When Things Go in Opposite Directions at the Same Time!

Last fall, in September 2022, I had bariatric surgery. To be precise, I had a gastrectomy, also known as a gastric sleeve. I had worked diligently with my PCP and bariatric surgeon for over a year to get to my long-awaited surgery date. Bladder cancer left my body and metabolism in proverbial heaps.

Dealing with bladder cancer

When I was diagnosed with bladder cancer, my weight ballooned to 305 pounds. I could not go for a walk or work out because I was constantly running to the bathroom.

I fought for over 2 years to get the diagnosis, presenting atypically and not fulfilling any of the stereotypical bladder cancer checklist items. I wasn't even sleeping through the night.

Getting cancer treatment

During treatment, I lost around 60 pounds and thought, "Great! I hope I can keep this up when treatment is done!" The naive new cancer patient didn't realize that cancer doesn't just end when treatment does. After treatment, I struggled with fatigue and neuropathy, among other things. I was barely making it through my work days.

My appetite came back, and despite efforts to exercise when I could and eat right, 120 pounds piled on almost immediately, and even with physician interventions, my weight continued to climb.

From prediabetes to type 2 diabetes

Trials of medications and supervision with physical activities did not help. By September 2020, I was officially diagnosed with type 2 diabetes after about 2 years of having prediabetes and a team effort to get my body in check.

By the time I waved my white flag in the spring of 2021, we had tried so much, and I realized that what used to work for me no longer did. I needed help - more than my primary care office could give me.

Working with a weight management team

I was referred to a weight management clinic to team up with the surgeon and a whole team of registered dietitians. Things were still awry despite changing my eating habits, cutting out foods that triggered my glucose levels to spike, and getting more exercise.

I was making all the right moves, but my body and the lab results were not showing progress. I think the whole team was frustrated, but most of all, I was.

Struggling with a high A1C

Eventually, after changing meds and working with the team for quite some time, my weight finally started decreasing, but my labs were still going haywire. My A1C continued to rise despite everything else trending downwards and in the positive direction we wanted them to go. The A1C had climbed above the limit to have the procedure, so I was indefinitely on hold until we could get that down.

I asked if it was time for me to get an endocrinologist. My primary care did not think I needed one - "Ah, you'll be getting this surgery, and everything should trend downwards after that."

"Yeah," I responded, "but first, I have to actually get to the point that I can have my surgery!"

Consulting an endocrinologist

Fortunately, my bariatric surgeon disagreed and referred me, but there was a nearly 5-month wait! I scheduled the appointment and continued on.

We removed one medication and added another. I was taking 2 oral diabetes medications. They made me nauseous, but I continued to power through. Fortunately, this medication change finally worked. My A1C rapidly dropped! I could get the procedure scheduled.

Following strict routines

In the following weeks and months, I followed strict routines with eating and drinking. I got IV hydration for a month post-op as a precaution due to having a urostomy. I adjusted to my new body and intake limits.

As I was cleared for physical activity, I started exercising at home. Winter is hard with neuropathy, so some days were challenging, but I pressed on.

Still, I plateaued much sooner and with less weight loss than any of the doctors anticipated (sarcastic voice: thanks, cancer!). I plateaued even with losing inches and having all my labs trending correctly.

Starting an injectable medication

The endocrinologist discussed adding medications to my routine. They were all injectables. I struggled with those options, being thrown into the midst of medical PTSD with the sheer thought of it—trauma from all the heparin shots and subsequent bruising.

I wasn't thrilled with the idea of giving myself shots. However, I was out of options. So I added Ozempic.

I'm still in the early stages of this drug and just received my first step up. It seems to be helping, and I'm hoping that with the increase, I'll see more success.

It's challenging to manage it all

Still, it's challenging to be doing all the right things, and all the things that the medical teams look at are still not aligning the way they wanted or hoped. Onward and upwards, as the saying goes. In this case, the hope is "onward and downwards!