I am Ken Clare, a 44-year-old white male, 6 feet tall, 238 lb, who lives in the United Kingdom. My body mass index (BMI) is 30. I am overweight, and yes, I struggle as many European men my age do with the energy intake vs output equation. This is fairly unremarkable in itself. What makes my story different is that although I have been overweight all my life, my weight reached a peak of 475 lb (BMI 64 kg/m2) in September 2002.
Here is short account of my journey from there (475 lb) to here (238 lb) and some of the work I have been involved in along the way.
My pathway toward 475 lb started with my mother, who had a history of yo-yo dieting, and my father, who was underweight all of his life-a situation that led to a loving home life wherein affection was "abundant" and typically expressed through fried food and sweet treats. My adolescence was resplendent with high-fat high-calorie snacks. As I got older, my chosen career of nursing led to unsocial hours. To compound matters, I kept making unhealthy food choices and engaging in a social life wherein the consumption of alcohol was the norm. Over the years as my career progressed, so did my waistline. Before my surgery, my diet was still high in saturated fats and calories. I would often eat take-out or highly processed convenience meals. My appetite was enormous and insatiable. I would eat at an alarming speed, and I honestly never knew what it felt like to suffer from hunger or feel satiated.
Approaching the new millennium and the ripe old age of 40 and after many abortive attempts to lose weight, I decided to take my health more seriously. I was getting sick of being overweight, both figuratively and literally. Moreover, in the United Kingdom, individuals who are obese are one of the last "safe" targets, and I hated being a "target." After talking to my family doctor, I was referred to a specialist obesity management clinic. Moreover, after 2 years of pharmaceutical, dietetic, and psychologic counseling, I was finally referred to the surgical team that would undertake my surgery.
Armed with all the information Discovery Health Channel could provide, I approached my pending bariatric operation with trepidation punctuated by excitement. I also surfed the Internet furiously but was disappointed to discover that the little information available was usually North American-specific and more often than not provided a female-slant on this surgical intervention. I am not certain if it was just my imagination or my admittedly pessimistic outlook, but many Web sites were dedicated to memorials to dead people or expound the negatives of bariatric surgery.
Foolishly, I attended my first consultation alone and entered it expecting to be offered a banding-type procedure. I knew everything, and indeed, this is the information I had gleaned from the Discovery Health Channel and the Internet. I left terrified. Although I am a registered nurse and well versed in Gray's Anatomy, the in-depth discussion of the gross anatomy of one's gastrointestinal (GI) tract becomes somehow difficult to follow, particularly when applied to oneself. I left the consultation dazed, confused, and unclear regarding which procedure I was to undergo. The next day, I called the medical consultant's secretary, who told me that I was put on the waiting list for a Roux-en-Y gastric bypass.
Before my surgery, it was explained to me that the expected perioperative mortality rate was approximately 1%, which surprised me because I believed it was probably near 50%. I also was relieved to hear that advances in anesthesia and expertise in nursing care had improved outcomes. However, even a 1% mortality rate is bad enough, especially if that statistic might happen to you. I am not a gambling man but realized that without further intervention, my mobility would decrease and I likely would be dead within 2 years.
Here I would like to take stock of the position I found myself in before my surgery. At dawn of the millennium, I weighed 475 lb (216 kg or 34 stone for those of you from Australia or the UK), my waist measured 64 inches and my chest 66 inches. My mobility was limited to approximately 50 yards aided by two elbow crutches. I was in constant pain from arthritic changes in my hips and knees-pain that was further compounded with referred sciatica. I suffered from frequent fungal infections in my skin folds and from eczema on my hands and legs. I had irritable bowel syndrome and would often pass between 10 and 15 stools each day. I suffered from stress incontinence of urine. My clothing was all purchased at premium through specialist clothing suppliers on the Internet. I was often sneered at or ridiculed by younger people on the street. It might be politically incorrect, but many UK residents believe that people who are obese are one of the last safe targets for abuse. They are free from any legal recourse or civil action. My mood was low and self-esteem nonexistent. However, I was an outwardly successful upwardly mobile middle manager employed in NHS informatics.
During the 6 months before my surgery, I found that my biggest challenge was building enough courage to tell people about my pending bariatric surgery. We have a daughter who was 12 years old when I underwent bariatric surgery, and I found that the discussion of the impending operation, specifically its risks vs my reasons for having the surgery, proved to be a particularly difficult topic for my family. My grandmother, however, a stoical woman in her late 80s, was more realistic: "Tell them to sew his belly up when they are in there."
On September 4, 2002, I underwent an open Roux-en-Y gastric bypass, with limb lengths of 1.5m each. I woke soon after my surgery in a high state of dependency. Although I was clearly aware of the pain in my abdomen, I was far more troubled by the intense pain radiating down the back of my left leg. As such, I spent an extremely agitated first night in the high dependency unit (HDU) of the hospital. As a trained nurse, I was shocked to discover that postoperative analgesia was kept to a minimum. I could clearly understand the reason for this measure preoperatively, but such pharmacologic economics immediately postoperative simply did not make any sense to me. I was in pain. The next morning, I was mobilized with assistance, and although I was clearly in deep discomfort, I found that I was extremely pleased that the nurses were giving me the opportunity to wash. More importantly, I was deeply impressed with the individualized nursing care I received.
On return to the general ward, I had all my care needs met at all times with extreme sensitivity paid to my large size and relatively helpless state. I was akin to a 475-lb infant. I received fluids well, and I soon graduated to the famous sloppy diet. Various bits of tubes were soon removed, and all progressed well. I was discharged home on the fifth postoperative day.
Home, however, presented a whole new set of challenges. The stairs, which had been a huge barrier preoperatively, now were insurmountable. The good news is that I am fortunate: my wife, who is a qualified occupational therapist, made adaptations and was able to procure every conceivable aid available to enhance my mobility and facilitate ability to re-engage in daily living activities. Community nurses attended to my needs and extracted my staples on postoperative day 14. During this time, I had acquired a wound infection, which required a course of antibiotics.
I was seen at the outpatient clinic at 6 weeks postop and was shocked to learn that that I had lost 63 lb. At that time, I was told to begin the transition to more solid food. That endeavor proved to be miserable, however, because every time I tried to eat something more solid than soup, I would immediately feel pain and wretch until I vomited and until the pain my stomach subsided. The sad fact, however, is that I believed this "recovery" was normal, how this operation was supposed work. I had no measure to know that this was not the normal sequence of events. I tried antiemetics and eventually fell back to sips of clear fluids. My dietary intake dropped below 400 calories a day, and I deteriorated. I began having visual and olfactory hallucinations, and my mood was mining new depths. In retrospect, this ordeal must have been extremely difficult for my family, because the smell of food would make me nauseous. I remember Christmas 2002-the effort of sampling a small amount of food, then spending an hour with my head in a plastic bucket, retching. As I heard the Christmas celebrations in the next room, I seriously questioned my wisdom in having this operation. Yet, in my ignorance and solitude, I still believed this was how this "magic surgery" was supposed work.
Shortly after surgery, I had vowed to my surgeon that I would build a Web site designed to tell people about his service and describe the marvels of bariatric surgery. Indeed, I knew from personal experience that the Internet is a truly enabling technology-especially for individuals who are morbidly obese. However, after the postoperative analgesia wore off and I found myself grappling with new challenges, I soon forgot my pledge to build this Web site. In January 2003, my wife reminded me of my promise. Consequently, mostly as a project to divert my attention from the constant nausea and to occupy my busy mind, I set about getting to work on building the promised Web site. After consultation with my surgeon, we agreed to offer an informational service to all bariatric patients, regardless of surgery provider or surgery type. More importantly, I knew from personal experience that I wanted to provide something to which British men could relate.
I taught myself Microsoft FrontPage and set-up an online discussion forum using Snitz Forums. The prospect of learning new skills, plus the sheer challenge of building and populating this Web site provided me with a useful diversion. With the help of a health-librarian friend, WLSInfo went online on the January 15, 2003, at http://www.wlsinfo.org.uk/. Initially, I had expected little interest in my little Web site project, but soon the trickle of members turned into a flood. Excited by this success, I used every contact and resource available to build WLSInfo. I dearly wanted to sharpen my skills to improve this service.
In late January 2003, I underwent a gastroscopy and dilation. The surgeon said there was a small stricture, and after he dilated this stricture, I felt the difference immediately. After many months, I was finally able to tolerate semi-solid food and soon graduated to solids. Along with the much-needed energy boost, being able to stomach solid foods provided a huge boost to my morale as well.
In March 2003, we set up the first of a series of local support groups to provide ongoing information and support to people in the North West Area. We decided early on that access to the support groups should be open to bariatric patients, regardless of provider and regardless of surgery.
After an admittedly rocky recovery, I finally returned to work on the fifth month postop, weighing 309 lb. I was full of energy and constantly amazed by the positive praise and encouragement I received from my coworkers. Indeed, I had chosen early on in my journey to tell people the truth about my weight loss. I realized, however, that not everyone found this topic as fascinating as I did, and I have no doubt that there were some people who thought less than charitable thoughts about me. However, on face value, people were generally supportive-and really, that is all that mattered. Indeed, I know from personal experience that bariatric patients often shoulder an additional psychologic burden of admitting they have a problem with food in the first place. Although I am sure that once one starts down the road toward a healthy weight, one will soon discover that people of all shapes and sizes have some sort of issue with food and body image.
Shopping for new clothing and experiencing increased energy and interest from the opposite sex can sometimes introduce new challenges into well-established relationships. As a middle-aged man in a happy stable relationship, my wife and I worked through the changes we encountered as a family. I have seen people emerge with new confidence and esteem levels, and this sometimes can be disconcerting for their significant others.
The first year is well documented as being the ideal window of opportunity for the Roux-en Y patient. I was fortunate to shed 227 lb in the first 12 months. I adopted healthy changes to my lifestyle and went from being almost immobile to a regular gym attendee. When I first started going to the gym, getting changed took longer than my workout, but by 12 months postop, I took part in a 5-km road race alongside my surgeon, wife, and personal trainer.
In November 2003, I was deeply honored to be presented with the Gastro-Enterology & Stoma Care Nursing Award and the Nursing Standard Nurse 2003 Award for having established the information and support Web site, WLSinfo. Still, it seems strange to me that the pinnacle of my nursing career was achieved working on a project that was unpaid, voluntary, and managed from my spare bedroom.
Life 2 years out remains a challenge. Like most men my age, I find the energy intake vs output equation difficult to balance with my busy lifestyle. Now I have a fighting chance-I can at least take part. Today, my first priority is to eat healthy foods, eat enough protein, and take care to avoid foods with more than 5% fat content. Chicken and fish are important staples of my diet. I drink copious amounts of water, and I no longer drink alcohol.
My blood serum levels of minerals and key fat-soluble vitamins are monitored regularly. I take a low-dose proton pump inhibitor, calcium, zinc, and a multi-vitamin supplement.
My digestive tract replumbing, however, still yields stools that are difficult to manage anywhere but the home environment. Steatorrhea is a common problem among the post Roux-en Y population, although many bariatric patients feel uncomfortable talking about this problem with their healthcare providers. Our Web site knows no such boundaries, however. People happily share suggestions on dealing with this and/or any other problems they face along the road toward a more healthy weight and lifestyle.
Today, as I survey the current weight loss surgery information packets and bariatric support scene in the United Kingdom, I am pleased to report that things have changed for the better. After a successful media campaign involving local and national press, radio, and television and numerous speaking engagements, Britain's health professionals and the general public's knowledge and awareness of bariatric surgery is now much greater than it was when I first started seeking information. Today, those who enter bariatric surgery consultations with healthcare professionals are armed with detailed information. They are also made to realize that bariatric surgery is not a quick fix but instead requires self-efficacy and commitment to bring about fundamental changes in their lifestyle. As a man who prides himself on keeping his promises, I started WLSinfo out of feelings of obligation. Learning how to build this Web site also proved to be an excellent coping tool that distracted me from my postoperative recovery challenges. Today, I am proud that this "distraction" has grown to include the following services to members:
[black small square]Quality-assured information online at http://www.wlsinfo.org.uk/.
[black small square]A Web-accessible library online at http://www.fade.nhs.uk/.
[black small square]Quality-assured printed information and diagrams.
[black small square]A network of support groups.
[black small square]An information and support telephone help line.
[black small square]A discussion forum online at http://www.wlsinfo.org.uk/newweb2/forum/default.asp.
WLSinfo has support from 16 groups throughout the United Kingdom and more than 1,600 members. The WLSinfo Web site receives 6 million hits per month. We have achieved national recognition for our work in what was previously an underserved community. More importantly, the NHS provision for bariatric surgery patients continues to grow. WLSinfo is now recognized as a key player in the obesity field throughout the United Kingdom and throughout the world.
The remarkable thing is that I look and feel "unremarkable"-a feeling I never believed I would achieve, and I must say, that feeling is priceless.