Pragmatic 57: Lap Band Bypass Gastric Sleeve

15 February, 2015


My wife joins me as we discuss our recent experiences with being obese and undergoing weight-loss surgery. It’s extreme but it works though it’s not without serious risks.

Transcript available
You made me laugh, stop. I didn't do anything. You looked at me, you had a laughy look. Oh, I looked at you, I'm sorry. Yeah, okay, you've got to close your eyes now. Oh, that's still funny. I just need to hold together for another minute. It's going to be 50 seconds too long. Shhh. Yes. Welcome to Pragmatic. Pragmatic is a weekly discussion show contemplating the practical application of technology. Exploring the real-world trade-offs, we look at how great ideas are transformed into products and services that can change our lives. Nothing is as simple as it seems. This episode is sponsored by Extrasensory Devices and their amazing Luxi4All, an incident light meter attachment for your smartphone or tablet. Visit for more information about their handy Luxi4All no modern photographer should be without, and to take advantage of a special discount exclusively for Pragmatic listeners. This episode is also sponsored by ManyTricks, makers of helpful apps for the Mac. Visit ManyTricks or for more information about their apps, Butler, Kimo, Leech, Desktop, Curtin, TimeSync, Usher, Moom, and NameMangler, as well as which. And if you visit that URL, you can use the code pragmatic25, that's pragmatic, the word, and 25, the numbers, in the shopping cart to save 25% on any ManyTricks product. We'll talk more about them during the show. I'm your host, John Chidjie, and I'm joined today by a special guest host, my wife, Kirsten Chidjie. Hey, sweetie, how's it going? - It's going fine, baby. Can I just apologize in advance if the whole sweetie and baby thing is sickening or yeah. - Just filter it out, you'll get used to it. - Yeah, we don't tend to use each other's names, first names, we tend to use mom or dad or sweetie or baby. So yeah. - I'm not gonna call you mom. - Oh, and you're not my dad. - Yeah, there you go. - Which is good. - Okay, good. Just clarifying that detail. - Yes. - Lovely. Well, there's a special reason that I've got you on the show, darling, and it's got to do with the procedure that we've both been through. Although we've actually been through three different procedures, but they're all related to the same thing. And that is-- - Between the two of us, yes. - Yeah, that's right. And that is weight loss surgery. And this is something that I didn't have to do much research for the show for, to be perfectly honest, because we both researched this to death before we actually had it done on ourselves. People that have been following the blog, my blog, Tech Distortion, will know that about nine months ago now, thereabouts. I posted an article, there's a link in the show notes, feel free to read if you want. And it was basically entitled, "How did I get here?" And it walks through all of the stuff. And I'm going to cover some of it again for people that haven't read the article, but I encourage you to read it for more background in my personal story. But I asked around a few people. I also put an open question on Twitter and I think also on Facebook, I asked a few other people personally if they were interested in coming on to talk about weight loss surgery with me. And I was, I guess, sort of surprised, but not surprised too much that people, I think, find it a very personal topic and they don't really want to talk about it. So... For some people, just let me interrupt, for some people, they like to keep it very secret. It's not something they discuss with work colleagues or friends. Some people won't even mention it to their family. When they're asked about weight loss, they simply say diet and exercise simply because there is still in some situations and circumstances there is still a stigma attached to weight loss surgery and we've both experienced that before our surgery but we'll we'll talk about that a little bit later on. Yeah absolutely right and I'm grateful that you're prepared to come on and talk about this because the show does have a reasonable number of listeners and it's not it's it's something that I've already put out there on the internet for me personally and I know that you sort of have on Facebook and on lots of the weight loss forums, I think on Facebook as well, groups, I guess you call them groups technically. And I realize that some of your story is out there, but there's a lot of people that may not have heard it. So I do appreciate your agreeing to come on. That's okay. I'm proud of what I've achieved in the last 18 months since I had my surgery. And if I can help one person to realize or help make the help clarify in their mind and make a decision either way, then I feel I've achieved something. Cool. Excellent. No, that's awesome. So, all right, before we get into any detail, we have to start by several big disclaimers. This is very important. One, we are not doctors. No. Nope. Make no claim to be. Check our bank accounts. We are not doctors. No, we're not. And funnily enough, when we're in a hospital a few times and we're asked, was your surgeon?" And we said, "Oh, it was such and such." And they're like, "Oh, yeah. Yeah, okay. Yeah, he's doing well for himself." So, no, we are not doctors. We're not surgeons from... Anyway, that's okay. Okay, we are also not nutritionists. Okay? So, yeah, again, nutritional advice, take with grains of salt, multiple or a whole salt shaker. No, not too much salt because it's not good for you. Actually, it's a good point. Quite right. Anyhow, so this is not medical advice in any and you need to do your own investigation, you need to speak to your own doctor, medical practitioner, soothsayer, whatever you got, do not just listen to this and then go do something extreme. This is our story, this is our situation and we are not saying go out and do this, make a decision. This is simply our story, our experience, take from it what you will. That's it. Cool. Alrighty. So, why is this a problem? Why is there such a thing as weight loss surgery? Because prior to 1950, there was no such thing. There was all sorts of different surgeries, but there was no weight loss surgery. And it really didn't become regularly practiced until the 1960s and even then, mainly in the States. So, why is this a problem? The World Health Organization recently updated their website. And so, these figures are relatively recent. Worldwide obesity has more than doubled since 1980. And in 2014, more than 1.9 billion adults 18 years and older were overweight. Of these, over 600 million were obese. 39% of adults aged 18 years and over are overweight in 2014, and 13% are obese. Now, most of the world's population live in countries where overweight and obesity kills more people than underweight. So 42 million children is another one for you under the age of 5 were overweight or obese in 2013 And their punchline in their article, there's a link in the show notes, feel free to read it if you'd like to be freaked out Is the quite rather obvious obesity is preventable How easily preventable is what we're going to talk about So everyone goes on about a few other things before we talk about the procedures First of all is body mass index This is something, BMI is actually very interesting I saw a program on TV a couple of months back that discussed how they came up with the BMI and the limits which showed what was a normal weight, what was overweight and what was obese. It was something that was created by an insurance company in the United States who were trying to skew their figures and just decided that the bulk of majority of people who were this weight would no longer be considered a normal weight and they skewed the graph so that they would then be considered overweight and they could then charge more premiums. So the whole BMI thing I think is a crock and if you speak to a lot of surgeons who deal with overweight and obese patients, they will agree. You can get someone out there who is super fit, full of muscle and according to their they would be considered overweight. And any system that can classify someone like that as overweight, the system's got to be flawed. So if you're looking at a BMI chart and saying, "Oh God, I'm overweight or I'm obese," take it again with the grain of salt and don't put too much stock in it. - Yeah, I mean, one of the problems is obviously that it's a simple calculation of height to weight and there's different numbers for whether you're a male or female but the problem is of course that it doesn't take, you know, people's build some people are very skinny build, other people are not and, you know, there's lots of other variables like you're saying sweetie about muscle mass and everything like that so a BMI is nothing more than a guide and they do have hard cut-offs but they do have them mainly because for the want of nothing better but ultimately the decision comes back to a doctor and a surgeon to make an assessment as to whether or not you really are at risk or not. So, I mean, it's been around as a measure since early to mid 1800s, and it was during the 1970s and the insurance thing happened you're mentioning. So, and I'll talk about it a little bit in the article, but if you wanna read up more about this some links in the show notes. Anyway, so BMI, that's the first thing. Second thing is dieting and the success of dieting. And I call this thing the weight loss industry for a reason is that it's an industry that takes people in, You follow all the rules and you do all the dieting fads. You take the right pills of whatever health stand, your head spin around three times, all out of the rubbish. Yeah, and what happens? Well, you just end up putting the weight back on again within one to five years. - You obviously, you lose weight. But you often find that once you start to either get to an ideal weight, or you get over it and old habits start to slip back, you start to put weight back on. You start to eat normally again, and the weight goes back on. simply because it is an industry. And sure enough, people who go on these diets, I mean, I've done all of them, you name it, I've done it. And at no point did I end up getting anywhere near a goal weight or a healthy weight. And I usually ended up heavier than I started. So that's why, like John said, it's called an industry because they expect you to fail and they expect you to come back again. - And the funny thing is that some of the times despite that they tell you they want you to come back again because that's their business. And in the same fashion in which McDonald's wants you to come back to eat more of their food, the weight loss industry want you to fail so you'll keep coming back year after year. So irrespective, some recent studies in America suggest that as many as 95% of diets fail. And when I say fail, the fail success criteria, it varies from study to study. But the idea is that the majority of the weight lost is regained within one to five years. So some of the things with gaining weight that make it somewhat, the addition of weight makes it harder to lose weight is that the extra weight you're carrying just makes it more difficult to stay fit. Carrying around that extra weight does burn more calories but your body then tends to reach a new equilibrium. It's also really hard to exercise when you reach a certain weight. The amount of pressure and stress you're putting on your joints and your body is actually doing you a lot of harm. People who are overweight will start running and find within a few weeks their knees give out or they end up with shin splints because their body's just not designed to carry that much weight and run or do seriously physical exercise. So it's a vicious cycle in that respect, is that the bigger you get, the less able you are to move and exercise, so you end up putting more weight on. So you find yourself caught in a catch-22. And the worst part is that once it affects your mobility to a point at which you can't move around, you can't get much, if any, exercise at all, then the solution in the last 15, 20 years seems to be get a mobility scooter, which of course then makes a bad situation worse. And with little to no energy then being burned at all, your weight skyrockets even more. So it becomes, like you said, a vicious cycle and it's a cycle that's very difficult to break. But it's not just because of that. It's also because food has an addictive element to it. Oh, absolutely. It's weird though, isn't it? Because people think, you know, like something like an opiate, like heroin or something like cocaine, there's an addiction to that because you feel the need to continue taking it because it makes you feel really good. But you could live without it. You could live without heroin, you could live without cocaine, you could live without those hard drugs, but you can't live without food. This is that the people get stuck on that and they're like, "Oh, we can't get addicted to something that you need to survive." The problem is that once you take the nutritional aspect of food out and put it to one side and say, "Well, I need the nutrition to survive. I don't need the sugary, fatty, bad foods. I don't need those at all." Those are the ones that are the problem. Those are the ones that have the addictive nature to them. The ones that stimulate the right pleasure centers in the brain and encourage the wrong behavior. They want to continue to keep taking them. Anybody who's ever been on a low-carb diet or a no-carb diet, which is probably if you've been overweight, you've tried at least once, you'll know that after two or three days of no carbs, you would kill. I know at one point I would have sold one of my children for a slice of bread. I was craving carbohydrates that bad. So, anyone who tries to tell you that food is not addictive has no idea what they're talking about. Yeah, absolutely. And I'd just like to add, no children were sold in that. No. No. Okay. I couldn't find anyone to take them. I just want to say, metaphorically speaking, we had an offer today. No, we didn't he offered to give us one of his oh, that's a trade Okay, anyhow, right good lovely So, um, you know bad food examples are the one that's become more popular recently that people bandy around as being horrible is high fructose Corn syrup, you know, but you know, we've also been told for years at carbohydrates, you know, they're great as a filler, you know But no, but we've also been told that in the past that fat was bad Fat was the enemy and sugar and Carbohydrates because carbohydrate of course is broken down Into sugar in the body that carbohydrates were good for us. Well studies are now finding that Fat isn't really that bad for you It is the carbohydrates that are not good for us because we eat them in such quantities and such highly processed carbohydrates flour anything made with flour pasta, potato, bread, rice, anything pretty much that's white is not good for our bodies in quite large, in the quantities that have been recommended to us in the past. Yeah, the whole food pyramid, the triangle thing. The food pyramid is the wrong way around. It's ass round, okay? It's upside down. Again, my opinion only. You're not a nutritionist. I'm not a nutritionist, but this is just based on my research and my experience. And the other thing to keep in mind also is that it's also based on some of what we're saying is based on the result of our changed eating habits as a direct result of our surgeries, which we'll get into as we progress through the episode. We are getting to our stories, we promise. Yeah, yeah, yeah. We're going to get there. Got to get there. Got to start at the beginning. This is just the way we structure this. So anyway, all right. So a few more little details before we start talking about the different kinds of surgeries the wine earth you would choose to do it. But anyway, next is the problem with our body is that we accumulate fat to store it for tough times, rough times, you know, like... Back to our caveman days when food was hard to find and there were famines and... Yeah. Yes, exactly right. Exactly. But it was never really meant for extremely long term storage. The body's simply not designed for that. And you sort of touched on that a bit before, Sweety, when you're talking about people's joints and everything. Even if you don't do much exercise and you put on a lot of weight All of that extra fat that your body's carrying will cause physical damage You'll get arthritis, you're going to have problems - Joint problems - The body's simply not designed for that And the other thing is that continued stretching of the stomach, for example If you continually stretch the stomach enough times over a long enough period of time It kind of like skin, once skin stretches as well, it never truly retracts to its original state, its original position. You take a balloon and you blow it up and then you let the air out and then you blow it up again and you let the air out. You do that a couple of times and the balloon never quite goes back to the same, the size that it originally was. And the stomach is much the same. If you're constantly stretching it and then emptying it, over time it stretches. But it's actually worse than a balloon because with a balloon, see, our bodies are also making cells to fill in. So as your skin stretches and so on, your body actually, to some extent, you know, fills in some of the gaps and and so on. And it can't restrain. There's a chemical. It's I forget the name of it. Elastin. Elastin, thank you. Yes. And it's just something people don't think about. So the problem is that once you've then stretched your stomach, It then makes it easier to overeat in the future. So, once you've done it a few times, it gets easy to keep doing it. And that's a big problem because... You can eat a bit more and a bit more and a bit more till you reach the point where you are never full. And that was the problem I had is that I never felt full. Yeah, same here. Exactly. And I mentioned that in the article I wrote is that, you know, looking forward to feeling full again, which I now definitely feel full again. That's for sure. Okay, so the whole point of that is to understand that once you go down this path, you've had too much over a too long a period of time, and then you go on a diet and you lose like 20 kilos or, you know, 50, 60 pounds, whatever that works out to, you know, ultimately, you know, it's still very easy to overeat from that point. And, you know, you are not resetting your stomach at all by dieting. You're not. So, all right. Okay, another thing just to think about before we dive in is I... Eating is actually pretty disgusting. You know, okay, hang on. Stay with me. Okay. Just think about, okay, take away taste, take away that feeling of pleasure, of feeling full, of, you know, the desire for food. You take that away. Think about it. You're taking a foreign plant or animal matter, you're putting it in your mouth. You've got a bit of saliva in there. You're chewing and grinding it up into a pulp and then you're swallowing it And then it sits in you inside the middle of your body for a while while your body tries to you know Pull any nutrition out of it And we won't go past that point because that's disgusting I guess but anyhow bodily functions beyond that So it is kind of disgusting but either evolutionarily speaking or you know Religiously speaking the body has been designed or has evolved either which way you want to choose to believe that that needs to be a pleasurable experience. So you have to enjoy eating. You have to like the taste of certain foods and, you know, taste develop in different ways. Some people will tell you that different tastes to avoid like poison. Yeah. Well, it's a defence mechanism as well. If something is doesn't taste right, there's a good chance that it's either poisonous or off or isn't going to be good for you. So that's why taste has developed. Things that taste nice are usually things that are not going kill us in certain volumes. - Have lots of energy typically as well. So the other thing is, the reason I bring this up is we're gonna circle back to this later and that is a hormone that was discovered only in 1999 called ghrelin. It's a topic of a lot of discussion in obesity and weight loss circles and talking about ways and methods of reducing the production of ghrelin as a, 'cause it's considered to be the trigger mechanism. - The hunger hormone. - Yeah, the hunger hormone. Yeah, it makes us feel hungry. Anyone who can bottle a tablet that will stop the production of ghrelin in the body will end up a billionaire. I swear, if I knew how to, I'd be onto that like a shot, trying to invent something. - Giving away a business strategy, come on. - Sorry. - Yeah. - That was our long-term goal, sorry. - Yeah, long-term, yes. - Study chemistry. - Yeah, biology. - Invent ghrelin. - Yeah. - Blocker. - That's it. - Become billionaires. - Done. - Yes. - Yeah, we're there already. Okay, good, back on track. Lovely. Don't know what house you're living in now. It's a nice special place. Anyway, okay, so... Sorry. Okay, so, several surgeries disrupt the function of this hormone, and that's why I bring it up, and we'll circle back to that as we discuss them. Okay, so before we dive into each of the individual kinds of surgeries that you can have, we've talked about the reason why you may want to consider doing this, But let's start with the first basic. This is none of the stuff we're going to talk about is free. It all costs money. Some surgeries are covered by some health insurances by some countries. It is so widely varied by country, by even state within a country. It is so hard for me to even give you any kind of advice or suggestion. But what I can tell you is that it's going to cost you something. Not necessarily. I think some countries like the UK where they have their NHS, you can get it on the NHS, but you may have waiting periods, etc. And I know here in Australia where we have the Medicare, you can go onto a wait list, but in most states that wait list is at least a year to try and get it paid for by the government. You also have to meet minimum criteria. - Absolutely, and most surgeons as well, I might just specify, most surgeons will have minimum criteria that you will have to meet if you want to have this surgery. - Absolutely, like BMIs, like you have to have a proven- - BMIs plus what they call comorbidities such as high blood pressure, high cholesterol, type two diabetes, any comorbidities that go along with being overweight and obese. - And you also have to have a proven record that you've attempted weight loss through alternative means in some cases as well. So there is a strict regulation for that. So if you assume that you may not meet some of those criteria, or maybe you shouldn't be considering weight loss surgery, but then again, nevermind that. Yeah, well, anyway, let's assume that you can't, you don't have access to that sort of, that healthcare of those waitlist options, or you don't qualify for whatever reason. The cost can range based on my research between 10,000 to about $35,000. Let's just say US dollars, just, you know, 'cause everyone knows roughly what the greenback is worth roughly. So the point is that that's gonna vary also by a hospital, by a surgeon, the type of surgery as well, 'cause each procedure is slightly different, has different costs and the cost usually relates to how long the duration of the surgery is. So shorter surgeries, usually cheaper. And of course, how heavy you are as well. The heavier the patient, the more difficult it is and more dangerous it is to sedate them. You know, so the anesthesiologist- - The anesthesiologist will charge more. - Absolutely. - Also, if you're having something like a gastric band, you have to pay, there will be an out-of-pocket cost for the cost of the band as well. So that can be a contributing factor as well. Any hardware, I think, that they may be using in the operation or in the surgery will need to be paid for as well. - Absolutely. So yeah, there's quite a lot of variables there. So first of all, I guess the takeaway from that is it's probably gonna cost you a reasonable amount of money. It's not something that, you know, and although there are, as you said, are some places that will cover it. Most won't. Okay. So, let's start with the crazy ones that are no longer recommended, shall we? Just for the sake of completeness. Just for laughs. Yeah, exactly. Laughs. Oh, geez, it's not that funny. All right. Have you ever heard of wiring someone's jaw shut? I have actually. I have. They actually did that. I've heard of someone, I heard of someone on the radio who had it done. But then I think if you're desperate enough, you'll find a way around it. Take for example Homer Simpson. He had his jaw wired shut and he put weight on simply because he put everything through a smoothie. So, with a lot of things, if you're really like any addict, you'll find a way around things, which I will talk about a little bit later. Yeah, that's right. So, anyway. So, yeah, jaw wiring because one pair of pliers and it's defeated, It's kind of considered to be a bit, yeah, no. So, and that obviously works by preventing food going in, but like you said, access to a good blender and a straw and that's defeated anyway, that plus the ply. So, you know, side cutters, whatever you wanna use. Hopefully not a blow torch. Okay, stomach balloon. That's another one. - That one actually has, I've seen recently, some people have actually had quite good weight loss with it. It's something that sits in the stomach, stops you eating as much and therefore, and also slows down the digestion. And it can be quite effective, but again, if you've got quite large amounts of weight to lose, it can be, I've seen it used short-term to get someone's weight down enough so that they can then qualify for this surgery. - Yeah, and that's exactly the point, is that originally it was suggested as a long-term potential weight loss technique, but it tended to only work for short periods of time. Like in terms of measured in months, not years. - Yeah, exactly. - Yeah, but which is now why it's only really used exclusively to, or almost exclusively as a method of reducing your weight to make the actual surgery you're getting safer to perform. 'Cause obviously the lighter you are before the surgery, the safer the surgery is. - Which may seem like a bit of a irony there where you've got to lose weight so you can have surgery, so you can lose more weight. But surgery has its own risks. The heavier you are, the more complications and the more at risk you are. So if they can get you to lose a little bit of weight before surgery, before having the full-on procedure, the full-on weight loss surgery, the safer the surgery will be. - Yeah, and there's even surgeons that will say, "I will not do the surgery until you are less than this." - Absolutely. - 'Cause it's just too dangerous. Because you gotta realize it's gonna put up their premiums and it's gonna put up their health. If you die... It's bad for their stats if you die on the table. Yeah, exactly. I mean, apart from the fact that you'd like to think they weren't all callous and only cared about their statistics, which, you know, I'm sure there's some out there that are doing that. Maybe that's why they get their money before surgery, in case you park it on the table and you're not going to pay them. And that's a pretty morbid thought, and I'm not going to pursue that any further. Yeah, thanks for bringing that up. Yeah, great. OK, cheers. Lovely. OK, now you were... God, lovely. OK, now you were telling me before, you know how to pronounce this word, Jujilinil, Julianna. Ju, no. All right. There's this, there's a bypass thingy method thingy called the- Lots of Js in it. There'll be a link in the show notes anyway, but it's, it's it's pronounced, that was Marco's suggestion when I couldn't pronounce. Ju, no. No. Yeah, okay. Janunilil, whatever, bypass. Okay, I'm mangling that. It was actually the first kind of weight loss surgery ever performed, and it was done at the University of Minnesota, actually, during the 1950s. And the idea is that you disconnect the outlet of the stomach and you reconnect it with part of the intestines further down. Essentially, well, hence why they call it a bypass. So, the idea is that you essentially remove a section of the intestines from- Small intestine. Yeah, from actually being able to process the food. So, you can't absorb anything. You basically bypass a portion of the small intestine that absorbs food. So, therefore, you're absorbing less. Yeah. It seemed like a good idea at the time. Yeah, it seemed like a good idea at the time, except there are a little few complications. First and obvious ones were diarrhea. It caused a lot of problems with vitamin A deficiency and that leads to night blindness, which is probably not good. Also vitamin D deficiencies led to osteoporosis in quite a few cases. A lot of people developed kidney stones after the operation, but the big one, the bad one was toxic overgrowth of bacteria in the bypassed section because of the lack of use of that section which then of course could cause liver failure, arthritis, skin problems and just essentially constant flu-like symptoms. So most patients required the reversal of that procedure. It's no longer recommended and it's therefore rarely performed anymore. So, they then refined that technique and evolved that technique to what's now become the Ruan Y gastric bypass, or some people just call it the gastric bypass of which you have had, darling. I have had. And we'll get to that a little bit later on. But before we do, I want to just quickly talk about our first sponsor, and that's Extrasensory Devices. Now, Extrasensory Devices are an innovative company based in Palo Alto, California, and they've recently released their all-new Luxi4All, an incident light meter attachment for your smartphone or tablet. If you're a photographer that likes to take the best possible shot, or even if you aspire to be a better photographer, then precise control of your exposure is critical, and to figure that out, you need a reliable, accurate light meter. Now, stand-alone light meters can cost upwards of $100. They take up a lot of space in your camera bag or any other bag you may choose to be using. 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Okay, a little bit of history of Roux-en-Y but because of the order in which everything happened to you personally, I think we might, we'll just cover them quickly as in what they are and then we'll talk about what we had done. Yes. Okay, lovely. Okay, cool. So, I mentioned in the 1960s it started evolving and it really sort of settled on its current form the Roux-en-Y gastric bypass in the 1980s. The technique since then has been pretty stable. And as a result, the effect of the procedure is now very well understood. There's a large body of people that have had it done and people know. - They've had it done for quite a long period of time so they know what the long-term effects and implications of the surgery are. - Yeah, exactly. So it is now the world's longest running bariatric procedure. And you'll hear the word, well, we'll say bariatric 'cause of course that means relating to the stomach and intestines and so on and so forth. Anyway, there you go. Okay, so just a little bit quickly, sweetheart, would you like to describe what they do with a Roux-en-Y gastric bypass? - Okay, a gastric bypass is basically they create, the surgeons go in and they use titanium staples to create a small pouch about the size of an egg, a chicken egg, and they also bypass about a meter or so small intestines. Everything stays where it is so nothing gets pulled out. So the rest of the stomach and the metre of bypass small intestine stays in the body. They bring up the small intestine, attach it to the new pouch. So you not only are able to eat a lot lot less. You also get what's called malabsorption. So you have less nutrition, less things like fat and sugars going into your body. This can cause problems. You have to be very careful with malnutrition of certain vitamins and minerals. So taking multivitamins and having regular blood tests after the surgery is very important to make sure you're not deficient. People have been known to die from not keeping an eye on it and from ending up malnourished from certain things. It's true. Really sell on it though. Oh, look. I know, it's a risk. It's a risk. You need to know the risks and you need to know that if having this procedure done, you'll probably be on multivitamins and regular blood tests for quite possibly the rest of your life. Yeah, it's funny though, just on that point, because some people have said, because I've I've talked to other people about this as well. And you know, their response, "Oh, I couldn't do that." And the funny thing is that a lot of people are already on multivitamins as it is. And a lot of people should probably have blood tests done to check their vitamin levels anyway. - Even if you have blood tests every six to 12 months just to check things like cholesterol and liver function and whatever else they test for, drawn a mental blank there for a moment, You should still have blood tests regularly anyway A friend of mine at work, for example, always had runny nose And got a blood test done years ago And they found he was deficient in some vitamin I used to know what it was Anyway, he took supplements and it just cleared it up So I mean, sometimes people have got these things And there's anemia and all sorts of things Maybe you need iron tablets So it's not as bad as it sounds But it's something that you have to go into with your eyes open If you're not currently on, you know, taking vitamins and stuff like that then you might sort of like scoff a little bit at it, but in any case. All right, cool. So that's just quickly the Roux-en-Y bypass. The next one, a lot of people have heard of this one, but it's actually not something that's done anymore, and that's stomach stapling. So stomach stapling was sort of a briefly tried concept and it started in the 1970s, and it uses a combination of stapling and fixed gastric banding, and it sort of creates a small pouch like the Roux-en-Y pouch, but it maintains everything else. So there's no interfering with the bowel or anything like that, or the exit of the stomach or anything like that. The long-term weight loss results, however, weren't as good and there's a very high rate of erosion of the fixed gastric band section of it. And as a result, the procedures essentially is no longer performed or very rarely performed. So people will say, "Oh yeah, you got weight loss, "you got stomach stapling." It's like, "Oh no, that's sort of like," well, no, that's what they used to do. And all these different terms you might hear sort of bandied around. I thought it was worth mentioning that one because I've heard that used quite a lot. And a few people say, "Oh, do you get stomach stapling?" I was like, "Oh, no, that was a 70s thing." OK, right. So the next one, it's sort of the order of these two is a little bit bit fuzzy because one came after the other, but the other came in terms of popularity after the other. That's actually really confusing now that I think about it. You've confused me. Fantastic. Good. That's what I'm going for. Good. No. All right. Lovely. So, let's... Goddamn. Okay. Let's start with the band. Oh, yes. The gastric band. So, Professor Dag Halberg in 1985 applied for a patent into an adjustable gastric band in Scandinavia. But he was not actually the first work in the area and he, although he's attributed with inventing the lap band as we know it today. Now, that's a long time from that patent to the first human trial. So the first human trial was actually in 1993 and up until that point, it had only been tried on animals. That's poor animals with weight problems. Yeah, it always seems strange, but anyway, all right, never mind. So yes, it wasn't approved by the FDA in America until 2001. So there's actually quite a large gap between when it was first suggested and patented, it was tried in a person, then it was essentially approved for use for the general popular. The lap band, as these techniques go, is relatively recent. Because you had one of these, darling, maybe you should explain how it works. The lap band, laparoscopic band, basically it wraps around the top portion of the stomach, creating a small pouch so that you can't eat much. If you do eat too much, you end up bringing up anything, you bring up or spit up food. Yeah, the sink gets clogged up and it backs up a bit. So imagine when you have the sink and you pull the plug. If you get something in there that's too big to go down, it blocks up your sink. Same thing happens in your stomach. That's why you have to chew your food very, very well. have to have small pieces and certain foods are completely off the list. So they're adjustable. And it's adjustable so they can increase how much restriction or how big that plug hole is basically. And there's a small port with a tube that they usually place sort of either above your ribs or in your abdominal wall. And you have to go in for an adjustment which that way they use a needle and just insert fluid. Now, enough, as little as an eighth of a mil, which is tiny, is enough to push you either too restrictive where not even your saliva goes down or no restriction when a T-bone steak will go down. So, it can be very finicky trying to find what's called that sweet spot and that has led to problems, which I'll talk about later. So, with the needle to gain the fluid in and out, it's not particularly special. It's not painful. No, it doesn't hurt. It's not painful at all, because that port is actually quite close to the surface and that's something that can be done in the doctor's office in 30 seconds. Yeah. It's just how much restriction it then provides, because like I said, an eighth of a mil is enough to be too much. - So, yeah. - All right, cool. Okay, so the last one I wanna talk about is the gastric sleeve. - Or sleeve gastrectomy. - Sleeve gastrectomy, yes. Anyway, the point is, it's nothing at all like a sleeve. This is the thing, when I first heard it, I'm like, oh, they put like a sleeve around your stomach or something? That's kind of-- - That'd be cool because then it'd stop your stomach expanding and eating too much, but no. - Yeah, but then of course you probably have problems erosion and all sorts of other things right? Yeah we'll talk about that later too. Yes indeed. So okay anyway right so no the reason it's given that name I think predominantly is because it makes your stomach look like it's a sleeve you know so it takes the stomach as you would ordinarily see it and again there's some links in the show notes if you want to check out the details of each of these individual procedures and it'll show you far better pictures of the stomach than I can ever hope to describe with words. And if you google it you can see some pretty cool cartoons and recreations You can find the gory stuff too You can even find the gory stuff Heck, you can see the gory stuff on TV sometimes You like watching that stuff too I do, I do, yes John can't stand watching it No, no, not my thing Totally not, but that's ok That's why I'm an engineer and not a doctor, just so you know I know before his surgery I kept saying "Look sweetie, look sweetie, this is what they're going to do to you" and he just went "Nah, I'm going to bed" and the next room was a safer place for me for me. The door shut and his headphones on. Hey, it wasn't quite that bad. I have my fingers in my ears. It's perfectly normal. I'm just saying. Yes, darling. Okay, good, lovely. Moving on. So, Gastric Sleeve. First try to 1993. Yeah, quiet you. And okay, first try to 1993. So about the same sort of time as the band was actually, and that was by Douglas Hess and Pierre Marceau. And it was originally intended to be the first stage of a two-stage weight loss procedure for extremely obese patients whose BMIs were greater than 58. That's pretty extreme, that is big. Now where the risk of performing the Roux-en-Y bypass was considered to be far too great on the first attempt at surgery. So the idea was you do the sleeve, drop some weight and then convert that sleeve into a bypass, a Roux-en-Y bypass, which is then much safer to perform. But by the time they got to 2003, they'd done enough of these two-step procedures to realize that, in fact, most people lost most of their weight just on the first procedure and it wasn't actually required for the vast majority of people to go to the ROMY bypass and so they simply left it alone. They said, "Okay, it's working. We don't totally get why, but it's working, so thumbs up. We'll leave it alone. Why risk additional surgery if it's working?" So anyway, the technicalities of this surgery, just the idea is that they have a staple line along the entire length of the stomach, the inlet and the outlet of the stomach are left untouched essentially. And they basically just remove-- - About 80%. - Yeah, 75 to 80%, depending upon which doctor you wanna talk to, which site you wanna look at. It's roughly that kind of range. But let's just put it this way, most of it, the bottom half of it, of the stomach. - Bottom half, back half. Back bottom... [Laughter] Kind of similar. I'm not... Did we preface this at the beginning by saying we weren't doctors? [Laughter] I just said, go Google it and have a look at it because you'll see that they create like a sausage or a sleeve shape. That's it. Yes. Indeed. A sleeve you cannot put your arm in. Anyway. Yeah. Okay. Lovely. I didn't need that visual. Thanks, sweetheart. Oh, you're welcome. Anytime. Okay. Good. Lovely. The whole stapling thing actually on that topic, I've got some really great links to this stuff. There's a great article that shows the PDF, it's the science of stapling and leaks. It's all about stapling procedures in medicine going back to the 1800s and showing the evolution and all the different statistics behind the tests they've done between single line, two line and three line staples. Our surgeon for example, darling, goes for the three rows approach. Although, interestingly, I read in the article that they said in the article that in their studies they found no specific improvement going from two to three. Improvement from one to two, but not two to three. Irrespective, a lot of surgeons still insist on the third row because it's, I don't know, makes them feel better. I don't know. In terms of, they swear by, "Oh, there's less risk of a leak." Because obviously leaks are the biggest risks in these surgeries. I mean, apart from, you know, in secondary infection and so on. Yep. So anyway, all right. The staples that they use, as you mentioned before, titanium, because titanium is non-ferrous, which means if you go to an MRI later on, they're not going to be ripped out of your body, which would be generally an unpleasant thing. Have you remember that episode of House where the guy had a bullet and it was a certain kind of bullet and... That's right. Yeah. And it went and destroyed the MRI. Sucked out of him. Yeah. Yeah. And House is like laughing, thinking it was the most hilarious thing ever. - It's probably not as funny if it was titanium staples in your stomach though. - No, anyway, so yeah, not stainless steel anymore. We go titanium. And the other benefit of titanium of course is it's used widely inside the body for all sorts of things like pins as well, because it doesn't get attacked by the immune system pretty much. I think there's a very, very small percentage of people for which it's a problem, but essentially it's practically zero or close enough. It's a very hard wearing too. So you put it in, you're good forever pretty much. Anyway, well, I say forever, forever being the standard lifetime of a person. So it's not really forever. - Oh yeah, moving right along. - Okay, come on, let's run, I got to focus. Okay, lovely. So we've now reached the point and now comes the part where we get to talk about our specific little procedures. (laughing) So you first, Swenney. Okay, I've been overweight my whole life. I got put on my first diet when I was 10 by my swimming coach. Sort of set me up for failure from that point. But like I said, I'd tried everything, Jenny Craig, Weight Watchers, OptiSlim, you name it, I tried it. I was still overweight, still obese. Anyway, 2008, after we had our third child, I decided I was going to have a lap band put in. I figured it was reversible, that way if I got down to my, when not if, but when I got down to my goal weight, I could have fill out, there was no cutting, there was no parts of my body being removed. So I had the lap band put in and over the course of about 12 months, I lost about 40 to 45 kilos. How I actually did that was not ideal. I would, something you'd eat one day and would have no trouble eating, the next day would get stuck and you'd be in pain and trying to drink soft drink to try and clear the blockage. Like I said, the sinkhole would get blocked. That would then cause inflammation, which meant that even once the blockage was cleared, there's a very good chance that you wouldn't be able to swallow your own saliva for a couple of days. dehydration was a very big risk, especially in an Australian summer. So I lost, yeah, 40 to 45 kilos. And I managed- Can I just say that's a hundred pounds by the way, for those people in North America. I wondered why you grabbed your phone then. So yeah, about a hundred pounds. And so I hit about 85 kilos. But I was pretty much living on flavoured milk and cuppa soup, because that was all that I could get down. Can we talk about the spit-up cups? All right. Okay. When I'd have something and it would get stuck, I would have soft drink and it would come back up and I used to sit there with a cup beside me, a rather large cup, and I'd spit up into it for the next half hour to an hour. And occasionally I'd forget that I had the cup there and it'd sit on the couch. And it was not pleasant. It was basically not a pleasant experience. It meant going out to eat was a horrible, horrible experience. Couldn't sit down and eat with the family because you'd have to concentrate so much on chewing and taking small bites, otherwise it'd get stuck. All it takes is a distraction. Yeah. It's like, because when you're having a conversation, it's like, "So what do you think, Kirsten?" And in that split second, you're just like, "Right, that's it. I'm going to have to respond to this person." And you swallow, but you haven't chewed enough and it gets stuck. And then you're like, "Oh, crap." And then you're in pain for the next half hour and your mouth is, you're salivating basically trying to get rid of this blockage. And it was a horrible experience. I think by the time I reached that 85 kilos, I would have been considered as having an eating disorder because I would eat stuff knowing that it was going to come back up again, knowing it had no chance of going through. But I was hungry. This was the problem. I was still hungry. I still needed to eat. Because that's the problem with the band is the band doesn't prevent hunger. All it does - It stops how much you can eat. - That's it. And my surgeon actually said when I went and saw him about my bypass, he said, he would not do a band anymore because it does not address that feeling of hunger. He said, he feels bad about how what the band did to people is it restricted what they could eat and how much they could eat, but it didn't take away the hunger. And you sort of think about when you get hungry, that is your body's trigger to eat. And anyone who's overweight and obese, when they get really hungry, they will gorge and they will binge. And that is the worst thing you can do when you've got the band. So anyway, okay, I got down to 85 kilos, got there for about a month. Then we had a miscarriage and my head was not in the right place and I fought the band. And by eating stuff I knew I shouldn't have and bringing it back up again. And as a result, my band slipped. And this can actually be quite common with the band, is that either the stomach ends up going back up through the band or it slips. Although the surgeon stitches it in place, sometimes you can put such pressure on it when you are throwing up or bringing stuff up that the band will slip. And so for three weeks, I was extremely uncomfortable. I could barely eat or drink. I had acid reflux every night. And I went and saw my surgeon and he put me back in the hospital and he repositioned the band. Anyway, within a month of having that band repositioned, we felt pregnant again. and when being pregnant I got morning sickness. So I never had any fill put back in my band while I was pregnant. So over the course of the nine months, I put all of my weight back on plus probably a little bit more. So that by the time I had the baby in September, 2010, I was back to where I was, if not heavier. Anyway, after we had that baby, I got diagnosed with postnatal depression and there was some other stuff going on in my life that I won't go into. But I was depressed and part of that depression was eating and was in a very, very dark place. So 2011, 2012, I tried to go back to Weight Watchers again, but by this stage I'd hit 140 something kilos. And Weight Watchers, I managed to lose seven or eight kilos, got to 136 kilos and just couldn't. The prospect of losing another 50 or 60 kilos just through diet and exercise just seemed like an impossible task. So January 2013, we went on a bushwalk down at O'Reilly's. I like to call it the death march of 2013 because it was horrible. It was horrible. Nearly killed you. It nearly killed me. It was downhill all the way, which was fine. Coming back up, however, 10 steps, I had to stop. I could have killed John quite easily at any point along that death march. Well, you kind of looked at me like you were going to. Oh, look, there's a photo there. It looks pretty killed. I would have been dead. There's a photo there. And you can see in the photo that I am not a happy camper. I am not happy. Anyway, I was 140 kilos and hauling around that much weight is hard. Anyway, it got to a point in June 2013 where John and I sat down and one of the things I will say is that most people who opt for weight loss surgery have a watershed moment or a low point. And for me, it was when John and I sat down one night and we sat down and ate a dinner box from Macca's designed for four people. We ate it between the pair of us and then had dessert afterwards. And I was at the time, I wasn't thinking, but I woke up the next morning and I went, I was disgusted with myself. I was horrified. And I literally woke up next to John, opened my mouth to say I wanted to get more fill in my band and I opened my mouth and out came, I want to get a sleeve done. I want a gastric slave. So, obviously there'd been something ticking away in the back of my mind for the last few weeks or months that subconsciously I had decided that the band was not going to work for me and I had written it off. Oh no, actually I forgot to mention there. Yes. That I discovered with the band that if you take too Neurofen Plus half an hour before you eat, everything goes down. Yeah, because it... It reduces the swelling. - And my dietician actually mentioned that people discovered alcohol also had the same effect. So people with the band were discovering that they were ending up with alcohol problems as well, simply in an effort to try and eat. - And not to mention the side effects if you're on the norepinephrine path, that has to your on your, your liver and your kidneys as well, I think. - There's a reason why they say, do not take for longer than three days on the box. - And you're taking it every-- - When you're taking it two, twice a day for a long period of time, it is not good for you. - And that's just so you can eat. - And that was just so I could eat, because you know what, with the band, good food would not go down. Crap food like ice cream and chocolate and chips went down a treat, but salads and protein, not a hope. So that was another drawback to the band, I guess, was that good food would not go down. And I'm not the only one who experienced this problem. So anyway, back to sort of June, 2013, I went, I've got to do something. I'd reached highest recorded weight was 147. That was highest recorded weight. - It's about 325 pounds. - 147 kilos. Although I suspect I was heavier than that. I was just in denial. So I went back and saw my surgeon and said, please help me, I need to do something. I want a sleeve. He went, "Because you've had the band, "probably wouldn't do a sleeve, I'd do a bypass. "Because my metabolism was so screwed up "from having the band and being on smaller amounts anyway, "that my metabolism was messed up." So he said, "A lot of people find that going from a band "to a bypass is usually better, "because you end up with that element of malabsorption, "and you're not just relying on metabolism "and smaller amounts of food." That's just me, my personal opinion and what my surgeon suggested. Every surgeon is different. Some people have gone from band to sleeve and had great success. Everybody's different. So anyway, I did the pre-op diet. That was a bundle of laughs. - How many weeks? - Four weeks of OptiFast. So the shakes, three shakes a day and 200 grams of protein for four weeks. Oh my goodness. - You are bubbling with positive energy, darling. - I was not a pleasant person to be around and I apologize numerous times to John. I'm sorry, I'm sorry, I'm sorry. My birthday fell during that four week period. I couldn't even have birthday cake. - Yeah, and the Ecker as well. - And the Ecker, which is like a state fair for those of you who are in America. Yeah, I couldn't eat. I went to the Ecker and I took my carrot sticks 'cause you can have veggies of course. Ah, but only limited veggies. Can't have the fun veggies like corn and potatoes and peas. - No. - So anyway, I went in, I had my surgery on the 21st of August. I'd lost eight kilos with the pre-op diet. So the day of surgery, I weighed about 140 kilos. That was August 21st, 2013. Within, by the time, by Christmas of 2013, I'd hit about 116, 117 kilos. So a weight loss of about, what's that? 23, 24 kilos in the space of about three months. Which, when you see weight come off that quickly, it's staggering. I was having to buy new clothes every couple of weeks. - Yeah, pretty much. - Pretty much, yeah. And over the last 12 months, so over 2014, my weight continued to drop. So that Christmas this year, so, oh, well, sorry, Christmas 2014, I was down to, no, actually I had a goal. My 40th birthday, which was in August, so 12 months after surgery, I wanted to be back to 85 kilos. And you know what? The week before my birthday, I achieved that. I had lost another 30 kilos in the space of eight months. And I was stoked. I figured if I got to 85 and I was, and I'd never, the thing is with this surgery, I'd never set a goal weight. I figured if I got to a weight where I was happy and that I could maintain, I would be thrilled. Here we are, February 2015. I'm sitting at 76, 77 kilos. For anyone who wants to put some weight, some stock in BMI, I'm sitting at about 29.9 BMI. I'm about 158 centimeters tall. So I'm still considered overweight, but you know what? And people will still look at me and go, "Wow, she's still overweight." You know what? I don't care. I'm happy where I am. 76, 77 kilos. I've started looking into plastic surgery because when you start at 140 plus kilos, you're gonna have spare skin. It's, skin doesn't stretch that far and then go back. - Yeah, like we were saying before, right? - Yeah. So look, I'm 76, 77 kilos and I'm happy here. - That's 165 pounds, by the way, for anyone who's wondering. - And you know what? I, in the beginning, after I had the bypass, - I was, you have to be very careful after the surgery. You have to do two weeks of liquids, two weeks of purees, two weeks of mushies to give everything a chance to heal. Because if you push it too early, you can burst those staple lines. And that's when you end up with a leak and you can end up with a world of problems. You can end up with leaks, even if you do the right thing. - Yeah, follow all the rules. - Yeah, you can still end up with a leak. - You can still get a leak. But that, I was one of the lucky ones. It didn't happen to me. - They kind of joke you're kind of like a poster child actually because your surgery went perfectly. - I still am not a poster child because my surgery went perfectly, recovery was perfect. Weight loss has been perfect. I do have some negative, there are some negatives. I won't lie in that respect. You can't eat certain foods, but you know what? They're the foods that you probably shouldn't eat huge amounts of anyway. Sugar and carbohydrates, they hit me. - We should probably talk about dumping syndrome. - It's called dumping. And basically because of the change to how your body absorbs things, basically you've got a meter less of absorption. And also with the bypass, the valve that is on your stomach, the bottom of your stomach between your stomach and your small intestine isn't there anymore. It's in what's called the remnant stomach and as a result stuff passes can pass through your pouch very quickly. So when you have something like sugar or carbohydrate it really hits you and it's called dumping because it dumps a lot of sugar into your bloodstream very quickly and effects can range from heart palpitations, heart pounding, right through to dizziness, feeling very, very ill and nauseous, and to the point that you just... I've been known to sort of... I had some orange juice once, I ended up falling asleep in the corner. You literally pass out. Yeah, you literally pass out as your body tries to... You go unconscious. Well, not really unconscious, but you get very sleepy as your body tries to deal with - You can't stay awake. - Excess sugar in your body. Yeah, you can't stay awake. - You can't will yourself to stay awake. - You can if you really tried. - Yeah. - But I tend to just go, right, I'm gonna have a little nap now. And... - So think of it like, you know, for people in North America after Thanksgiving, I see a lot of this, I hear a lot of this after the big Thanksgiving dinner, you know, you got lots and lots of carbohydrates in your food. You know, it's like, if you binge like that on a massive amount of carbohydrates and you are going to be affected by that, that snoozyness that where your blood sugars are going absolutely crazy. Well, it doesn't take anywhere near that quantity of food to get the same effect for us. - It can really, yeah, it can be as little as a slice of bread or some noodles or something that's got some sugar in it. And you'd be surprised at how much food has sugar in it and you don't realize until you go, oh, I don't feel very well. - Yeah, that's it. It's in everything. - Yeah, it's in everything. On the plus side, I have lost my sweet tooth. Four small squares of chocolate or a small Mars bar or whatever, and I'm done. That's all I can eat sugar-wise. Not because it makes me sick, but because I just physically cannot eat any more sugar than that. If I eat too much fat, in the beginning, I ended up with quite severe diarrhea from it. Now too much fat just leaves a horrible, oily, greasy feeling in my mouth. That's one of the things I really want to talk about is that the surgery that you've had and I've had, it affects... It seems crazy, but it actually does affect the way you perceive certain tastes. I've actually found my palate has changed significantly since the surgery. I know you've seen this first hand, is that I've been having different foods that previously I would never touch. and ones that I used to have, I can't take anymore. Like I used to... - John used to love hot spicy food, used to love it. And now he really, occasionally he'll venture out a bit more and try a Vindaloo or something from Indian, but he's no longer putting chili on everything. So tastes change. But I guess the biggest contributing factor to the weight loss, besides not being able to eat as much, and the disincentive of eating crap food because it makes you feel sick, is because I don't feel hungry. And it is such a liberating feeling after 30 something years of being at the mercy of your hunger to no longer feeling, to no longer feel it. It's just the most mind-blowing experience. You'll get to two or three o'clock in the afternoon and go, "Oh, I haven't really eaten anything today. "Oh yeah, I haven't eaten anything at all. "Probably should eat something." And sometimes the first sign that you haven't eaten anything is the fact that you start to feel a bit shaky and a bit woozy, simply because your body has run out of easily digested material and protein for the energy. And it comes back to that hormone ghrelin, like I said, by they think there's still not 100% sure on what ghrelin is or how it's affected. There's still learning, but it's something to do with the bypass and the fact that the ghrelin is possibly produced in the remnant stomach, the part that no longer has access to the food. And that I guess has been, I guess the most contributing factor, excuse me, to the weight loss is the lack of hunger. Because when you are not obsessing about food and thinking about food and wondering about what you're gonna have, what you're gonna eat, what you're gonna have for your next meal. Food simply does not become the focus that it once was. Whereas before surgery, you'd stand in a food court and you'd go, "Oh, what am I gonna have? "There's so much to choose from. "I want all of it. "I can't decide." Now you'll stand in a food court and go, "Yeah, I'm not hungry, but I know I have to eat something." And so you tend to make the better food choice, which for someone who's had weight loss surgery, your first food choice and food priority is protein. And after protein, if you've got room for veggies, fantastic, carbohydrates and even fruits, because fruit, let's face it, is a sugar, is quite a long way down the list. your top priority is protein. However you can get that into your body, you need to have it. Whether that's through adding protein powders to foods, having slices of extra high protein foods, meals entirely based on protein. That is your main priority after you have weight loss surgery. - And the key thing to remember, sweetie, is that because the size of the pouch is so small in relative terms, then you have to prioritize what you have. So it's got to be the proteins first because that's where you're going to get the benefit. You're not going to get the benefit from the carbs. You're not going to get the benefit from the fruits or the... or not even the veggies to some extent. You've got the vitamin deficiency because of the malabsorption and you're compensating that already with the vitamin tablets and so on. So it becomes all about the protein. So for example, you know, like, well, I'll get to my stuff in a minute, I guess, but 'cause I still gotta talk about my stuff. So, okay, before we go on any further though, I'd like to talk about our second sponsor for this episode, and that's ManyTricks. Now, ManyTricks, they're a great software development company whose apps do, like the name suggests, many tricks. And their apps include Butler, Kimo, Leech, Desktop Curtain, TimeSync, Usher, Moom, NameMangler, and Witch, and a new one that they're working on that'll be released in coming months. It's a very, I'm very excited about. So there's so much to talk about for each of their apps. We're gonna focus on four of them specifically. And first of all, we're gonna start with Usher. Usher can access any video stored in iTunes, Aperture, iPhoto, or on any connected hard drives on your Mac, allowing you to easily group, sort, tag, and organize them in one place. And if you install pairing or flip for Mac, there's no need to convert anything into an iTunes format, like H.264 to watch it. You can leave it in its native format. So if you've got a video collection that's scattered across different programs and drives, and Usher can help you straighten it all out in one place. Name mangler. Now let's say you've got a whole bunch of files you need to rename quickly, efficiently, and in big numbers, well, name mangler can extract the metadata from the files, use it to rename those files with search and replace, obviously, as well as creating staged renaming sequences. But the best part is if you mess it up, you can just, you know, revert back to where you started and have another go. Which, and you should think about which as a supercharger for your command plus tab app switching. So which is great for, and it's very popular with X Windows people like myself. And if you've got three or four documents open at once in any one app, then which is beautifully simple pop-up quickly lets you pick exactly the one that you're looking for. MOOM is my personal favorite. It makes it easy to move any of your windows to whatever positions you want on the screen, halves, corners, edges, fractions of the screen, whatever you like. And then you can even save and recall your favorite window arrangements with a special auto arrange feature that when you automatically connect and disconnect an external display it automatically reconfigures your windows in the right places just where you like them. It's really awesome. Anyway, now they're just four of their great apps. There's five more to check out. So all of these apps have free trials and you can download them all from ManyTricks or and try them out before you buy them. They're available to buy from their respective pages on that site or through the Mac App Store if you prefer to buy them that way. However, if you visit that URL and yes, they keep extending it, so that's awesome. You can take advantage of a special discount off their very helpful apps exclusively for Pragmatic listeners. Simply use the code Pragmatic25, that's Pragmatic the word and 25 the numbers in the discount code box in the shopping cart and you'll receive 25% off. Now, this offer is only available to Pragmatic listeners for a limited time. It will eventually end, I assure you, so take advantage of it while you can. Thank you to Many Tricks for sponsoring Pragmatic once again and for their continued support of the show. Okay. Well, darling, I think- Can I just say also, I'm looking at your notes here. The effects of alcohol. Oh, yeah. We didn't touch on that. We haven't talked about that. Oh, that's great fun. Before surgery, I was a pretty cheap drunk anyway. It didn't take much. It's true. That's right. Now, I don't have to do much more than smell alcohol and I am pretty well tipsy. You find with the bypass and with the sleeve as well is that alcohol hits you much, much quicker because of the malabsorption and the difference in how your body processes So, alcohol hits you a lot quicker, but it also wears off a lot quicker, which is good and bad, because it also means that the hangover hits you a lot quicker as well. So, alcohol you have to be very careful with. There's still juries out on to how it will affect you if you're ever breathalyzed. So yeah, you've got to be careful in that respect. Yeah, all the rules go out the window. So in Australia, they have this system where you have a standard drink, well, two standard drinks in the first hour, one standard drink every hour after that and you'll be- That's for men. That's for men. And for women, it's one standard drink per hour, I think. Is that right? Yes. Yeah. So the point is that if you follow those rules, you'll always be under 0.05, which is the legal limit in Australia if you've got an open driver's license. Reality check, once you have the surgery, you cannot count on that. No. You just can't. far better off to employ the trite and true practice of if you're going to drive, just don't drink at all. I mean, you know, alcohol, obviously. Yes. Yes. If you don't drink any liquids at all, you'll die. So we recommend liquids. Yes. Anyhow. Lovely. OK, so. My turn. It's your turn, darling. OK, so since you start at the beginning for you, I'll start at the beginning for me. Can I just add to that since I've had my surgery, I no longer have high blood pressure. I no longer take antidepressants and the only tablets I have to take are my multivitamins and you can now buy them in gummy form. So, it's like a little lolly bag. So, I'm off on my medication because of this surgery as well. That's fantastic. There you go. That's fantastic. And I'll be honest, I mean, you've been so much more consistently happier as well, which is just awesome. So, the kids and I are... I think John's implying here that I was a bit of not much fun to be around when I was at my heaviest. Don't put it like that. That's not really what I mean. The truth is... I was depressed, okay. I was in a bad headspace. And we all know you get into a cycle, you're depressed so you eat. You put more weight on, you get more depressed so you eat. That's it. So, you have to do something to break that cycle. And I did. That's it. It was drastic, but it had the virtue of working. - It is drastic. It is, I can't stress more, any more that this weight loss surgery is a last ditch effort. - It's extreme. - It is extreme. And people who are seriously overweight and obese, some people are overweight and obese and quite happy and good luck to you. and they're healthy, fantastic. But you know what? There's a lot of people out there who are overweight and obese and are miserable. But I think like most things, you have to reach that low point, that watershed moment for you to really realise that you need to do something and you need to do something drastic. - Yeah, that's it. - Okay, we will come back to that. - It's your turn, John. - Thanks, sweetie. Look, we will come back to that at the end, of course, because that is a lot of the point of this. So, my journey. Well, I'd always been a little bit chubby when I was a teenager, but never really overweight, exactly. I guess technically they would- - You're eating the thing. - Oh, stop it. No, I did have a weight problem when I was at university, though. I went on an insane diet that I refer to as the noodle diet. It was amazing. I lost something like 30 something kilos in a space of about three or four weeks. - Apparently everything went yellow. - Yeah, it did. Yeah, no, no. You got to realize that I was living in the tropics at the time and I was going to university. I was riding my bike to and from university. I wasn't driving at that point. And you know, when I was, one fair afternoon, I was riding home from uni And as I was going up the first hill to get out of the university campus, the whole world, everything I saw went a very disturbing shade of yellow. For anyone in North America or not in Australia, the noodles John is referring to are two minute noodles or ramen noodles or cuppa noodles. Yeah. So, not lots of nutritional. Not the most nutritious item out there, no. I found that by the third week to make them even palatable, I had to add so much chilli into them to make them actually that I could eat them. That's probably where your hot food addiction started. But no, possibly. Anyway, let's not go there. Anyway, the point is that that's generally an unhealthy thing when the world looks yellow, especially if you're not wearing yellow glasses. So, yeah. And of course, a little funny little pinpoints of multicoloured light, kind of like I've been punched in the head. So, let's just suffice to say that it was bad, at which point I ceased that diet, but I got down to about 78 kilos, which is still my lowest weight as an adult. But if you look at photos of John at 78 kilos, he was too skinny. Yeah, well, that's just, you know. That's just my opinion. Yeah, but you believe BMI, and I know BMI is BS. When I went over to North America the first time, I didn't really have much of a weight issue. I was staying on a residential campus at University of Calgary with some mates. We would go jogging around the Olympic ice skating rink in the middle of winter which was an interesting experience because you're hot and sweaty and you step outside in the minus 20 and it's like, "Oh, that's brisk." Anyway, so I didn't actually have a weight problem until after that and I sort of stopped moving and I started driving everywhere and then my weight sort of gradually increased and increased and increased. I met my lovely wife and it turns out she could cook and she introduced me to a whole bunch of foods that I never tried before and they were really, really good. And I mean like the five cheese lasagna for example, which is, you know, that's kind of like, it used to be considered to be heaven on a plate, but never mind that. The point is... That's just sickness on a plate, but anyway. Yeah, I know, things change. Things have changed. Anyway, so the point is that we sort of, both of our weight sort of spiraled out of control together. I'd like to think that we were as bad as each other. Codependence perhaps. A lot of nights sitting on the couch with dinner and dessert, watching TV and yeah, it tended to, yeah. Yeah. So, long story short, my weight, because I'm just under six foot, so I'm what, 5'11", 5'10" and a half, something like that. And so, yeah, anyway, but my weight got up there to my BMI hit 140. Sorry, my BMI hit 40. Oh, my God. BMI of 140. Oh, my God. You know what I mean? I just clarified. Good. The point at which I started to develop problems, though, it started with blood pressure. So, yeah, it was my... I was in my early 30s and I found that I was getting a pouting in the base of the back of my neck, sort of at the base the skull meets the top of the neck in particular close to the sides. Granted, we had a bit of a diet caffeine addiction in the form of diet coke going, which probably didn't help. But yeah. Yeah, cutting out the problem was when I cut out the diet coke, because I went through periods where I cut out the coke completely and I still diet. Yes, I don't mean cocaine coke. No, no, no, not full like full sugar coke. Yeah, I know. That's just that was too sweet even back then. Yeah, I even cut out sweetness from my coffee now. Yeah, that's another sidetrack. Anyhow, my point is... - The podcast. - Yes, it was already done that with Marco. That's done. It's in the can, in the basket, it's in the... - Okay, let's go. - Yeah, okay. Just, all right. Anyhow, lovely. So, yeah, I had high blood pressure and I was on medication and it reduced my blood pressure and it's like, okay, that's fine. You know, I'm still in denial. Everything's all good. Early 30s, right? High blood pressure early 30s? No, that's not normal, that's not good. So, the next thing is that I gradually found that I was becoming constantly out of breath. I mean, if you're walking on a flat level ground, it wasn't that noticeable, but as soon as you had to go up a flight of stairs or as soon as you had to go up a gent... even a slight incline, you know, you would notice that you were breathing heavily and Kirsten would often turn to me when we were walking around. She's sort of like saying, "You're puffing." And I'm like, "No, I'm not." Because your brain tunes it out. You don't realize you're doing it until someone else points it out to you. It's like, "Yeah, you're puffing over there." And I'm like, "I am? No, I'm not." And so, yeah, I refer to denial. Okay. So, okay, all these so far, yeah, denial's in full swing. I'm not too concerned. Okay, well, the cholesterol is not necessarily related. It's more genetic. So, I've sort of left that off the list because I still... Can I just add in here that John's dad had a heart attack at 42. So there's definitely this, there was a family history there for John of heart disease. And that was always something that was in the back of his mind, was that he was going to die young like his father. Well, the bottom line, though, is that I didn't really start to take things seriously enough until the Sleep app now. And that was that was the beginning of this for me. So by that time, you'd had the sleeve done. No, I'd had the band. The band. Thank you. I'm told, yes. By that time, you'd had the band done. And I was at work and Sam, our fourth child, had been born was a little cute little cherub waking us up at all hours. And I just blamed it on that. I was always tired, tired, tired all the time. I couldn't concentrate at work. And I was I blamed it on, you know, my newborn son keeping me up at all hours. I mean, don't get me wrong. He was. But it turns out that no, it wasn't actually that. It was one thing not causing that. It was the other thing which was a sleep apnea. So anyway, I got called into my manager's office at the time and I was told, get your fatigue under control or we will get it under control for you. And that's code for if you don't get it under control, you're sacked. So basically I had no choice but to take it seriously. And I snapped out of my denial. I went to go and see a doctor. I'd already seen a doctor in like in a year, almost a year, maybe about nine months previously, and he'd recommended a sleep study. Well, this time I actually went to the sleep study. I walked out, well, rather stormed out, I think it was at two in the morning when I could not sleep because what they do in a sleep study if you don't know is they'll attach a mask to your face For a CPAP machine, which is stands for constant positive air pressure And what it does is it forces air through the nose and the nasal passage And there's a small flap of skin that when you're more overweight It basically allows it to completely block. When you're overweight you tend to have a lot more fat around your neck and When you sleep, especially on your back that fat puts added pressure onto the airway Which then obstructs your breathing when you're asleep What this causes you to do then is when you stop breathing you get no oxygen to your brain What happens then is your heart starts racing like hell to try and pump whatever oxygen is left to your brain to wake you up Enough so that you can move to clear the obstruction So your body wakes up you move slightly you get airways Pathway conforms and then you essentially fall back to sleep again But you never wake up just enough to even realize that it's happening to you And that's what they refer to as obstructive sleep apnea. That's what I was diagnosed with I used to lie there next to John and you'd hear him snore You'd hear him breathe in, snore in and it had stopped and he'd stop breathing Just silent. Just did silent. Yeah, and then he'd breathe out again. It got to the point where the snoring was so bad I used to kick him and roll during the night and then roll over and pretend I was asleep Yeah, you're like the extension of my brain telling me to wake up. Yeah, well, that's it Oh, you'd poke him and say roll over roll over It got it got pretty bad. That's not I will admit the snoring got Got very bad Especially when I was pregnant and wasn't sleeping. Well anyway, so that that put a lot of strain on us Because he was tired. I was tired. I was pissed off This is getting touchy-feely. Shh! This is the most touchy-feely episode of Pragmatic that's ever been made. Hey, if you were getting touchy-feely with any of those other people, I'd be getting worried, darling. It's okay, it's fine. You can always go back and listen. You're a regular listener, aren't you, darling? Moving on. I'm not going to answer that on the grounds it may incriminate me. That's just lovely. Okay, so let's just pause the rest of that discussion right there. there. I was diagnosed with 19, I think it was, if memory serves, episodes every hour when I was in a deep sleep in my sleep study. Which basically means he was waking up, stopping breathing and waking up 19 times every hour. That's what they call severe obstructive sleep apnea. Not just like mild, moderate, severe. So, it was recommended that I get a CPAP machine immediately and I needed to use it every single night. Now, the funny thing is, I was difficult to embrace this. Oi. I'm using... How would you just... Let's just say he used to pull the mask off, cursing and swearing. He'd even do it when he was asleep. He'd pull the mask off and I'd wake up to snoring and I'd like kick him and poke him. put your mask back on, put your mask back on. But you know what? After the first couple of... Yeah, I stopped asking nicely after a while. After the first few nights of John leaving them, putting the mask on and leaving it on all night, he would wake up and say, I feel so much better. This happened within two or three nights of putting the CPAP on. But leaving it on all night for two or three nights in a row. And he woke up saying what a difference it had made. It's a matter of retraining your brain to getting used to having this thing on. And once you've done that, once you've crossed that bridge and once you've suddenly... They talk about sleep debt, you know, but the truth is you can never recover lost sleep. You really can't. There is no bank account that withdraws and stuff. Yeah, no kidding. How much have we lost in the last 12 years anyway? Point is that it made it was a profound difference. So once I'd reached that point, I thought it's all good, right? It's all good. Okay. I'm back into denial again. Okay. Let's not think about what caused the sleep apnea Let's just, we're treating it, right? So I'm treating my blood pressure I'm treating my sleep apnea. Sure. I'm constantly out of breath whenever I go up, you know, one micro fraction of a millimeter in height That's okay. No problem still in denial still well overweight Okay By this stage, can I just add, John had seen what I'd gone through with the band and how horrible that was and he swore That he would never ever get weight loss surgery Because he'd seen what I'd been through. That was with the band. That was with the band Okay, and now we're roughly at the point where you had given up on a band due to all of the complications and difficulties that and that came with it and had gone to the Ruan Y gastric bypass and I had seen the first few months of that and the absolute night and day difference in you because I'd been trained to associate weight loss surgery with the band and with that was constant frustration because you still felt you were hungry and you still had to eat because there was no interruption to the hormonal balance in telling you that you were full so you were still starving and you couldn't eat and abusing Nurofen in order to be able to eat the spit up cups You sound like a druggo No, but my point, towards the end it was getting pretty bad It's the point. The point was that it was not a good experience, not for you, not for any of us. It was bad, just bad. But the Ruanwai was a complete polar opposite. Once you'd gotten past that and past the mushy back on to normal food again, it was night and day. It was just unbelievable. I could not, I cannot express with words enough how different it was. And suddenly I started to notice around about that time a tingling in my feet. And this is when I started to freak out. Now, I'm not going to say exactly why that was, but let's just say that somebody that I knew was also having a lack of sensitivity in certain extremities. And that is, of course, for those that are not aware, an early sign of developing diabetes because of circulation, because of the increased pressure and the extra weight you're carrying around. Essentially, it causes a lack of circulation. Eventually, the lack of circulation can require the amputation of toes, feet, you know, limbs. It actually is really kind of serious. And I wanted to keep all of my extremities. I figured that they were, you know, functional and, you know, useful for the most part. So, you know, I don't want that kind of thing. And it was just after Christmas of 2013. that I had my moment. And, alright, bottom line, I came home with a box of Krispy Kreme doughnuts, as was one of my guilty pleasures at the time. It was our guilty pleasure. In the past, before I'd had my surgery, John had come home with a box of Krispy Kreme doughnuts and we have some with the kids and we'd basically down a box of a dozen doughnuts between Yeah. Between us. But at this point, yeah. At this point, I couldn't eat them. You couldn't eat them. And your sweet tooth, like you said before, had gone as a result of the bypass. You just had no interest in those sorts of foods. And so what happens is you're sitting and standing there watching me sitting down eating these doughnuts and, you know, making decent progress into them, shall we say. And you made an offhand remark that was that was disgusting. And the funny thing was that at the time, it's one of those comments that sort of made me stop and think after the fact, like in the hours that followed, it sort of nagged away at me. Did I actually say that it was disgusting or did I have a look on my face? No, you said it. You did. The truth was, though, that it was disgusting sitting there shoveling these things into my mouth like there was no tomorrow after having just had like Christmas, it just was not that far gone and we were still downing huge amounts of food and well, okay, sorry, I was, you weren't. And I'd been troubled by the tingling in my feet. I knew that that was an early indicator of diabetes. I'd seen the success that you'd had with the bypass. And I was on a CPAP machine, I was on blood pressure medication, I felt terrible, I got winded. It just I got to that point where I just snapped and I'm like, you know what? I need to consider this seriously as an option. For John, that was his low point, his moment, his aha moment. I think with the alcohol, people that have problems with alcohol abuse, They talk about hitting rock bottom, right? That was the moment. And obviously, maybe that sounds trivial to you or ridiculous to you, but in the end, it was wine and that's what mattered to me. So anyway, I don't want to dwell on that. The point was that I made an appointment to see a surgeon and we started to talk about options and they recommended the sleeve. Now, the sleeve, as I said, came out like around about the same time as the band. But the timeline that Kirsten may have glossed over a little bit of is that consider that 2001, FDA approves the band and then 2008, I'm not sure of the exact date it started to be practiced in Australia, but I believe it's within two to three years of being passed by the FDA in the States that it was performed here. So let's work with five years. So five years out and it was generally considered to be the best way to go. least intrusive, fastest recovery time, fully reversible, you know, it seemed like a godsend. But then the problems started happening. People were discovering that bands were eroding into their stomach. They'd have endoscopies where they put the camera down your throat to check out what was going on in the stomach. And they'd actually find the band that had been placed on the outside of the stomach was now on the inside of the stomach. Yeah, exactly. It's friction, right? think about you've got a fixed foreign body and it's basically constantly as your body flexes and moves and as food goes in and out and as you're stretching and whatever else it rubs back and forth back and forth back and forth what's going to happen you're going to rub through you're going to wear through hence the term erosion. And the band only has a life of 10 years anyway like any implants into the body like breast implants they only have a 10 year lifespan. A band is the same it only has a lifespan of 10 years. And people were finding that they were having so many problems with the band and it was causing devastating long-term problems that it just became not practical anymore. That's right. So, and then of course, when you went back in 2010, Sorry, in 2013, it had then reached the point where the same surgeon was no longer recommending the band. So, in that short decade or thereabouts, it went from being a godsend to, "We're going to probably not do that anymore." In the same time, the sleeve gastrectomy, which is the one I had, had only gained significantly in popularity. the fact that you're essentially removing the vast majority of the stomach, you've got, it's an intrusive procedure, you can't get that bit of stomach back later if you're like, "Oh, can I have my stomach back please?" No, you can't, it's gone, right? Removed, gone forever, bye-bye, you know, and the staple line is quite long, it's significant, and if there's a leak, well, you know, it's far more statistically probable to have a leak the longer the staple line is, therefore, it's, you know, got higher complication rates. So I had to look into this, And there are numerous studies, but you know, you're looking at about 3.2% complication rate where you had to have readmission to hospital and a 0.19% mortality rate. So those are the figures I found a bunch of different studies. And the bottom line is that as time goes on, the statistics will improve. And I don't mean improve in terms of numbers in the reliability and accuracy of the statistics. That said, I had personally no complications and I'm still talking. Therefore, I was not a mortality statistic cut obviously inherently. Yes indeed. Yes, so bottom line is Yes, so there you go, that's that's how I reached that decision so I had my surgery it's getting close to 10 months ago now April 26 2014 How do you remember that? I don't even remember It was the day after Anzac Day Oh yeah, that's right It was the day before Alex's birthday You have a gift, I'm just saying for remembering dates. I mean I've got a calendar out for that that. Oh dear. That's lovely, good. Anyhow, bottom line is it's been unbelievably successful. So I'm now down to 92 kilograms, I think I am, which I will just very quickly figure out for you is just I'm almost exactly 200 pounds. And I started out at my absolute worst recorded weight was 145 kilos, which is 320 pounds. So I've lost a lot and I feel absolutely fantastic. So no more blood pressure medication? Yeah, right. So yes, I'm off my blood pressure medication. Now I haven't gone off my CPAP machine and what I did do is I did go in for a reassessment and the reassessment in the sleep study reassessment, they essentially took my dose, the pressure, it your dose, I call it a dose, it's an air pressure, right? So the air pressure required to maintain an open airway has now been cut essentially in half and to get the same effect. So honestly, I'm at the point where I could probably live without the CPAP machine if I can, if I lose another 10, 15 kilos, which is still quite within the realm of possible. I don't know, we'll see what happens. The thing with weight loss surgery, and let me stress this, is that, and the doctors will stresses as well. Usually the first 12 months is when the most weight loss will happen when the weight loss surgery is at its best. So they say lose as much weight as you can in that first 12 months because over time of course the The pouch or the sleeve tends to loosen up a bit and you'll be able to eat a little bit more which means that you won't lose weight as quickly and you won't lose as much weight. So this is why they say you've got to lose as much as you can in that first 12 months. A lot of people still go on to lose more after that 12 months. I've still lost more in the 6 months since I had my - after my 12 months. I've still lost more, but the weight loss has slowed dramatically, which is fine. That doesn't worry me. But yeah, that first 12 months is crucial. Absolutely right. Yes. So just to talk a little bit more about my experience, the lead up to my pre-surgery diet, which you always remind me is only half what you had to do. So, I only had two weeks and the doctor gave me the option. Sorry, I said doctor, surgeon gave me the option. He said that my BMI was right on the line, I was right on 40. And at that point in time, and he said that that sort of borderline where you probably don't need to do it. But the whole idea of it is that it reduces the amount of fat in the liver. Which means they can access the stomach and the area where they're doing the surgery better. And that increases the safety of it. So I basically said, I put a question to him 'cause well, I'm me, which basically went along the lines of will it improve the potential outcome and reduce the risks of the surgery? Yes or no? He said, undeniably, unquestionably, yes. So I said, well, there's no question, I'm doing it. So we went away on a holiday down to the Gold Coast and I was on my diet for the Gold Coast. So you had your birthday in the ECCA and I had the holiday down the Gold Coast where I was on Opti Slim, Opti Bar things, which they dare to call food. And oh my God, I don't know if you've ever tried them, but anyway, so then there's those. And of course I was allowed to have mushrooms. - No, he's allowed to have certain vegetables. - Mushrooms. - So you'd look a bit, John, okay. And I'll be honest here. - Yes. You're gonna be honest? - I'm gonna be honest here. I'm going to tell your listeners exactly what you like. John doesn't eat vegetables. - Okay, he'll eat peas, corn, potato, mushrooms and onions. Well, when you're on Opti, you can't eat peas, corn, potatoes which means John was basically living on Opti shakes and bars and mushrooms and onions. - Can I just say that was the best. - Hang on, so we'd go out and when we were on holidays, we'd go out and you'd go into a coffee shop or a restaurant and hard rock cafe and say, "Hi, can we just get a plate of sauteed mushrooms onions, please. And the looks you'd get was just like, excuse me, do you want some toast or something with that? No, just the mushrooms and onions, thanks. Can I just say the Hard Rock Cafe mushrooms were fantastic. They were the best mushrooms I've ever had. Mind you, I was starving at that point. And I probably would have said that a brick of concrete tasted like it. At that point, a plate of grilled styrofoam probably would have done the job as well. Don't knock styrofoam as a foodstuff, I'm just saying. It's lightweight. Anyhow. Okay, good. Lovely. So, the bottom line is they were two interesting weeks of which I had a blast. Oh, I had a ball those two weeks. Okay. Remember the vegetables, the mushrooms and onions I made you, darling, and you made me put so much curry powder into it. I remember that. The next four hours. You did, you did, you did. His stomach... His stomach... I was sitting across the couch and his stomach was making the loudest noises I have ever heard. Oh, can I also say another side effect of the weight loss surgery is the gurgling noises from your stomach. I've heard of people being in meetings and their stomach starts gurgling and the meetings have just come to an abrupt halt because the gurgling from people's stomachs is so loud. As it is our four year old will rest his head on my tummy when he's sort of having a bit of arrest. And he'll then look up at me and look at my tummy and look at me and go, "Mummy, your tummy's making noises." Yes, I know, sweetheart. Yes, that's right, indeed. So, it can be quite embarrassing, but you know what? It's just one of those things. OK, good. Now, let's move on. We've explored that more than enough. Have I embarrassed you enough now? Not yet, I'm sure you can do better. OK. OK. That's not... Challenge accepted. No, that was not a challenge. God. Okay, good. The insights into people's personal lives. Here we go. Anyone who'd like further insights, you can email me. No, you cannot. It's not email. I'm not giving out your email address or they could probably figure it out. My naming method is pretty simple and consistent. Anyhow, good, lovely, moving on. So, my post-op diet was exactly the same as yours, which is of course clear liquids. I think it was mostly for the first two weeks. Not clear, but liquids. Just liquids, yeah. And then after that it was... Pureed. Pureed food, and then it was mushy food for two weeks after that. So six weeks after all that, I can actually have proper food again and of course, chew the living you know what out of it. However, the other side effects that I did not count on, previously I had never really had a problem at all with acid reflux. Well, I had acid reflux from hell after that surgery. And I learned very quickly that you do not... Because previously I used to have my tablets medicine before I went to bed. Like I would have a glass of water and I would have my blood pressure tablets, which I didn't need anymore, and a few other different things and so on and so forth. And I had them before I went to sleep, then I would lie down. Okay, big mistake. Can't do that anymore since this surgery because otherwise if I do that and I lie down, it hasn't... Gravity helps it to get through my stomach now because the valving and the back pressures and all that stuff is all messed up now because of the work that's been done to my stomach. So, I can't do that anymore, which means I now get reflux. And not everybody gets reflux. No, that's true. If you have reflux before surgery, they will often recommend you do not have the sleeve done because it can be a side effect. Yes. And this is what this is what the surgeon said to me afterwards. That we should have told me that if you had reflux before and I'm like, I didn't. What you did gave it to me. Yeah, exactly. So I was less cheerful about it than him, but the bottom line was that I was on medication to reduce the amount of acid produced in my stomach for several months after the operation and then we tried going off for a while, wasn't quite ready, went back on for a bit longer and then I came off it, I haven't had any now for nearly two months and I've really only had one bout of reflux in two months now and that was because I had a drink way too close I didn't follow those rules, which is if you're going to drink or eat anything, you've got to have it and sit upright and make sure it's passed through before 30 minutes before you go and lie down horizontally. I suppose if I were to sleep sitting up, that would be fine and you can just prop your head up with a pillow or double your pillow over and it usually reduces the problem. Anyway, so that's something to be aware of that I've had to deal with that I didn't previously. So for the first few months afterwards, I was very intolerant to lactose. So, I had a lot of really bad bowel cramping and it was pretty horrid actually, very painful. Thankfully though, that dissipated as I've discussed on the coffee episode. Yes, I don't have any problems with having a latte right now, so that's all good, thankfully. Okay, right, good, lovely. So, honestly... of the, it's little things you notice. John had had kidney stones before when he was at his heaviest and in order to blast the kidney stones, they had to wait until a certain machine was available that could handle someone of John's size. When he had kidney stones again last August, because he'd lost, had this surgery and lost so much weight, it was so much easier for them to get in and deal with the kidney stones because he was no longer carrying the extra weight. And it's things like being able to get yourself up off the couch easier, being able to cross your legs. It's little things that you don't really notice at the time when you're at your heaviest. But as you start to regain them, you realize how much you miss them. That's right. I mean, silly things for me like, and I mentioned this in the article I wrote, is having to tie my shoelaces a different way. So, I traditionally have leaned forward in a seated position to tie my shoelaces. Well, I couldn't do that when I was in my heaviest. I couldn't. There's too much belly in the middle. So, I had to lift my legs up or prop my foot up on something in order to tie my shoelace, which you know, looking back, not a big deal. No, it's not. But it's like, it's more of an annoyance, but you know, you do realize it. And once you can do it again, then, you know, it's like, oh, thank goodness I can do this again. You know, but it's not just that. The thing that I find frustrating and horrible about humanity is the way that people look at you differently. And, yeah, that's been the biggest, one of the biggest underscores, I guess you'd say, that I've experienced in losing all this weight so quickly is that in a short period of time, you know, we tend to dilute things, you know, over long periods of time, the human brain, we sort of tend, memories fade and get fuzzy and we tend to sort of gloss over certain details. But when things happen over shorter periods of time, you notice them more. And just the way that people look at me, they come up to me to strike up a conversation and the way that, you know, the way that you are perceived and the way that you are either ignored or paid attention to, it varies in the way that people look at you. And I can see it in their eyes. And it's not a paranoia, it's a fact. It's just that's the way that people are. It's terrible. But you know, I mean, I had all sorts of horrible comments. I mean, do you remember that time when we were walking? I think it was while we were out walking Maddie and the pram and we were just driving, walking along the side of the road on the sidewalk and there's some yobbos sort of leaned out the window and yelled out, "Hey fatties!" Do you remember that when we're down in our old house? Yeah. And it's like sort of horrible BS, you know, that you got to put up with from, you know, they're jackasses. Okay, fine. You know, whatever they were people. I don't know what sort of people would ever say something like that, but well, we didn't meet them. They weren't nice people. They weren't nice people. But I mean, that's not the point is that that's the sort of thing you got to deal with. And one time I was in a meeting and, you know, I keep on talking about people in suits and I have this thing against suits, but the point is that, you know, okay, so suit guy, you know, he's like says, "Oh, the food was served for lunch. We had a day-long meeting, you know, and the food platter came in and, you know, he's like, you know, "Make way, John, you know, you can go first, you know, I'm sure you're hungry." And it's like, you know, that wasn't as exactly "you're fat, therefore you got to eat first because you're fat" comment. It was a thinly veiled, you know, disrespectful comment. Now, would that same individual make the same comment to me now? No. In fact, that same individual, when he saw me now, because I still work with this individual, is he has this nervous look on his face and he sort of says, "Oh, you're looking good." And that's all he's got. You know, it's like it's just it's sad to me. I mean, beyond the health benefits of doing this, which frankly, you know, I'm so glad that I did because of the health benefits. I feel fantastic. I haven't felt this good in a decade, really. It's really that dramatic. And I'm so glad I've had it done. I mean, forget the fact that I do get, not quite as badly as you, darling, of course, I do still get mild dumping syndrome. If I have the wrong things, I still get racing heartbeats. I still break out in cold sweats. I still feel the effects of alcohol hitting me faster, not to the same extent as you, but still relatively significantly and certainly a lot more than pre-surgery. But the net benefit is a positive. It's a net win. And that's the way I choose to see it. And the underscore, the biggest benefit I would see for me, the thing that drives at home is standing in the food court. You sort of touched on this, but maybe you didn't quite say just how profound that is. Imagine right now that you are at your favorite shopping mall, let's assuming you go to shopping malls, but anyhow, your favorite food court and your favorite shopping mall, they've got a massive variety of foods from all around the world and they are the most beautiful foods that you could ever imagine Tasting now imagine staying there salivating at the options in front of you Now have the surgery and imagine standing in that same place the same spot and feeling nothing And just saying you know what I? Can smell food? I know I have to eat something. I gotta eat something, but I can just you know Fuel for your body rather than the big deal. And I guess this is something that I've come to appreciate and why I've decided I'm happy at the weight I am is because I don't have to exercise four or five times a week to maintain this weight. I don't have to count every calorie that goes into my body. Because you can't consume that much. Well, I could if I if I wanted to you pass out No, not really if I was to eat graze all day As I could I could Eat quite a few calories Especially if it's sort of Quite high fat and high carb as well But I find my relationship with food is a lot different If I'm going to eat something, I will go for quality rather than quantity. I will go for something quality and something that I've had a lot of trouble getting my head around and John is still having trouble dealing with is leaving food on your plate. If I'm eating something and I'm not enjoying it, you know what, I'm just gonna stop. I'm not enjoying it so why bother eating it. If If I'm going to eat, I'm going to eat something that I am enjoying or something that tastes good but you know what? I'm only going to eat a small amount of it. I still get cravings. I'm human, especially sort of around certain times of the month, I crave chocolate. And you know what? I give in to that craving and I eat a small amount. In the past, if I crave chocolate, I'd eat a family block of chocolate. Now if I crave chocolate, I'll have as much as I want, which is quite a small amount. You said three or four squares. Three or four squares, yeah, three or four squares, and I'm happy. And you know what? I'm not having to count every calorie and watch every bite. I don't feel guilty anymore about eating something that isn't healthy or isn't good for me. Because you know what? I know that it's a once off, that it only happens very rarely. nine times out of 10, I do make the right food choices because that's what my body wants. It wants the good food. It wants the protein. If occasionally it wants the crap food and the bad food, you know what? I give that to my body and I don't feel guilty about it. That's because you're back in control. That's the point. That's it. Our hunger and our desire. I am in control. Food does not control my life anymore. And that's the final point. And that's where I want to wrap up on this, is that weight loss surgery, the funny thing is it's about losing weight only superficially. It's actually about the war. Gaining control. The war on hunger, the war against control of your hunger and control of your relationship with food. And people will say, well, you know, you should just diet more, you know, and I've got that. And actually, yeah, before his... Sorry, sweetie. Before his surgery, some people did... Some people quite close to us did turn around and say, "Well, why don't you just stop eating so much and exercise more?" And anybody out there who's grossly overweight and obese will know that it's... Only a skinny person would make that comment. Yeah. is that we are at war with our own hunger and the surgery is a rather inelegant solution to that. Maybe someday there'll be a better, more elegant solution, like they can control the hormone with a certain tablet or something. Yeah, maybe. I don't know. Ultimately, though, if you don't want to end up having to have this surgery to get that control back, first of all, I don't think you should feel ashamed about taking the surgical option to get control back, especially if like Kirsten and I, you've tried so many different things and you've always failed. And it's the admission, to me it was an admission, "Yes, okay, John, you know what? You tried, you tried and you failed." And you know what? Fine. I would rather try and fail and then try this and succeed and then have to look two or three people in the face that don't care and don't understand and they say to me, "Well, you should have dieted harder or something. You should have just, whatever you were doing, you weren't doing it hard enough, do it harder." So, well, you know what? I'd rather look you guys in the face and say, you know what? That's your opinion and you're welcome to it. Because now I get to live longer. Now I get to not die and have die and not have diabetes and not have high blood pressure. I succeeded through a means that, you know, some people say is copping out. It's not. It's not easy. This is not the easy path. This is the hard path. This is not a cop out in any way. Because the weight loss surgery is just a tool. It is not a quick fix. It is not the easy way out You still have to make the right food choices You can have the weight loss surgery and still eat the crap food Constantly eat the crap food and eat all day and end up stretching your pouch out and not lose any weight It is only a tool Some people do that and you know, that's what people throw back sometimes They say, "Oh yeah, well there's a statistical chance that it's not going to work" Well, you know what the statistical chances are of the ones that don't work Because the biology doesn't lie. The biology will work. It's not the biology. It's what if you listen to your what your body is telling you after the surgery, you won't have a problem. You will lose weight. But if you do like you were saying, sweetheart, like you just graze constantly and you eat all the wrong foods. And there is something called head hunger that a lot of people don't realise. And that is the whole eating when you're not hungry, eating, finding out what your triggers are, whether it's depression, whether it's the weather, whether it's stress, it's head hunger, not stomach hunger, it's head hunger. And a lot of surgeons will recommend and suggest that you see someone about it to deal with your food issues, either before or after you have the surgery to help ensure the best possible outcome for the surgery. Before we do wrap up, and we do have to wrap this up, Darlene, is I had a note here to talk about something that I don't think we've actually talked about. And I think we kind of talked a little bit about the alcohol side of things, but do you just want to talk quickly about addiction transfer? There is, yeah, there is something called addiction transfer. Most of us who are overweight and obese are addicted to food. When you take away that food, you can no longer be addicted to food. A lot of people can find that they transfer their addiction to other things. Some people find they end up with alcohol issues or gambling. Shopping is another big one that you can become addicted to. Some of us just have addictive personalities and will become addicted to things. transfer is definitely a... Something to be aware of. The reason that triggered that off is that you mentioned the psychological component. So that, you know, the head hunger and dealing with the head hunger. It's like that's not the only problem that can arise. Another one of the sort of psychological head problems that can go along with it and something that both John and I've had to face is after the surgery, you go through a mourning period. And that may sound really weird, but you mourn the loss of food. Food was always, before the surgery, food was always a comfort. When you were stressed, you'd eat. When you'd celebrate, you'd eat. Food was always that constant companion. And after the weight loss surgery, food can no longer be that friend, that crutch, that companion that it once was. do go through a mourning period where you really miss that food and you miss that comfort that it gave you. And a lot of people find that they replace that food with something else. And that's why you have to be very careful after the surgery with this transfer. So I prefer to think that food used to be one of my best friends. Food is now a distant acquaintance. That's it. Food is fuel. Food is not, you know... Your best friend anymore. It's not my best friend anymore. And that's the way... Someone you use to get... That's the way it needs to be. Use their car. Yeah. So if I have to wrap this up with a bow and put a pragmatic spin on all of this, this, what does all of this mean? And I guess what it means to me is if you're listening to this and you don't have a weight problem, thumbs up. Never, never stop worrying about it. It'd be my advice. Keep on top of it. Do not let it get away from you. Always keep an eye on it because if you do let things go, there reaches a point where it's difficult to come back and the further you go, the harder it is to come back. And once you get onto the diet roller coaster, the conclusion statistically is that ultimately you're going to end up in a bad place. So I don't know whether or not you should consider weight loss surgery as a savior or as a warning. Either way you want to take it, I really don't care. You need to choose, make the right decisions and the right decision for you. It was the right decision for Kirsten and me. Given the alarming number of people that are technically now obese in the world, it's going to become far more common. It's already more common than it was even as recently as five years ago. I say now, "Oh, I had a gastric sleeve," and people know roughly what I'm talking about. You go back five years ago, despite the fact that the procedure existed, most people give you a blank look. It's becoming more prevalent. It's going to become even more prevalent. People are going to become more accepting, I think, I hope, of this. People are going to become more aware of the diets and the problems with carbohydrates and high fructose corn syrup and all those other bad things that are driving a lot of this and controlling how much sugar is going into their diets. All of these things, it's going to increasingly come to a head and governments are going to start regulating things. In the meantime, my advice to you is always care about what's going in your mouth, think about it, try to keep your weight under control or you'll end up where I am. And frankly, it is an option. It's not the best option necessarily. I wish I could have kept it under control, but I chose a far more, how should I say, last resort measure. That said, as last resort to go, I think it's a net win in the end. And yeah. Do you have anything you'd like to add to that, sweetheart? Cool. Well, if you'd like to talk more about this, you can reach me on Twitter at JohnCheegee and my site, That's where the podcast is hosted, along with my writing and other stuff I've done. If you'd like to send any feedback, please use the feedback form on the website. That's where you'll also find the show notes for this episode on the podcast, Pragmatic. You can follow Pragmatic Show on Twitter to see show announcements and other related stuff. I'd like to thank my guest host, my wife. Thanks for coming on the show, sweetheart. Thank you for having me, sweetie. Normally, I now direct people to the to your Twitter account, which you do. You do have one. I do have one that you set up for me, but I never use it. Yeah. And you check it like you've never checked it. Yeah. So, feel free to figure out what Kirsten's Twitter account is. Yeah, if you can figure out what my email address is, you're quite welcome to... I am not... Please use the feedback form on the website. Anyway. Okay, lovely. Okay, once again I would like to thank Extrasensory Devices and their Luxi4All for sponsoring Pragmatic. The Luxi4All is a compact and lightweight incident light meter attachment for your smartphone or tablet. Visit for more information about their handy Luxi4All Luxie for all and use the coupon code TechDistortion for 15% off exclusively for Pragmatic listeners. Taking better pictures starts with your Luxie. I'd also like to thank ManyTricks for their continued sponsoring of Pragmatic. If you're looking for some Mac software that can do many tricks, many, many tricks, remember to specifically visit this URL, for more information about their amazingly useful apps and use the discount code Pragmatic25, that's Pragmatic the word and 25 the numbers for 25% off the total price of your order. Hurry, it is only for a limited time and I guarantee you, yes, it will end. So get in while you can. Once again, thank you darling and thanks for listening everybody. 20. (upbeat music) (upbeat music) [MUSIC PLAYING] (upbeat music) ♪ ♪ (upbeat music) (upbeat music) [MUSIC PLAYING] ♪ ♪ [Music] - Yeah, well, this is why I say BMI. - BS BMI. - Yeah, I call b****** on BMI. But, um... - You just... I'm going to have to beep that. - Oh, can I swear? - But, no! This is a family show! - Really? - I don't know. I don't know how many families listen to it. Dear listeners, if you are a family... - I apologize for my language. - Okay, lovely. This is about me. This bit's about me. me. Me, me, me, me, me, me, me. Thank you. Yes. Anyone would think it's your podcast. Yeah, well, I would think that, wouldn't they? I keep talking all the time. Okay, lovely. Can we focus? No. I'm going to try. It's getting late. It is late here. It's late here. They don't know that. They could be listening to this in the midday. So if I say whatever time of day it is here relative to... It's 10 o'clock. It's quarter past 10 and we have four children. You draw conclusion spokes. Yeah okay it's late. Okay good. Stop it! I've almost got to the end! Right visit... oh god I'm gonna have to record this later. I'm leaving, I'm leaving. Thank you. I just... thanks sweetie. Visit Oi! Shut it! When I was setting up for this episode, my son, my four-year-old son, decided that he'd help me out with my little sound test. This is what happened. Hello, I'm Sam. Tee-tee-tee! Hello, my name's Sam and I'm four years old. I'm going to turn five and then I'm going to turn six and then I'm going... and I love you daddy. Aww and I love you too. Thank you Sam. Bye. Bye. Broom boom. We out.
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Kirsten Chidgey

Kirsten Chidgey

Kirsten is my wonderful wife. She has a Twitter account but never uses it. She has no blog, but honestly I think she should.

John Chidgey

John Chidgey

John is an Electrical, Instrumentation and Control Systems Engineer, software developer, podcaster, vocal actor and runs TechDistortion and the Engineered Network. John is a Chartered Professional Engineer in both Electrical Engineering and Information, Telecommunications and Electronics Engineering (ITEE) and a semi-regular conference speaker.

John has produced and appeared on many podcasts including Pragmatic and Causality and is available for hire for Vocal Acting or advertising. He has experience and interest in HMI Design, Alarm Management, Cyber-security and Root Cause Analysis.

You can find him on the Fediverse and on Twitter.