A challenge: Losing weight to avoid the surgeon's knife

The question before us is: can a 53 years old, morbidly obese man lose enough weight to positively impact his health and avoid gastric bypass surgery?  I intend to use this blog to publicly explore that question.  I am a type two diabetic with a family history of heart disease, diabetes, and obesity.  Can I make the changes in my diet and lifestyle that will undo years of bad habits and faulty thinking, or must I resign myself to radical surgery that will artificially limit the amount of food I can ingest?

Perhaps a little background is in order.  I am 5 foot 10 inches tall and weighed 273.5 pounds as my last doctor's visit. This is more than 100 pounds over my ideal weight and gives me a Body Mass Index of 40, well beyond what is considered healthy.  Since I was diagnosed with diabetes more than four years ago, I have been able to manage my diabetes with a bunch of pills every day, and by injecting slow acting insulin before bed each night. While this regime has kept my diabetes under control, the amount of insulin I need to take each night has been slowly increasing. This is bad sign, as it indicates I am becoming more resistant to insulin. Additionally, it seems to be much harder to lose the weight than it once was. I have tried moderately cutting back my daily calories and getting regular exercise. In the past, this would be enough for me to drop some pounds.  Now, my weight doesn't seem to want to drop off. My doctor said this is probably a result of the insulin. How ironic, the medicine that is controlling my illness is slowing my ability to reverse it.  Given my apparent increasing insulin resistance, both my family doctor and my endocrinologist have recommended that I consider bariatric surgery, specifically a gastric bypass.

So, with my physician's referral in hand, I sat through the mandatory information session sponsored by my hospital's bariatric surgery center.  The presentation was very informative. The surgeon outlined the six month screening process of supervised dieting, exercise, and psychological evaluations that are required before they would consider conducting the surgery.  She described the various surgical options such as the lab band or sleeve gastronomy, but strongly recommended that I undergo a complete gastric bypass. The thinking is that the other forms of bariatric surgery are not nearly as efficacious in addressing chronic diabetes.  Essentially, they would surgically reroute my digestive system, making a much smaller stomach and by-passing much of my intestines, hence the name.

The orientation seminar asserted surgery has a significant chance of completely reversing my diabetes. Essentially, the surgery limits how much you can eat at one time. According to the seminar, I could expect to lose (and keep off) about 70% of my excess weight after a gastric bypass.  However, this surgery is not without its risks and it is a very radical solution to the problem. The orientation did not try to undersell the significant risks from surgery. Instead, they pointed out that the risks from surgery may be warranted by significantly lowering of the risk of death due to complications from chronic diabetes.

At the end of the information session, a former patient talked of her experience with the bariatric procedure. The patient explained how she had been morbidly obese since she was 14. She said she had struggled with type-two diabetes for her entire adult life.  When her diabetes began to worsen as she turned 30, she decided to get the gastric bypass her doctor had been recommending.  Now, four years after the surgery, she obviously was much thinner and healthier than the woman in the "before" pictures.  She said her diabetes was gone and that she was very satisfied with her new post-operative diet. She said her surgically altered stomach makes it very unpleasant for her to eat more than a small portion of anything at any one meal. She also said she becomes physically ill if she eats anything with too high of a sugar content such as cake frosting or ice cream. The surgery has created a negative feedback loop that triggers discomfort, nausea, and cramping if she resorts to unhealthy eating habits.  She said the combination of the feeling of satisfaction along with the post-surgery aversion to sweet foods has enabled her to maintain her diet in an effortless fashion. She said that this was unlike all the other diet and exercise programs she tried and failed at.

Following the orientation session, I completed the required forms and submitted the paperwork to the hospital Bariatric Center to enroll myself in the pre-surgery counselling program.  Because morbid obesity with chronic diabetes is such a common diagnosis, the bariatric center may take up to a month to fit me into the schedule for the next step, a mandatory supervised diet and exercise program.

However, I have decided not to wait to begin the supervised diet.  Instead, I have begun a self-initiated diet in which I will try to limit myself to no more than 1800 calories per day.  This is a probably half of my normal calorie intake, and is much less than my "typical weight-loss diet mode" calorie limit of 2500 calories. However, 1800 calories is 300 calories more than the total calories I will be expected to consume after the bariatric surgery.  Because the total daily calorie count for the diet is relatively low, I will be logging all the foods I eat using a program that helps me also track my nutrient levels. Anyone who is interested in my diet or progress on my weight loss goal can see it at  Mike Summers' Public Diet and Activity Log. In addition, I intend to use this blog to narrate my journey to lose this weight, or if I fail that, with my experience with the surgery.

So, the question at the moment is can I maintain such a radical diet to lose the weight and thus avoid having the surgery?  I don't know, but my initial results from the diet have been surprisingly good.  I began the 1800 calorie a day diet on 17 July when I weighed 273 pounds.  As of yesterday, I had easily remained below the daily calorie limit, and I had lost 12 pounds. So, I am now down to 261 pounds. Another noticeable impact from the diet is that I have seen a significant decrease in the amount of insulin I take each night. This is probably not related to my modest weight loss to date. Instead, it is probably related to the significant drop carbohydrates in my diet as cutting empty carb calories is how I have stayed below my daily calorie limit.   Of course, it is easy to keep on the diet for a few weeks.  The real test will be if I can sustain a true change in my eating habits over the long haul.  Wish me luck, and check back here again from time to time to see my progress.  

“High Hopes” for new Springsteen Record Rewarded

Bruce Springsteen’s new album, High Hopes, is a solid collection that again confirms Bruce’s talent. Although this record consists of several older, previously unreleased songs, two rerecorded older songs, and two covers of other people’s songs, it does not sound like a grab bag of outtakes. Instead, it is a coherent record that stands up to comparison with his best works.  And, because some of the basic tracks were initially recorded some time ago, we are treated to two songs that include the late Clarence Clemons' saxophone work.

High Hopes strength is its varied arrangements. These arrangements provide just enough ornamentation to keep the songs from sounding stale.  Yet, the production also shows restraint. This restraint prevents the songs from being buried under a blanket of production effects.  The opening title track ‘High Hopes’ provides a prime example. This track begins with a polyrhythm that is uncharacteristic of a Springsteen composition. This rhythm propels the song and it, along with the track’s horns, keeps this song sounding fresh. Yet, the song retains a traditional Springsteen-esqe core that would be at home on the 1980’s Tunnel of Love.

Throughout his history, Bruce Springsteen has had the services of two outstanding guitarists, Nils Lofgren and Steven Van Zandt, to compliment his own guitar prowess. This record features those East Street Band regulars along with the ex-Rage against the Machine guitarist Tom Morello. Tom Morello is featured on all but one of the album’s tracks. Morello’s contributions add an additional texture to the two new versions of previously released tracks, American Skin (41 Shots) and The Ghost of Tom Joad.  The latter song is a studio recording of the arrangement previously available only on the live EP, “Magic Tour Highlights”. The transformation of the originally acoustic Tom Joad by Springsteen and Morello is akin to the transformation by Hendrix of Dylan’s All along the Watchtower.  This new arrangement powerfully expresses the anger, frustration and longing for justice that lies at the heart of this song. It is the highlight of the record.

If you are Bruce Springsteen fan, you should give High Hopes a listen.  You will not be disappointed.

My 2013 Best and Worst Film List

Laura and I go to the movies a lot. On average, in 2013, we went to the movies five times each month. Fortunately, there were a lot of decent films this year; films that didn't make me regret spending my money on the ticket. Most films I saw this year didn't make either the best or worst list. They were ok, but I could have just as happily waited to see them when they rotate to cable.

The list of recommendations are those films that I thought were the best and that you should seek out if you haven't seen them yet. The list could be incomplete as I haven't seen some films still in wide release such as Anchorman 2, or Inside Llewyn Davis yet.

The films on my worst list are films I regretted spending my money on.  Stay away from them.

The films on both lists are in the order of their release, and are not ranked against each other. However, the films on my best list tended to get better towards the end of the year. December was a particularly good month, and  American Hustle, released in late December, was my favorite film of the year.

My 2013 Recommendations 

42

• The Jackie Robinson biopic, good acting, good story, it left me with a good feeling

Star Trek  into the Darkness

• The latest Star Trek Reboot does not disappoint. If you liked the original series, you will be pleased with the parallels with the original, but you will be surprised by the twists. 

This is the End

• Seth Rogen apocalypse comedy that had to have been written when he was stoned. Still it is funny if you like scatological humor. 

The Way Way Back

• Steve Carell plays a real ass-hole in this comedy/drama but is easy to see why this film won awards at Sundance. 

Fruitvale Station

• Not a feel good picture, but definitely puts you right in the heart and mind of the characters

The Butler

• I expected this to be a black Forest Gump for some reason based on the trailers. However, it turns out to be a good, solid film about how the choices people made in the black community during the struggle to win civil rights impacted one family.

Enough Said

• James Gandolfini and Julia Louis-Dreyfus had real chemistry in this comedy that almost no one saw

Killing Them Softly

• A very faithful (almost word for word) adaption of the novel Cogan’s Trade. Brad Pitt, Ray Liotta and James Gandolfini are excellent in this film that absolutely doesn’t follow the standard underworld hit man cookie cutter plot.  Some people were disappointed with the ending, but it is faithful to the novel.

Don Jon

• As film about a Guido addicted to Porn, I was surprised I liked it. But, Joseph Gordon-Levitt, Scarlett Johansson, Julianne Moore and Toni Danza really were good in this romantic comedy that does not follow the formulaic rom-com plot.

Gravity 

• Sandra Bullock is excellent in this non-stop action drama that is best seen in 3D

Captain Philips

• Tom Hanks won me over again in a film that I did not think I was going to like going into it.

12 Years a Slave

• A true story, it is brutal but honest look at slavery.  Definitely not a feel good story, but it was not as depressing as Fruitvale Station.  Worth your time though.

Dallas Buyers Club

• Matthew McConaughey and Jered Leto are fantastic in this film. The plot is original, and  the unlikable characters are interesting.

American Hustle

• The Best film of the year, Christian Bale, Amy Adams, Jennifer Lawrence, and Bradley Cooper make you care about the characters in this funny comedy/drama about the Abscam scandle in the 1970s.

The Wolf of Wall Street

• The film is too long, and it is morally ambiguous but the excellent performance by Leonardo DiCaprio and scene stealing performance by Jonah Hill redeems this film.  Martin Scorsese captures the essence of the sleaze that was Jordan Belfort.

The Worst Films of 2013 (I want my money back)

Broken City

• Mark Wahlberg and Russell Crowe let me down with this stinker in which the bad acting is matched by the bad plot

World War Z

• Even Brad Pitt could not save this lousy plot that shares nothing in common with the excellent book except for the title.  Even the zombies are wrong.

Stand Up Guys

• I had high hopes for an Al Pacino, Christopher Walken, Alan Arkin gangster flick, but the plot completely let me down

A Good Day to Die Hard

• A noisy excuse for explosions and car chases, an asinine plot and bad acting. Nothing about this film was good. Bruce Willis must have needed the money

The Great Gatsby

• This film could have been great, but the soundtrack, editing, and desire to make a “spectacle” instead of telling the story ultimately bog the film down. Tobey Maguire spend most of the movie looking dumbfounded. Leonardo DiCaprio plays a decent Gatsby, but his screen charisma just couldn’t save this one.

White House Down

• Stupid and predictable with bad acting to boot.

Killing Season

• The first in a string of bad Robert De Niro films.  John Travolta also stinks in this one. His acting is as bad as his facial hair (Amish Beard).

The Family

• The second Robert De Niro film that sucked. Bad plot and poor performances killed this one for me.  Michelle Pfeiffer didn’t fare much better either.

Thor: The Dark World

• It is a comic book film, so I don’t expect much. But this stinker could not even hit my very low bar. Laura is not going to forgive me for dragging her to this bomb. 

Last Vegas

• I got free tickets for this comedy so I was predisposed to like it. However, the plot was weak and predictable, the characters were one dimensional and the jokes just weren’t funny.   Not a single one.

A Prescription for Newtown

The Newtown tragedy has prompted numerous individuals in the news, blogs and in social media to call for greater gun control or less frequently, more mental health care. While both suggestions would be a step in the right direction, they alone will not make us safer.  The real prescription is much harder.

Any solution must ensure that guns and other tools of mass homicide do not get into the hands of alienated homicidal mentally ill individuals. However, passing draconian laws limiting access to firearms to all would rob too many law abiding citizens of their rights without really being effective. Any regulation of firearms needs to allow for competent individuals to possess guns firearms for self-protection, hunting, and sport shooting.  Firearms aren’t the only option for mass murder. Bombs, arson, and even knives have been used in mass killings. The key is limiting access to the tools of mass murder to mentally ill maniacs.   

The challenge here is that we do not know fully know how to successfully diagnose and treat this type of illness.  Unfortunately, there have been enough of these killings that psychiatric professionals should be able to develop a likely cohort that will include these potential killers.  However, the vast majority of individuals meeting that profile will not commit mass murder but it is better to temporarily restrict these individual’s civil liberties with respect to gun ownership, body armor, bomb making ingredients et cetera than to allow yet another senseless tragedy to occur. 

Our efforts should concentrate on identifying the individuals who fit the profile and to intervene before the sickest members of that group are able to act on their impulses. Increasing access to mental health care would help, and we need a mechanism to allow for individuals to be compelled to undergo a mental health evaluation when the warning signs are detected.  If an individual is diagnosed by mental health professionals as meeting the profile of someone who may potentially be dangerous, then weapons of mass murder need to be temporarily removed from their household.  Not only would this decrease the potential of these individuals to worsen and go on a murderous rampage, but it would also decrease the rate of suicide. Individuals meeting the criteria to have their access to weapons curtailed are also likely to be suffering from mental illnesses that are highly correlated with suicide. More than 50 percent of the death by suicide involve the use of a gun.

We need a society that can accept the temporary loss of some rights for some for the safety of themselves and the community while allowing individuals to get treatment and hopeful regain their full second amendment rights. It should be possible to establish temporary, public armories to store weapons removed from such households, so that other members of the household can still access their weapons for hunting, sport shooting and other lawful purposes and to allow for the return of weapons to individuals who have been judged to have recovered from their mental illness.  We need to concentrate on limiting access to weapons of mass murder only to those who are most likely to be of harm to society.