"I wasn't hungry, but I still wanted to eat.”
Elizabeth Wolinsky was 29 in early 2011 when she decided to have LAP-BAND surgery. Although she wasn’t suffering from diabetes, high blood pressure, or any other obesity-linked conditions that lead many women to consider bariatric surgery, she was tired of the number on the scale. "I’ve struggled with weight my entire life it’s always been something I wanted to do," she says.
Unfortunately, the procedure—which creates a smaller stomach "pouch" by placing an inflatable band around the upper portion of the stomach—didn’t turn out exactly as she hoped. While she did lose a lot of weight, about a year and a half later the band eroded into her stomach.
In other words, her body tried to reject the band by building up scar tissue around it, which is one of the possible (yet rare) risks of the surgery, according to the American Society for Metabolic and Bariatric Surgery. "I couldn’t eat or drink anything because there was all this scar tissue building up around the band," says Wolinsky. "It was making the band really tight, and I threw up for weeks." In the middle of 2013, she had emergency surgery to remove the band.
Within eight months, Wolinsky regained all weight she lost—and then some. At 345 pounds, "I’d had enough," she says. "I had a long conversation with my doctor about gastric bypass versus the band, and after doing a lot of research, I knew 100 percent that I wanted to do it."
Despite the complications with her prior surgery, Wolinsky says she wasn’t too worried. With gastric bypass, the size of the stomach is decreased by creating a small pouch where the top portion of the stomach is divided from the rest of the stomach, according to the American Society for Metabolic and Bariatric Surgery. The small intestine is then divided and connected to the new stomach pouch.
In October 2014, she underwent a laparoscopic gastric bypass with the same bariatric surgeon in Atlanta who removed her band.
Now, having tried out both types of surgical weight loss methods, here are a few things Wolinsky wishes she knew about gastric bypass and its side effects before she did it.
From the outside, gastric bypass is more intense than lap band surgery: After all, they’re actually detaching a part of your digestive system. "I thought [it] would be a lot more painful and a lot longer recovery period," says Wolinsky. "And while the recovery was longer, it wasn’t more painful. As far as surgeries I’ve had, it was pretty easy."
In any minimally-invasive laparoscopic surgery (like gastric bypass), doctors don’t cut you wide open. Instead, they insert small surgical tools into a tiny incision and use a camera to operate from the outside. In order to see and maneuver around, they pump some carbon dioxide into your body around the part that’s being operated on. So in the case of gastric bypass, it's pumped into your stomach and intestines.
Although the gas is let out before the incision is closed, inevitably, a tiny bit gets trapped inside. So patients are asked to keep moving immediately after surgery to help the body move the air out. "Even though you just got out of surgery and you’re tired and in pain, you have to keep walking," says Wolinsky.
"You feel the air travel upward, toward your shoulder. It’s 10 times more painful than your body actually healing from surgery." Working out all of the CO2 took a few days. "I'm really goal-oriented, so I just breathed deeply and thought about my goal to get through it," she says.
For a week after gastric bypass surgery, many patients have a bag hanging outside of the body connected to a thin tube attached to the stomach; this allows any excess fluids to drain from the abdomen, according to the University of Iowa Hospitals and Clinics. And every day you have to clean it, Wolinsky says. "It’s excruciatingly difficult," she says. "It’s such a gross and painful feeling, knowing it’s attached to an organ in your body and you can see it." Fortunately, Wolinsky’s aunt is a nurse and helped her to clean the port until it was removed.
For the first couple weeks following surgery, Wolinsky slept in a semi-sitting position. "I’m a stomach- or side-sleeper, but you can’t sleep on your stomach for two to three weeks," she says. "It’s odd and uncomfortable, especially when you’re trying to recover from major surgery," she says. Fortunately, the pain medication along with extreme exhaustion from the healing process made getting her z’s possible.
As your body recovers from surgery and adjusts to its new digestive system, doctors advise a liquid diet. Despite the fact that she didn’t really feel hungry, Wolinsky was surprised by her food cravings. "It’s a weird thing to get used to not eating real food," she says. Wolinsky spent a total of about two months on a diet of liquid and soft foods. "I didn’t think I’d crave the act of eating," she says. Walking by her mom’s room at meal time was tough. "She was eating, and I’d be like, 'food…what’s that like?'" she says.
To get through, Wolinsky tried out a variety of blended protein drinks. Ricotta—especially a ricotta bake made with Parmesan, an egg, and seasonings baked till bubbly—was a favorite. "Making a variety of different-tasting things really helped me feel like I wasn't being cheated," she says.
Although Wolinsky was lucky to have a lot of hair before the surgery, she says about 30 percent fell out post-op. According to the University of Iowa Hospitals and Clinics, hair loss is normal after any surgery, and it’s especially common with weight-loss surgery. That's because your body is absorbing less nutrients.
"I knew it was a possibility, but I was hoping it wouldn’t be me," says Wolinsky. "People tell me it’s not noticeable, but for me it is," she says. "I look at old pictures and even though I was so much fatter, I’m also like, 'damn, look at my hair!'" Wolinsky combats hair loss by taking a biotin supplement and using Nioxin shampoo and conditioner. "I honestly don't know if they help or not because I'm too scared to stop either to find out!" she says.
One of the unpleasant side effects of gastric bypass, according to the University of Rochester Medical Center, is what’s known as dumping syndrome. Since the new stomach pouch isn't able to digest all foods, like simple carbs (i.e. sugar) and sometimes artificial sweeteners, those foods get "dumped" causing nausea, vomiting, abdominal pain, cramping, diarrhea, and weakness. Since simple carbs are one of the culprits, gastric bypass patients are advised to avoid all sugars for life.
While Wolinsky has learned to read food labels and avoid everything that contains any type of sugar, it’s nearly impossible to completely avoid. One time, for example, Wolinsky says she ordered what she thought was a diet Coke, but ended up with the real full-sugar deal. "The severity surprised me," says Wolinsky. "I thought they were exaggerating just to tell you what you shouldn’t be eating, but it feels like a heart attack that lasts for 20 or 30 minutes," she says. "I get dizzy and light-headed, and my heart starts beating fast." Wolinsky says she lies down and covers herself with pillows until the feeling passes.
Fortunately, Wolinsky says she isn’t a "sugar person," but she does occasionally have sugar cravings. When she does, she’ll nip it in the bud with Halo Top lemon cake ice cream, which is made with stevia. "Fake sugars can cause dumping, but as long as I keep my portion size smaller it's all good," she says. And if she’s at a birthday party where she really wants cake, she’ll have a bite. "One bite won't cause digestive issues," she explains. "Plus it's very easy not to overindulge when the consequences are so swift and painful."
In the first six months after surgery, Wolinsky lost 50 pounds, which is not as much as she was expecting, she says. Then, for three months, her weight plateaued. She realized that although her stomach was significantly smaller, she needed to revamp her eating habits to see continued progress.
"I thought with surgery I could eat whatever I wanted," she says. That included lots of her comfort foods: bread, potatoes, pasta, processed snacks, and lots of meals out with friends at restaurants. "Even though I ate really small amounts, I didn’t pay attention to what I was eating," she says. "Surgery is not solution, it’s a tool to help get you to where you want to be."
She now follows what she calls a modified Ketogenic diet, i.e., super low in carbs and high in fats and proteins. She aims to stay below 25 grams of carbs per day and avoids all processed foods. Instead, she fills up on plenty of veggie- and protein-filled meals she cooks at home. And she logs every bite she eats. In the two years since her surgery, Wolinsky has lost a total of 130 pounds, weighing in at 215. And that's huge progress, though she’d still like to lose another 70. "Now I have so much more energy. It feels like my body runs more efficiently." That said, Wolinsky says she still craves carbs all the time. "What gets me through is my monthly cheat meal. I make sure it's a good one," she says.
Immediately after her surgery, Wolinsky says the weight loss helped her to feel hopeful about future. Then the plateau hit. But now, she says the experience was good for her. "I know I can do this even though it’s hard," she says. "It’s made me more tenacious and given me a whole new outlook on myself and what I can do."
What’s been essential: forgiveness when she inevitably slips up. "Some days you’re having a bad day and you eat too much because you don’t know what you’re doing," she says. "But I would never take back having the surgery. It’s one of the best things I’ve ever done for myself."