than wanting to be thin(ner) but the aesthetic changes in my body are something I also have to deal with.

You know you’ll have loose skin. I mean, come on. I’ve lost 200 pounds, my body is going to change. Logically I know this but…logic isn’t always enough. You can see how my body changed. It’s not really something I noticed while it was happening but when I look at my body six years ago, I can’t deny the difference.

My body shrinks and my skin hangs. I sometimes notice the size of the space between my belly and the steering wheel. I no longer need to use a seat belt extender. I see some of my clothes fitting looser. Friends comment on the weight loss. I try to not focus on those things because, ultimately, those things aren’t why I did this. But we’re so trained by this world to pinpoint those moments above all else. The only thing I can do is follow up those thoughts with corrections. “Your body is getting stronger. You feel healthier. Take your pills. Listen to your body. Everything else is superfluous.”

So, here we go, you know what's next!  This is more terrifying than I can even express.  But I do this because people should know what happens to a body after surgery and extreme weight loss.  Though they're a little too big, I wore cupcake undies for you.  I need to fuck with my hair soon. I could have taken much better pictures but, hell, why bullshit?  Plus I have this thing about posting "bad" pictures as a way to stop obsessing over looking perfect online. The only Photoshopping done was to lighten them up enough to see and cropping.



Also, I am quite saucy these days!

The Psychological

Self Esteem
This is a tough one. 

I don’t hate who I was because who I was isn’t deserving of hate. I can look at the body I had and feel compassion. Compassion for who I was and the body I was in. How strong that body was, surviving the best it knew how.

For awhile I debated whether I was more comfortable with my looks pre-surgery than I was post-surgery. Which probably sounds ridiculous to a lot of you. But the fat bodies I see - the fat bodies that are declared representatives of beauty - are soft and round and full whereas my body is deflated and hanging. It had taken me this many years to accept my fat. And now I have to figure out how to accept a whole new body!? What the fuck, man!?

It’s strange, I often forget that I’ve had surgery. I forget how important my vitamins are. I forget about the absorption issues and have to go back and tell the doctor. I forget that this is what post-surgery bodies look like. I forget that other people experience these things too. I’m not involved in any sort of wls website or group. That’s the case because of how self-loathing so much of that space is. I had trouble with that even before I had surgery. No, I’m not going to talk about fat bodies being gross or how all fat people are unhealthy or how eating a fucking ice cream cone makes you a failure. I felt better once I stopped reading wls forums and posts. It was just so sad to me. I wanted and needed to change…I’m not going to emotionally destroy who I was and am so I can feel superior to anyone, even to the person I was yesterday.

I’ve had intense body issues from the moment I could think consciously. When I found fat acceptance my whole world became a better place. Reconciling that I loved my body but making the decision to cut it up anyway…it was a tough one. And after that I needed to accept the body I’ve had over the last 1/2 dozen years. 
I can honestly say, no hesitation, that 2013 has been the best year in terms of accepting and loving myself. My face, my body, my soul. By focusing on myself and tuning out the shit I’ve used to distract myself from doing so, things are improving by leaps and bounds. I feel myself growing and improving. My body is getting stronger and the shame much less intense. The fear of, well, everything is subsiding. I’m able to be more honest with myself and others. I work at becoming the person I know I am, the person I want to be. I’m finally reaching a point where I can believe that my body is acceptable as it is now.

I was hurt a lot over the last few years and it was beating me down. Physically, I worried my body was too ugly to want. Too abnormal. That it would be harder to find people who could “overlook” the loose skin and dimples. But I was wrong. I mean, yes, of course, there are people who have seen my photos and have had issue. But that happens with any body really. Attraction is subjective, regardless of what society tries to pound into our minds.

No one I’ve allowed into my bed in the last 10 months, no one who has taken off my clothes, has never said anything negative. I get fingers stroking my body and am told how soft my skin is and how amazing I smell. I have roaming hands and hungry mouths on my fat belly and sagging tits. I don’t get any complaints. Quite the opposite. I leave the lights on and will fuck during the day. I allow myself to be photographed and filmed because it helps me normalize my body to myself. Even at my smallest, I wouldn’t have allowed these things to happen before.

Ultimately, when you work so hard to love your body, watching that body change into something else is difficult. Like anything else, it takes time. It takes time and work and determination.  That's what I'm focusing on right now. 

99% of people in the fat/body acceptance movement supported me, understood me. The kindness was overwhelming and beautiful. They stood up for me, fought for me, told me they wanted only for me to be safe and happy. They understood my pain, my fear, my shame. And they loved me anyway.

A few people in the fat acceptance movement shunned me, one of them being someone I’d admired and whose book introduced me to fat acceptance in the first place. I lost some friends because who told me I was a hypocrite and a sell out. A fat acceptance blogger said they hoped I ended up disabled so I could be a poster child for how dangerous wls is. After surgery someone told me that they wished I’d died on the operating table so they could be right about how stupid my decision to have surgery was. They wished I’d died because they wanted to be right. Their politics were more important than my life.

Then this shit went viral. Which is the last thing I ever expected. I mean, I can barely comprehend a handful of people reading anything I write. I still can’t really understand or believe that. I very quickly learned: do NOT click on ANY referring page. Reading a single page in a forum and I was suicidal. That’s when I promised myself, never again. I don’t even bother to look at referring links anymore. 

Unfortunately that wouldn't be the end of it.  Not content with ripping me apart without my knowledge, I got ridiculous numbers  of emails and comments that made me question humanity.  I mean, Jesus, people!  However!   A lot of folks who found me through reddit, Something Awful, etc were really sweet and kind to me.  That meant a lot.  It still does.  Plus, honestly, I don't judge people having hate-reads.  If I am that for you and you keep it away from me, knock yourself out!  And I really do appreciate it when you don't try to contact me and be actively cruel.


All of it - including the questionable internet fame and the hate spewed at me - was worth it. Because, for reasons I’m not able to really understand, what I write helps others. Talking about puking and posting naked pictures. Being honest about what happens, letting you know when I fuck up, admitting my faults, what I struggle with, how I try to grow…it helps others. I try to not talk a lot about the amazing things people have said to me over the years.  It feels egotistical.  OH HEY I'M HEIDI AND I'M SAVING LIVES.  But people have said that.  And that being the case, how could I ever regret any of this? 

So, yes, no regrets.

Actually, no, wait.

Do you know what I regret? I regret that I was too afraid to grab at the opportunities my questionable internet fame laid before me. The suggestions to write a book, to write articles, to do x, y, and z. Editors, writers, agents telling me I have talent and a story that needs to be shared. It was too much for me. With the vitriol I was being bombarded with, I couldn’t handle the idea of more exposure because I was already stripped naked and scraped raw. So scared that I had somehow tricked everyone and would be exposed as a talentless fraud. Six years later and I still think that. I've never had a quote hit harder than something Maya Angelou said:

Each time I write a book, every time I face that yellow pad, the challenge is so great. I have written eleven books, but each time I think, ‘Uh oh, they’re going to find out now. I’ve run a game on everybody and they’re going to find me out.
And that's Maya Angelou talking!!

The Conclusion

In the end I  think my experience has made me even more weary of wls in general and the way it's viewed as a quick fix. This is a lot of shit to still be dealing with six years later.  But I would never take that choice from anyone.  Body autonomy and all that.  For me, this was a last resort and whatever weight I get down to while eating in ways my body asks of me and moving in ways that make my body feel strong and powerful, I'll be happy there.
If I knew that I would stay at the weight I am right now, I'd still be doing the things I'm doing. I'd still swim. I'd still fuck and love and laugh. I'd still try to become the person I know I can be.  And maybe this is where I’ll stay. Maybe 350 pounds is where my body is meant to be. And if that’s the case?   So be it.

If I could tell pre-surgery Heidi anything it would be to just hang in there.  Which is what I would always tell past Heidi.  It's hard and it sucks and will be no fun but you can do this shit, I promise.  Also, one day you'll actually watch and enjoy a football game and a NASCAR race.  Dude, I swear!

I don't want to be your "before" picture; the thing you strive to never ever be.  I don't want to be your thinspiration. But if that's your choice, that's okay, I can't prevent that.  But I’d much rather you look at me as inspiration for realizing you’re amazing and deserving as you are. That you don't need to hate yourself or hide.  That you can do what terrifies you. That you can grab onto the opportunities presented to you and run with them, no matter how afraid you are. That you can do huge scary things and still survive

150 pounds or 550 pounds, you don’t have to feel that you're not good enough. You ARE good enough. You ARE acceptable. Your existence ISN'T demanding of apology. You have NOTHING to be ashamed of. Your body does NOT make you a bad person.
The best and scariest and most amazing thing you can do for yourself is love and/or accept your body. If you haven't reached that place, try to see your body as neutral.  Look at your body and the bodies of people in your life and try to hold on to the kindness and love you feel for their bodies and give it to yours.  Be as kind to yourself as you are to others.  You would never hurt others the way you hurt yourself.  I know it's hard.  I know it's so hard it feels impossible.  But it's worth it. Even the tiniest little kindness you can show yourself counts.
Try to remember that it’s not you that’s broken, it’s society. Loving and accepting yourself in this world is revolutionary. Let's try to do this together, okay?

I decided that the most subversive, revolutionary thing I could do was to show up for my life and not be ashamed.  - Anne Lamot