If you've never been extremely overweight (okay, I'll say the dreaded "O" word - I was morbidly obese), it's nearly impossible to understand the emotions, fears and real physical needs that exist in the bariatric population. We are a group with tender emotions, physical challenges and health issues that can be quite complex.

Let me back up a bit before I get into the story of my surgery. I'm a registered nurse and the administrator of several ambulatory surgery centers. I'm a wife, mother and grandmother, and an active professional in nursing and ASC associations. I was also morbidly obese for the past 10 years, 395 pounds at my heaviest.

Overweight as a teen (the largest cheerleader that Waterloo High ever had, I think) and one of those people who could lose and regain half a person without a blink, I found myself 56 years old and unhealthy. I had a wonderful family and church, terrific peers and friends, a great job and interesting professional outlets. The excess weight was a real monkey on my back. It overshadowed the good in my life, limiting my activities and making me feel old and look unattractive. I was in chronic pain from arthritis and degenerative disc disease. I also had such severe sleep apnea that I was forced to sleep with a continuous positive airway pressure machine to help me breathe.

My private demons
My weight never seemed to stop me from gaining promotions or from taking part in professional activities, such as public speaking and writing, but, make no mistake, it did limit me in many insidious and privately painful ways.

This is the toll one pays for obesity. The challenges to self-esteem, physical comfort and wellness are huge. The difficulty of completing everyday activities is something that the obese person tries to hide at all costs. Not being able to tie your shoes, walk up a flight of stairs, fit a seat belt around you, squeeze into a movie theater seat or scratch your own back are incomprehensible to normal-weight people, but a daily struggle if you are obese.

The obese person faces discrimination just like other minority groups, even in medical settings. Let's face it: How many of our own team members and physicians make inappropriate comments or gestures about the obese patients in their care? Don't believe that your facility is without fault on this score.

It is culturally taboo to be overweight in our society. Heavy sweating, snoring, loud breathing and slow, lumbering gaits are some typical characteristics of the morbidly obese person that aren't considered socially acceptable in a "beautiful" world. Now, I don't mean to categorize all obese people as having the same emotional and social concerns; these are my thoughts. But I believe they are pretty typical of most.

A great grandmom
In the early spring of 2002, I began to contemplate extreme treatment for my extreme problem. Like many obese people, I had tried and failed at weight loss a number of times. With the potential problems of a surgical solution, it wasn't an easy decision. Did I want to risk my life to lose weight permanently? I researched the medical implications and surgical techniques, checked out local surgeons, discussed the options with my primary care physician and finally resolved to go ahead with gastric bypass that summer. My grandchildren were the deciding factor. More than anything else, I wanted to be around for a long, long time to be a grandma. I also wanted to have a lap for them to sit on.

Having a medical background made the decision easier in some ways, but more difficult in others. I knew very well the possible complications, but I also knew the surgeon, and that made me more comfortable because I knew his expertise. Even though bariatric surgery without gastric bypass was an option, I decided to have the bypass because that has the highest rate of success and long-term weight loss.

When I made my decision, I told few people. I chose not to talk about it ahead of time because I expected that people would tell me not to do it. I used a pseudonym (my maiden name) on the OR schedule because so many people in the system know me and I didn't want to hear their opinions.

The first step in the process was to meet with the physician assistant who started me on the long road of diagnostic testing to clarify my appropriateness as a candidate. I had to clear many hoops before I even got to see the surgeon. At that time, I also underwent counseling. My surgeon has a very aggressive pre-op screening process. A psychologist or psychiatrist had to assess me to make sure I would be compliant with the huge lifestyle change after the surgery. Physically, I had normal pre-op tests, including a cardiogram and blood test, plus an upper endoscopy (EDG) to make sure there was no pathology in my stomach and upper intestine. I also had to have an echocardiogram because I had taken the Fen Phen combination years ago, and that was linked to heart issues.

I became a patient at one of my ASCs for the EGD testing. Knowing the nurses, technician, anesthesiologist and physician who'd care for me was so comforting. It gave me a better insight as to how frightening it must be to go through the test without knowing any of your caregivers ahead of time. Still in a hulking body, it was very embarrassing to be cared for so hands-on by those I knew.

Life after surgery
After the surgery, I had a stricture where my stomach and jejunum meet. It shrank to the size of a pinhole and I couldn't get food through, so I had to have that dilated four times by a gastroenterologist. Other than that, I had normal follow-up visits - in fact, I just went in a few months ago for my first year checkup.

On the nonsurgical side, I had to make changes and watch my food, vitamin and protein intake very carefully after the surgery. I couldn't eat normal food for months, so I was at risk for protein and vitamin deficiencies. Because of the protein depletion, I lost a lot of hair. (You can see in the picture that it's since returned.) I was counseled beforehand that that would probably happen, but after feeling pretty wiped out for quite a few months, losing my hair was a little demoralizing. Vitamin deficiency can also cause some serious problems. Without enough B12, there can be neurological consequences, so for the rest of my life, I have to take B12, either by injection or by pill.

As my stomach stretches, I can eat more, but after the surgery I had to start small. I began with liquids such as skim milk and protein shakes and progressed to broth and then more solid foods. I could only eat a couple teaspoons of solids in the very beginning. Now I can eat just about anything healthy, as long as I keep portions small. The plan is for three small meals a day and lots of water. These days, I can eat a small piece of meat and a small serving of vegetables and a small salad. It's very easy now to know exactly how much to eat. A few times I've had severe pain from eating one mouthful too many and suffered for several hours. It's very self-limiting.

No more sweets
I've also had to cut out sweets because gastric bypass permanently bypasses the duodenum, where sugar is metabolized. If I eat sugar, I can get "dumping syndrome," which means sugar dumps into a part of the intestine that cannot handle it, resulting in a lot of pain and sickness. I stay away from sugar now because, as my doctor explained, either I'll get dumping syndrome from it and be sick, or I'll find out I can eat sugar without dumping syndrome and start eating sweets again and gain weight.

I'm lucky because now there are so many sugar-free products on the market that it's easy to eat better. Another lifestyle change I've had to make is to add an exercise program, just as any healthy person should. It's easier and more fun to exercise now that I've lost the extra weight.

Buying clothes off the rack
The whole process took about a year, from the time I made my decision, through the surgery and initial recovery. In the year after my surgery, I lost about 135 pounds, and my weight is now stabilized at about 160 pounds.

Besides helping my health, the surgery has made positive differences in so many small ways. There is a lot of subtle discrimination against obese people that many think is just a figment of the imagination, but is definitely there.

I had to change my entire wardrobe, which was expensive, but fun. It's wonderful being able to buy normal-sized clothing and to go in any store and get clothes without having to search. I'm able to cross my legs now, which wasn't possible when I was obese. This may seem like a silly thing to mention, but it was a real defining moment when I could do it. I was also very reticent to travel by plane before my surgery because it's not easy to sit in such a crowded setting next to a stranger.

Like many post-bariatric surgery patients, I experienced an extreme loss in skin elasticity, most noticeably on my jowls and under my eyes. I looked sad and tired. This lead me to have a facelift. I haven't undergone any body contouring cosmetic surgery procedures to tighten the excess skin hanging off of my arms and stomach.

Being a patient
Going through parts of the screening process at my own ASC, I learned a lot about being a patient. The thing that sticks with me most is how important it was to not be treated like a number. When I went for testing, it was all in my own health system, but not all at facilities where people know me intimately. It was important to me when people were kind and personable and smiled at me - when there was a warmth to people. When treating the physical side, remember how emotionally vulnerable your patients are during this time and that everyone has a need to be cared for.

As health professionals, we can do a lot to bring more humanity and comfort to the obese person's care. It's amazing how simple much of it can be. Seemingly small touches like having the right size gown and blood pressure cuff ready so that a patient doesn't have to be embarrassed by asking for a larger size can make a huge difference in comfort. In my own surgery center, I've made sure that waiting room chairs don't have arms, so that larger people can sit down.

Ensuring beforehand that your stretchers and OR beds can handle an obese patient's weight during surgery is also an important step for comfort and safety. Train your staff to be sensitive to the emotional needs of obese people by smiling, touching and leaving prejudices at the door. Remember that obesity has its own set of health issues that must be incorporated into a plan of care and make sure you remain educated on health and nursing issues for all diseases and conditions. I feel that my center has always looked after smaller needs like these and I'm proud of my staff for doing so. As I told my surgeon, "Your hands provided the technique, but your heart and soul provided the humanity."

The human touch
I share my story to hopefully dispel the myth of the fat person being uneducated, lazy, poorly groomed, unprofessional and weak-willed. The obese person who comes to the outpatient facility for a procedure in a sweat suit with no makeup and hair pulled back may not look her best, but may well never go out in public that way in normal daily life - just like the average-weight person. So judgments are tricky.

The reason I agreed to put myself out like this is to bring to light the impact that we as health professionals have on people who are struggling. Our humanity makes it or breaks it for people. If you remember nothing else about my story, I hope you remember that.