For those of us that are morbidly obese and decide to loose a lot of weight, sagging skin especially skin folds of the abdomen, arms breasts, thighs and neck will sometimes become a concern. If we are considering “bariatric” surgery, including gastric banding and gastric bypass perhaps sagging skin is more of a concern as the result of the quicker weight loss.I am looking forward to the future where I will feel comfortable wearing a bathing suit in public. As I started to fantasize about a wonderful new figure my thoughts turned to sagging skin. I wondered if Medicare would cover the cost of corrective surgery to remove this flabby skin? Obviously the loose skin would be a result of weight loss due to a surgery authorized by Medicare! After doing considerable checking I learned that Medicare considers the removal of loose skin to be “cosmetic surgery” and therefore do not cover it. I also learned that many insurance carriers would not cover this surgery as they also considered it cosmetic. Still, a person should always check with there own physician and insurance company and even Medicare, as there are carriers that will cover skin removal if it is found to be medically necessary.

As I browsed the Internet I learn that body contouring designed for those that go through weight loss surgery is becoming a specialty of many surgeons. I also learned that the costs associated with this type of plastic surgery could often be as expensive as the bariatric surgery. I can certainly see where having a tummy tuck along with other areas of sagging skin removed would be a desire. I can also see where the removal of flabby skin can also be a necessity for some that loose a large amount of fat and are now experiencing problems such as rashes, blisters and infections.

Our skin has pretty good elasticity. For many if not most of us time and exercise will take care of the sagging skin problem. Sure we may always have a few areas that we would like to have tuned up. For me, while I see the weight loss as a real health concern I will look upon the remaining sagging skin as a battle scar from a battle that I am winning against the Obesity Demon.

Chap 15: A Better Body for Better Sex (Part 2)

By Terrance Lile - Uncle Terry

Finally heeding the doctor’s advice I started to take exercise seriously. Knowing that I was still lacking the motivation to do it entirely on my own I purchased a gym membership and worked out with a personal trainer 3 days per week. During the first few sessions I was like a beached whale. My endurance level was a zero on a scale of one to ten, with 1 being the worst and 10 being the best. My trainer would call me the human “C” for I walked bent over like a 90-year-old man.

For the first several sessions the trainer worked with me on stretching, posture and balance as he slowly introduced weight training and cardiovascular exercise. Week by week I was becoming more flexible and my body was getting stronger and I was able to perform more intense cardio exercise. I was working up from ten minutes to a half hour and on many days 2 half hour cardio sessions. I was getting more energy, losing weight and feeling great. Seeing the results I added more cardio and started participating in a spinning class.

After a few months I was no longer being called the human “C”, I was walking upright and looked a few years younger. I had lost 25 combined inches from my hips, waist, chest and neck, and had gained a lot of muscle. Six months after starting to work out I felt so good and so much younger that I went skydiving for my first time. Let me tell you, folks, this was my first dive and free falling at 12,000 feet is one hell of a climax!

Just prior to my next birthday I spent a couple of days camping next to a lake with the family. As you probably recall, one of Spike’s friends had a Seadoo type watercraft with him and was using it to pull a tube in which a person would ride. The tube would be pulled around the lake at high speed and he would try to throw the rider. The young people really seemed to be enjoying the tubing but none of the older people even seemed to have an interest in trying it. Well, finally this old fart uncle of yours took the challenge and, while being towed, I felt 40 years younger. Unfortunately, for the next couple of weeks I had a lot of aches and pains but, still, let me tell you that tubing is a blast. Now I am trying to talk myself out of bungee jumping, something I want to do so badly but my doctor advises against it due to an ongoing spinal condition.

Through continued exercise I have helped to control my weight and, month after month, instead of feeling older, I feel younger. Yes, anyone can turn back the clock and enjoy a better life in everything they do, including sex. “Yes, Uncle Terry, we can see that you are proud of yourself and we are, too,” Pieter said.

Continuing on, I said, “I have talked too much about myself and how I did it. Let’s talk a bit about some basics for better sex that apply to most everyone.”

Exercise Equipment

During sex you will find yourself maintaining certain positions for short to long periods of time depending upon the activity and your endurance level. To hold these positions conditioning of your muscles is very important. While all kinds of equipment are available for the home gym, you need not spend a fortune. Most of my home workout equipment was purchased at garage sales and thrift stores. It does not take fancy equipment to have a successful program. The shoulders, chest, abdominal and glutes that are all used during sexual intercourse can be strengthened through push-ups, sit-ups or crunches and back extensions.

An exercise or body ball is a wonderful, inexpensive piece of equipment. If you have back problems you will find it easier on your back then a mat or the floor. If your back is in great shape, or even if it isn’t, you will find that you can do many advanced exercises on the ball. In addition to working out at home I still enjoy going to the gym and usually go there 2 to 3 days per week. I have continued to use a personal trainer but now only once per week. While a personal trainer is an expense that can stretch a budget, he helps to keep me motivated, monitors my training and it is money not spent on medication and doctors.

Exercise Basics

To get started on an exercise routine you need a plan. If you belong to or join a gym they will have “experts” that can assist you in designing a plan to achieve your goal. There are also independent experts that will come to your home or you can go to their facility. Ask about and check out the credentials of these “experts. ‘ In many locales there are no licensing requirements for trainers and the qualifications vary widely. If you plan to do all of your exercise on your own, you will find information on the Internet and a number of good books at the library or bookstore, but for now we will cover a few basics of exercise.

Strength training has many benefits, from building stronger bones and better-toned muscle to making you look and feel a whole lot better. Increased strength can improve one’s balance and posture. Our risk of osteoporosis and injury are reduced. Our ability to perform in our daily activity is increased and we enjoy life a whole lot more.

Strength and endurance training are activities that we should perform 2-4 times per week and neither the upper or lower part of our body should be overlooked. A planned, balanced exercise program is important but we also have additional daily options that can help us get stronger.

• Use the stairs instead of the elevator and this means not only going down them but also up them.
• Park the car further away in the parking lot instead of searching for a spot up front. Even at the gym you see people driving around in circles as they search for a parking spot close to the door instead of warming up by starting their routine with a little walk.
• When visiting friends or taking care of an errand a few blocks away, walk instead of taking the car.
• Put more effort into your chores and stretch a little further when working in the yard or doing housework.
• When watching television we can use free weights or resistance bands. When alone and others will not be disturbed, I will often do a full exercise and stretching routine while watching the news or a favorite program.

Opportunities to improve our endurance are right in front of our face, we only need to get off our duffs and take advantage of them.

Warming Up and Cooling Down

Warming up and cooling down are a very important part of our daily exercise routine. The short time spent here will aid the body during the transition period from rest to activity and back to rest. These steps help to reduce soreness and the chance of injury, which we are especially prone to as we get older.

Warm-up exercise is recommended for a period of 5 to 10 minutes at the beginning of an exercise routine and older people should warm-up a little longer. A combination of stretching and light to moderate aerobic exercise can be used as an effective warm-up. While the mode of aerobic exercise is not important, low-level aerobic exercises such as a treadmill, stationery bike or brisk walking is ideal for warm up. Whether you are biking, walking, swimming, rowing or performing another activity, you can warm up by slowly and gradually increased the intensity of your exertion over the course of 5-10 minutes. Active and static stretching can also be used in conjunction with an aerobic warm-up. Just remember that the body will respond to stretches better if you have completed some light-to-moderate cardio first. Cool down is done at the end of an exercise routine. During this time you are bringing your heart rate down to 10 to 15 beats above the resting heart rate. This reduces the risk of muscle cramps and helps prevent a sudden reduction in blood pressure.

Flexibility Training (Stretching)

Great sex requires good flexibility, physical and muscular endurance. If a person is out of shape it is never too late to get started. At the gym I will regularly see both men and women in their 70s and 80s that work out 2 - 4 days per week and they look absolutely great. Seeing these people has certainly been a good motivator for me.

Stretching is a key ingredient to improving one’s health and yet many individuals overlook this very important aspect of their training program. Daily stretching or even yoga is one of the best things you can do for yourself. If you have time to vegetate in front of the television you have time to stretch and, in fact, you can do both at the same time. Experts recommend that you stretch for at least 10 to 15 minutes and a minimum of three times per week. As an alternative they recommend shorter bouts of more frequent stretching. We hit age 30 and it’s downhill from there if we don’t take care of our bodies. The great thing is you can start the climb back up the hill and stretching is a good place to start.

Stretching will also:

• Help you to feel better in all of your daily activities.
• Reduce risk to injury, muscle soreness and stiffness.
• Improves your performance and range of motion in your joints.
• Reduce arthritis pain.
• Reduce the incidence of back problems while improving the back.
• Expand range and mobility, allowing a broader variety of sexual positions.

Basic Stretching Safety

• Warm up your muscles before starting to stretch.
• Stretch slowly and smoothly, avoiding unnecessary bouncing and jerking.
• Exhale while extending your muscles to the point of tension, (not pain) and hold the position for 20 to 60 seconds. Breath evenly and continuously while stretching. Do not hold your breath, for this causes muscle contraction and raises blood pressure.
• Inhale while returning to the relaxed position and as you prepare to repeat the stretch.
• When performing stretches that involve the back, relax the spine by keeping your lower back against the mat while working only the abdomen or other muscles required for position changes.
• Stretching should not be performed before warming up and is appropriate for the cooling down period. When the muscles are still cold they are more easily injured by over stretching.

Forms and Functions of Exercise

Aerobic (Endurance) Exercise

Weight bearing aerobic exercise builds endurance and strengthens the bones in the spine. Aerobic exercise that maintains the pumping of the heart over an extended period of time while using the large muscle groups helps to lower weight, control blood pressure and boost HDL, the good cholesterol level.

“Uncle Terry, what is a good goal for aerobics exercise?” asked Reggie.

For me, a good goal for aerobic exercise is 30 minutes to an hour 3 to 5 times per week. For a young person in great shape or an athlete, even more time may be required. For people out of shape, they might start out with 10 to 15 minute sessions and work up from there. As my endurance improved and I got stronger I found that I needed to increase the intensity and duration of my sessions. Listen to your body, for it can tell you a lot, including when you need to increase an activity. From aerobic exercise alone a person will physically and sexually be able to perform better and more frequently.

Low and High Impact Exercise

Aerobic exercise is divided into the two basic categories of low and high impact.

Low to moderate exercise includes such activities as swimming, walking, rowing, cross-country skiing, water skiing, hiking and stair climbing. Most people, including the obese and elderly, can perform this type of exercise regularly.

High Impact exercise includes activities such as jogging, spinning, dancing, tennis, racquetball and handball. This type of exercise should be performed no more than every other day and less often for the elderly, those who are out of shape or the seriously obese. As with other forms of exercise, consult your physician if you have a medical condition or injury, for under some circumstances this form of training may not be advisable.

Strength or Resistance Training

Strength training becomes even more important as we age. Us old folks age 30 and up have started the slow process of our muscles wearing down. Resistance training can reduce or reverse this erosion, increasing the endurance and strength of our muscles. As our muscle tone and strength improves we can increase our metabolism, balance, endurance, get around better, feel better, look better and are a whole lot more healthy.

Unlike aerobic exercise, which increases the endurance and strength of the heart, resistance training can increase the strength and endurance of our muscles.

Strength training burns fat, builds muscle, helps us to maintain bone density, improves digestion and helps to lower LDL, the “bad” cholesterol levels.

• Strength training involves 3 distinct types of muscle contractions.
• Isometric contractions are those experienced when performing an activity such as pushing against a wall. No change takes place in the length of the muscle.
• Concentric contractions are those such as the “up or positive” phase that takes place when the biceps curl while lifting a weight. These movements shorten muscles.
• Eccentric contractions take place during the “down or negative” phase when the weight is lowered. These movements lengthen the muscles.

The Pelvic Floor Muscles

Exercising our pelvic muscles develops a greater capacity for blood flow, nerve sensitization and energy circulation. The training of these muscles enables us to achieve a greater awareness of inner sensations. With increased strength we experience greater arousal, more intense and multiple orgasms and the stamina to last longer.

The PC (Pubococcygeus) muscles run from the pubic bone in the front to the coccyx (tail) bone in the back. The muscles lie about an inch beneath the surface, supporting the pelvic organs like a hammock. These muscles control the bladder and bowel. Both males and females commonly strengthen this area using Kegel exercises. The diagrams below are of a female. To make them applicable to a male, just substitute a penis for the vulva. The PC muscle, which is partially hidden in the diagrams, circles the anus, genitals and perineum.

Kegel Exercise: Strengthening the Pelvic Floor

Kegel Exercise is named after Los Angeles physician Arnold Kegel. This is a great exercise for controlling stress incontinence in both women and men. The exercise strengthens the muscles used during intercourse, firms the muscles of the vagina and helps women gain muscle control so they can grip the penis better, while at the same time helping themselves to reach orgasm easier.

By contracting the pubococcygeus (PC) muscles just prior to orgasm and then relaxing them, a man can delay ejaculation. Squeezing these muscles allows the body to become naturally centered and grounded. It helps you to gain better balance and more energy, including sexual energy, and triggers the release of endorphins and serotonin, which are natural chemicals that give you a high feeling and are often associated with orgasms.

Instead of me just talking about it, let’s all practice performing the Kegel. You can perform it standing, sitting, or lying down so go ahead and choose your position.

Needing a stretch, I stood up, as did Klitty, Labia and Reggie, but Pieter decided to stretch out on the couch. “Remember,” I said, “you will not become proficient at this or any exercise without practice, so practice it two to three times per day. Since you can do it in any position it should not be difficult to work a few practice sessions in and you will probably enjoy it anyway. First, control your muscles as if you are trying to hold back gas.”

At that point our charming Prince Pieter let one rip. “Lord Pieter,” I said, “you were instructed to hold it back not chase us out of the room.” With a broad smile, Pieter replied, “Sorry.”

“Let’s try locating those muscles again,” I continued. “Now did you all notice the muscles you are using?”

Everyone agreed that they did so I went on. These are your PC or, to be more specific, the pubococcygeus.

• Now, contract the PC muscles and hold tight for 3 seconds (10001, 10002, 1003).
• Now release for 3 seconds (1001, 1002, 1003).
• Now do three more repetitions. Do not tighten your abdominal, leg or buttock muscles.

You can check for movement while exercising by placing your hand on these muscles. If you can feel the muscles moving you are not using the correct muscles.

Now, in the future you will want to work on increasing the “hold” and the “relax” to 10 seconds each. To develop controlled and intense orgasms you will want to increase the exercise time to at least 10 minutes three to four times a day so that you are doing about 100 repetitions per day (not per session). Again, you can do it at just about any time or place - sitting at your desk, driving, watching television, taking a shower or lying in bed. Do not try it while urinating, as holding back the urine in midstream can lead to a urinary bladder infection.

Pelvic Lift Stretch

The pelvic lift stretch will further assist you in strengthening your PC muscles for better control and more intense orgasms. Now, everyone find a spot where they can lay out on the floor and we will give it a try.

• Now that you are on your back, bend your knees up and slightly apart with your feet flat on the floor.
• Extend your arms at your sides to form a “T” with your upper body.
• Inhale; clench your abdominal muscles and buttocks, lifting the pelvis so that your back is aligned with the floor. (Do not arch your back and focus on using your abdominal muscles instead of the buttocks to move your hips.) Be sure to breath while holding this position for at least 10 seconds. (10001, 10002, 1003, 1004, 1005, 1006, 1007, 1008, 1009, 1010.)
• Now exhale as you lower your body back to neutral. For now, we will start out with 12 sets. In the future, as you get stronger, increase the length of the hold and the number of sets.
• Work toward a goal of 100 repetitions per day and these muscles will become a powerhouse.

Before anyone had a chance to get up, I instructed them to remain on the floor for we were going to practice some other exercises.

The Thighs

Many women hate their thighs and yet they are a great sexual tool and can be one of a woman’s best assets. As men it is incumbent on us to boost our woman’s confidence by paying more attention to that area of her body.

During sex a woman’s thighs separate her knees from her body and enable her to control her vaginal muscles. Using a simple technique of squeezing her thighs together, a woman can strengthen her vaginal muscles so that both her and her partner will enjoy better sex. Through learning to control these muscles by squeezing, a woman can bring a rush of blood to the area enabling her to achieve an instant arousal. Now men, toning these muscles will also give you more sexual endurance and better orgasms.

Toning of the inner thighs will help to tone the pelvic floor muscles, which span the bottom of the pelvis. The pubococcygeus (PC) muscles in this region control the flow of urine and, as we established earlier, the ability to hold back gas. These are not the same muscles used to hold in the stomach or tighten the buttocks. These muscles can be weak from irregular use or being under constant tension.

Inner Thighs (Hip Adductors)

The adductors help to stabilize a person’s knee joints while walking. By contracting the hip adductors your legs can be moved across the middle of your body. As the legs are traveling back and forth, the inner thighs are working with the muscles located in the buttocks and at the back of the thighs to stabilize you. Now, let’s give it a try.

• Lie on your side and bend the knee of your top leg. Place the foot of your top leg on the floor behind the lower leg.
• Lengthen the lower leg from the hip down to the sole of your foot with your ankle pointed toward the ceiling.
• Without changing your spinal alignment lift your lower leg up as high as possible and hold this position for 5 seconds. (1001, 1002, 1003, 1004, 1005.) In the beginning you will start at 5 to 10 seconds and work up to where you can maintain this position for about 60 seconds. Do at least 3 repetitions each time. As with all exercise, do not forget your breathing. Inhale as you prepare, exhale as you lift, inhale as you return to neutral.

Additionally, relax your pelvic floor with breathing, keep your shoulders relaxed and engage your abdominal muscles, and always be sure to maintain a neutral spinal alignment.

The next stretch we are going to do is the butterfly stretch. This stretch can be performed solo or as a couple. Let’s first do two repetitions of the stretch as a single and then for two repetitions you guys can double up.

Butterfly Stretch (Solo)

• Lie on your back with your knees bent upward and your feet flat on the floor while keeping them together.
• Pull your feet in until they are against your buttocks and turn your ankles in so that the soles of the feet are now facing each other. Your knees will now be pointing outward.
• Lower your knees toward the floor but do not force them (if you choose you may gently push down on your inner thighs).
• When your knees are as far apart as you can comfortably get them, hold this position for one minute before bringing the knees back together. Perform 3 - 4 repetitions.

Butterfly Stretch (Partner)

• The couple will sit up as straight as possible, back-to-back with their spines pressed together.
• Relax your shoulders while keeping your head in line with your spine.
• Bring your feet as close to your body as you can while touching the soles of your feet together while pointing your knees outward.
• Clasp your feet and breathe deeply, allowing your knees to lower (but do not force them down). Hold this position for one minute before bringing the knees back together. Perform 3 - 4 repetitions.

As we finished the butterfly stretch I mentioned to the couples that they were going to have some homework tonight.

Abs

Squeeze your abdominal muscles as tight as possible and keep them tight for as long as you can. This will cause your anus to contract, help you to control your ejaculation, increase sexual energy and enable you to sustain orgasms for a much longer period of time. This exercise can be performed just about anytime you choose and it has the added value of helping your posture.

The Penis “Muscle”

While the penis is frequently referred to as a muscle, this is a misnomer. If you think you are going to make that little guy bigger by exercising it you are going to be disappointed with the results. Unfortunately, doing pull-ups (or should I say pullouts) with the penis does not add length or circumference. But, heck, it’s an enjoyable exercise and any amount of cardio will certainly strengthen your heart.
The human penis does not actually contain a muscle; it does contain specialized structures that enable it to accomplish its major tasks of transporting urine, semen and partaking in sex. During sexual excitement the penis expands as the two cylinders of spongy tissue called the corpora cavernosa fill with blood. The fibrous sheath that covers the spongy tissues has limited ability to expand and, as the tissues fill, they press against the sheath and make the penis hard. While the penis extends far into the body, almost to the rectum, since it contains no muscle it cannot be enlarged by exercise (sorry Pieter and Reggie)” So, gents, while you might impress the ladies by pumping iron, you do not get the same results by pumping Winkie.

“Do you have any other tips you can give to me?” asked Pieter.

“Well, Pieter, since we are all relatives I guess you are going to have to go with the suggestions that I have already given you.”

Pieter replied, “Uncle Terry, stop kidding around, you know what I mean.”

“Okay, Pecker, like your Uncle Terry you are pretty good at wagging your tongue, so let’s discuss some exercise techniques that will surely improve your love life and keep your wife pleased.”

You have just read part of a chapter of my unpublished book “Sex From the Womb to the Tomb,” This is a story about a royal family in which Uncle Terry is a family member and serves as the sexual advisor. The book also discusses sexuality from birth until death. Much of the non-sexual information in this book parallels my life.

The following is part of a chapter of my unpublished book “Sex From the Womb to the Tomb,” Read more

As a senior, when I looked into bariatric surgery I first checked to see if any of them were covered by Medicare. I was pleased to learn that presently Medicare nationally covers open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch even though the terminology was just a bunch of babble to me.

One of the requirements of Medicare and my insurance company was for prospective candidates for bariatric surgery to attend a seminar. I attended an excellent seminar that was hosted by a local Bariatric Center that was approved by my insurance company. At the seminar both experts and patients spoke and all gave me a feeling of confidence in the procedures and the Center.

The following day as I started to review the information I was overwhelmed. While I really liked what I heard I needed to absorb what I had learned and perform a bit of research on my own.

During the seminar and as I begin my research, I learned that there are many types of weight-loss surgery. Reviewing the Medicare information I observed that they do not cover every type of weight loss surgery. The bariatric center that I was referred to by my insurance company performs Restrictive procedures where the amount of food and calories ingested is restricted. They also perform Malabsorptive where the absorption of the food is reduced. Their procedures include Roux-en-Y Gastric Bypass (RYGB) and Adjustable Silicone Gastric Banding. They perform both of the surgeries laparoscopically.

I knew that I wanted the surgery to be performed laparoscopically meaning that only a small incision is made. Heck, I want to look good in that bathing suit when I loose all that weight.

I was also quite pleased to learn that with most surgeries hospitalization is usually just a day or two. They even said that with the lap band surgery many of the patient go home the same day.

I do not have an extra $25,000 to spend on a surgery that is not covered by insurance or Medicare. After the seminar I also felt comfortable with the local Bariatric Center and therefore have limited most of my research to the approved surgeries they offer. For those of you that are interested in other types of surgeries I have placed some links that you may find helpful.

Roux-en-Y Gastric Bypass (RYGB)

Roux-en-Y Gastric Bypass (RYGB) surgery, was referred to as the gold standard treatment for the morbidly obese. This method combines a gastric restrictive operation with a small amount of malabsorption.

How the RYGB is performed

The stomach is divided into two parts. The upper part will receive food from the esophagus. The lower part of the stomach will not receive any food but it does deliver stomach acid into the duodenum. The surgeon also divides the small intestine in the upper jejunum and connects it to the small stomach pouch leaving an opening about the size of a dime. The joining of the stomach pouch and jejunum is called an anastamosis. Now if you are still with me and don’t understand the difference between halitosis and anastamosis, don’t worry about memorizing all these things. You might be an inquisitive person though and wondering what the surgeon does with the other end of the jejunum. Wonder no more for that end is reconnected creating a “Y” shape. Absorption will now begin at the point where the two pieces of jejunum come together. Now if you are a visual person like me and all of these fancy words have confused you perhaps the diagram will help you out! The American Society for Bariatric Surgery - ASBS has a lot of good information and you also might want to check out.

Advantages of RYGB

• Appetite reduction.
• Low complication rate
• Low rates of mortality, complications and failures.
• Highest long term success at achieving weight loss.
• Effective loss of 50 to 75 percent of excess weight.
• Weight loss is better that the totally restrictive methods.
• Low incidence of protein-calorie malnutrition and diarrhea.
• Weight-related comorbidities are rapidly improved or resolved.
  Appetite reduction

Complications of RYGB, Early

• Wound infection
• Pulmonary embolism
• Gastrointestinal hemorrhage
• Repertory insufficiency
• Slight risk of death

Complications of RYGB, Late

• Internal hernia
• Incisional hernia
• Bowel obstruction
• Stomal stenosis
• Marginal ulcer
• Micronutrient deficiencies

Adjustable Silicone Gastric Band

The adjustable silicone gastric banding surgery is a technology that was first approved by the FDA in June of 2001. During surgery an adjustable silicone elastomer band is placed around the upper part of the stomach to create a small pouch that will only hold a small amount of food. Food passes from the small pouch through a small outlet that has been created by dividing the stomach with the band. Food will now pass slowly through the outlet resulting in the patient feeling full.

The gastric band sounded pretty straight forward but as I read about it I learned it has many advantages and disadvantages as does the gastric bypass. The American Society for Bariatric Surgery - ASBS also has a lot of good information on the various gastric band surgeries.

Advantages of Adjustable Gastric Band

• Absence of anemia
• Absence of dumping
• Lack of malabsorption
• Short hospital stay
• Very low mortality rate
• Adjustability of the band
• Reversibility (by band removal)
• Laparoscopic placement

Complications of Adjustable Gastric Band, During Surgery

• Hemorrhage
• Injury to the spleen, stomach, or esophagus
• Conversion to open procedure

Complications of Adjustable Gastric Band, Following Surgery

• Band slippage (stomach prolapsed)
• Leakage of the balloon or tubing
• Port Infection
• Band infection
• Obstruction
• Nausea and vomiting

Late complications

• Band erosion into the stomach
• Esophageal dilatation
• Failure to lose weight

MEDICARE EXPANDS NATIONAL COVERAGE FOR BARIATRIC SURGERY PROCEDURES
February 21, 2006 The Centers for Medicare & Medicaid Services (CMS) announced that it is expanding Medicare’s national coverage of bariatric surgery for all Medicare beneficiaries. For seniors, who have experienced high complication rates in some settings, Medicare will cover the procedure only in high-volume centers that achieve low mortality rates.

“Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons it is an important option for some of our beneficiaries,” said CMS Administrator Mark B. McClellan, MD, PhD. “While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries.”

This decision expands coverage beyond a proposal published in 2005 that would have excluded coverage for bariatric surgery over the age of 65 years. CMS reviewed new data and analyses which demonstrate that surgeons with more experience have similar outcomes for patients of all ages. After reviewing the evidence and considering recommendations of professional societies and other experts in the field, the Agency determined that of the various bariatric surgeries currently available, the evidence indicates that only three types of bariatric surgeries benefit Medicare beneficiaries. Prior to today’s decision, CMS’ only nationally-covered bariatric surgery procedure was gastric bypass surgery. Effective today, the list of nationally-covered procedures now includes open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. Until other evidence is available, all other bariatric surgical procedures will be nationally non-covered.

According to the National Institutes of Health, approximately 34 percent of Americans are overweight and 27 percent are obese. Overweight and obese persons have an increased risk of a number of diseases compared to those with normal weight and waist circumference, including hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and certain types of cancers. Because of the relative lack of success of many weight loss programs, persons with obesity have turned to bariatric surgery at an increasing rate. In this national coverage analysis, CMS evaluated the benefits of bariatric surgery in patients who have one or more of these or other diseases in addition to obesity and found that the benefits of surgery have only been seen in those obese patients who have these problems. Thus, in this decision, Medicare is not covering bariatric surgery in patients who only have the diagnosis of obesity and not one of these other problems.

Also, the Agency determined that the health benefit of bariatric surgery can only be assured in facilities that do large numbers of these procedures performed by highly qualified surgeons. We have evaluated the certification programs of the American College of Surgeons and the American Society for Bariatric Surgery and believe that those facilities recognized by these organizations as Centers of Excellence will be most likely to produce this high level of results. Thus, CMS will cover these procedures only in facilities certified by these organizations. CMS will include a list of certified facilities on its website at www.cms.hhs.gov/center/coverage.

“CMS’ expanded decision draws upon the specific criteria that facilities must meet in order to obtain certification from either the American College of Surgeons or the American Society of Bariatric Surgery. Utilizing these groups’ expertise will ensure that beneficiaries will receive optimal care in a manner that provides the greatest likelihood of successful outcomes from this important procedure,” said Barry M. Straube, MD, CMS’ Acting Chief Medical Officer.

The final decision memorandum is available online at www.cms.hhs.gov/center/coverage.
Page Last Modified: 5/14/07 12:00 PM

I overslept and was now running late for an appointment an hour away. No time for coffee, better skip breakfast; I need to stop for gas. At the gas station I go inside for that morning fix - a cup of steaming hot black coffee. As I pour my coffee - staring back at me is lonely custard filled chocolate donut. No, I tell myself as the Obesity Demon within me argues back. It did not take long for that demon to convince me that a single donut for breakfast would be okay. As I savored every bite and then licked my finger to clean off that last drip of custard filling I sunk into a low for once again I had not only disrespected myself, I had also taken another step toward a shortened life. We cannot allow the Obesity Demon to control us if we are to win the fight against terminal obesity.

As obese individuals sex often becomes a challenge. Read more

I have spent my life as a fat person. While not always morbidly obese, most of my childhood and adult life has been spent thinking that way. I started out as a cute little bundle of fat, seven pounds at birth, which is a normal-weight. As I matured though I quickly became an overweight child. The extra pounds started slow but by the age of five I would be considered obese. Each year I added a few extra pounds and this continued into my adult life.

By the time I was fifteen I weighed 250 pounds and 265 pounds by the age of 17. That weight would have been okay if I was seven feet tall instead of 5′ 11″ tall. By age 59 I had lost two inches in height and weighed just short of 300 pounds. Since age 59 I have been up and down the scales by 70 pounds having dropped to below 230 pounds and now at the age of sixty-six I am once again nearly 300 pounds of mass. I have lost at least another inch in height and find myself shrinking so rapidly that sometimes I believe I am as large around the waist as I am tall.

I had an older brother whose weight varied between normal and obese from birth up through high school, later he became morbidly obese. James passed away at age 50 from heart failure.

A Fat Life Long Traveled

As I look back on my life I have thought about my childhood and all that I missed out on as a fat kid. I have thought about the good times when my weight was normal and the bad times when it was not. I have thought about the remaining years, which continues to draw closer for each of us with each passing day. None of us know how long we are going to be here but I realize that I do have the choice of making whatever time I have left enjoyable and weight control needs to be part of that choice. I realize that if I make the correct choice these remaining years can be a whole lot more fulfilling then they otherwise will be. I also realize that these remaining years can be a whole lot more in time and I am not anxious to leave this earth as I have a lot of unfinished goals.

Many of us that spent our childhood being fat can remember a lot of hurt. Pain that we could have avoided if we only new how to at the time. Pain that was within our own control but we did not know how to control it.

• In junior high school the physical education coach would select two individuals who would then select others to be on the daily teams. The fat kids and squirts were always the last to be picked.
• As a fat kid I was not invited to many of the parties that others went to.
• Getting a date was difficult. Some girls would just tell me no and others would have a great excuse. I remember one telling me that her uncle was going to die that weekend and she would need to go to his funeral.
• As a fat kid I tried to fit in by being a joiner in school clubs and found that while I could participate in the meetings and got along with everyone I still wasn’t invited to most outside parties.
• In high school I went out for football but was so fat that I was clumsy and earned my letter as the water boy. My brother had earned his on the team and my father had been captain of his team. While looking back, I should have been proud, at that time I was ashamed to wear my letter on a jacket.

By my junior year in high school I had only a couple of dates. My weight was about 265 pounds and I was developing a very poor self-image. With girls as my motivation to loose weight I went to see a medical doctor that specialized in weight control. This doctor was a bit overweight himself but not morbidly. After a short exam the doctor said “Terry, if you don’t do something about your weight now, you wont live to be twenty five.” I now had two good reasons to loose weight, girls and life. This doctor specialized in diet pills and injections of human chronic gonadotropin, which was derived from the urine of pregnant women, rabbits and mares. By 1957 this medication had become the most popular medication for weight loss. While studies have shown that this drug is useless for weight loss it is still available today.

I was placed on a low calorie diet, supplied with diet pills and vitamins and visited the doctor weekly for a weigh-in and injection. The diet seemed to work for a while but eventually I fell off of it and gained all of my weight back.

Looking back, the surprising thing was that I didn’t need to loose much weight before my attitude to start to change.

In 1961 the diet book Calories Don’t Count came on the market. The author Herman Taller, warned against carbs and refined sugar and advocated large quantities of unsaturated fat. I immediately went out and bought his book and went on the diet. As with previous diets the pounds were once again falling off and within about 3 months I had lost about 50 pounds. (In 1967 Taller was convicted of mail fraud for selling “worthless” safflower capsules.)

When I was 18 and in my first year of college I had only been on a few dates. Now weighing about 275 pounds I was seriously interested in girls and still getting turned down when asking for a date. I had tried a few diets and been up and down. I started to recognize that if I wanted to fit in I really needed to loose some weight and needed help in doing it.

Shortly after starting on the diet I asked a girl by the name of Lynda to go with me to a Christmas dinner that my parents were hosting for the family business. Lynda was a pretty girl and to my amazement she said yes. After that dinner we continued to date. Lynda’s friends asked her if she was dating me because my family was rich. Now we really weren’t rich but my father had a successful business and lots of people thought we were! Lynda stuck with me though, and was later to become my bride.

So here I was with these two great reasons to loose weight, the doctors choice of life or death and my choice of life with or without women. In a few months I had lost about 50 pounds on the pregnant women’s urine diet. With the weight coming off and a woman on my arm my attitude started to change. I found myself not only a joiner but also a leader. I found that I did have real friends and was invited to participate. I became president of both my fraternity and a service club I belonged to. I ran for student body president and while I lost it was a big step forward. Was this magnificent change because I was thinner or was it an attitude? It was both, for as I lost weight I liked myself better. As I liked myself better people liked me better.

I was not a great student and the country was in the midst of the Vietnam War and I knew that I would likely be drafted. I made the decision to join the Air Force Reserve. After looking in to it I found that I would need to loose another 30 pounds if the reserves were to accept me.

I decided that I needed to loose the weight quickly so that I could get into the reserves before I was drafted. Based on the presidential elections of the past several years, I would likely be called a chicken for becoming a reservist instead of volunteering to go to war. I was chicken to die then and am chicken to die now. I had a way of reducing my chances of an early death then and I also have a way of reducing my chances now.

When the decision was made to go into the reserves I needed to loose weight quickly. I first put myself on a carrot diet, for breakfast lunch and dinner I ate nothing but carrots. I was loosing weight rapidly but becoming weak and sick very rapidly. And no, they did not give me better eye site. Following this diet it took several years before I could eat another carrot.

I went from the carrot diet to the Atkins diet where I ate all kinds of fatty foods and as promised I still lost weight. A couple of months later I was down to the weight where the Air Force would accept me.

The night before I was to join the Air Force, I was at a Junior Chamber of Commerce party. Some of my friends at the party were in the Marine Corps Reserves. One of the Junior Chamber members was a young Marine Major by the name of Bob Harder and he was the commanding officer at USMCR Third Anglico reserve unit. I had a few drinks that evening and the only thing I remember is some of my buddies saying that they were in this unit and if I joined Bob would take great care of me. What a deal! The next thing I know I was over at the marine base being sworn in. About thirty days later the Junior Chamber had a joint going away party for Major Harder who had been transferred to Hawaii and Private Weinheimer who was on his way to boot camp in San Diego.

Marine boot camp is an experience that I went through with mixed emotion. I was twenty years old and undisciplined. I had recently been on crash diets that had taken off both pounds and muscle. Within the first couple of days they gave us a strength test. I did so poorly on this test that they sent me to the “pig farm”.

The pig farm was for weaklings and many of us weaklings were also overweight. Here they put us on a diet that consisted of a hard boiled egg, slice of dry toast and glass of skim milk for breakfast, a dish of lettuce without dressing and piece of meat for both lunch and diner and also that glass of skim milk. While those of normal weight could eat all they wanted, us fat-guys had to yell DIET as we went through the cafeteria line.

Daily at the pig farm they would weigh us like a heard of cattle getting ready for slaughter and give us vitamins. They not only had us on a starvation diet but also had us performing physical exercise, lots of pushups, sit-ups and squat thrust, obstacle course, team rowing of boats, and lots of running. I can honestly say that I never fell out on a run no matter how rough it was for those that did had to run again at night. Within a couple of weeks my weight was down, my strength was built up and I was back in a regular unit where I could eat.

Within a couple of days of being back in a regular unit I had a collar bone injury and was now in a hospital unit for a few weeks before once again being assigned to a regular unit. Back in a regular unit I found that I could eat, and with all of this exercise I was continuing to loose weight and getting in the best condition of my entire life. While many recruits were looking for a way to get out, I had learned to place a positive spin on boot camp and was able to convince myself that it was a health spa that I was being paid to participate in. A spa is kind of a stretch but most of the time my positive spin worked. I said most of the time because now it was my mouth that got me into trouble. While in boot camp I received a letter from home that included a draft notice for the Army. I remember going to the drill instructor and asking if I could take the Army up on their offer, naturally this resulted in some extra pushups.

About a week after the draft notice incident we were out on a long run of about 10 miles. This particular day we carried our riffles and ran up and down hills with our riffle being held above our heads much of the time and stopping for a calisthenics exercise break every now and then. We were doing pushups and on a repetition I remained down. A drill instructor yelled, “Private are you tired?” Knowing better but a little sarcastic that day I yelled back in a loud “YES SIR”, the correct response would have been a loud NO SIR. The drill instructor yells “we will take care of that private, the rest of the time your in my unit you can do 500 sit-ups a day in your spare time”. He then assigned two recruits to do the counting and I got started on stomach muscle improvement. At the time I wondered why he hadn’t given me push-ups as it was during that exercise I had smarted off. But looking back I realize that he knew I had been a fatty up until recently. Five hundred sit-ups sounds like a lot but it was not long until I was like a hinge and like the Timex watch I could take a lickin and keep on ticking.

When I graduated from boot camp in December of 1963 I weighed between 155 and 160 pounds a mere shadow of myself a year earlier. Graduation day they served calf liver. I had always detested liver and remember my mom trying to disguise it in meat loaf and saying that it was all in my head. That particular day I had seconds of liver so maybe it is in the head but I still hate it today.

The next five years I was in the USMC reserves going to meetings one weekend a month and two weeks each summer. During this period of time I put on a few pounds but maintained my weight at less than 175 pounds. I did this by running 2 - 3 miles almost daily with our dog Sandy. I knew if I put on to much weight I would not fit into my uniforms and would catch hell at the monthly meeting.

Once out of the reserves I again became lazy, stopped running as frequently and started to put the weight back on. Leaving the reserves coincided with the loss of my running mate our dog Sandy. While this may seem strange, Sandy was like our first son. We treated him like a child for our first 5 years of marriage. Sandy would swim with us and if he thought we were drowning he would swim over our head until we would grab on to him and he would pull us to the side of the pool. I would toss a ball and Sandy would knock it back with his nose. I even have pictures of him riding a hobbyhorse. Following this loss I started to once again gain weight and before long I was well over 200 pounds.

By 1970 my wife who had been skinny all of her life also had put weight on. Lynda was experiencing the new stress of raising a child and I was working 6 to 7 days a week building a new business. Lynda joined Weight Watchers and I went to a couple of meeting but did not like them. Lynda continued with the meetings and we both continued with a sensible diet and we were soon down to our goal weight.

Over the next several years my weight continued like a teeter-totter. I would gain weight, loose weight and gain it again. One thing that I noticed during this period of time was that every time my weight went down my attitude improved. It may seem strange, but when my weight was down I was always more successful in business than during the periods my weight was up. This of course is because I like myself better when my weight is down and I have a whole lot more confidence.

At the age of 36 I became a Lieutenant Governor in the California - Nevada- Hawaii Kiwanis Club. At one of our board meetings I announced that I was accepting pledges for a charitable activity and the total amount was based upon how much weight I could loose within the next sixty days. Both people who wanted to help raise money for the charity and those that thought I couldn’t loose but a few pounds were making some pretty hefty pledges. I immediately went on a diet of nothing but fruit and vegetables for the next sixty days and exercised regularly. At the weigh-in sixty days later I looked great, wearing my small wardrobe again and the charity took in over a thousand dollars from the board members alone. Over the next several months I put most of the weight back on and a lot of people were disappointed in me.

From the age of 36 to the age of 59 my weight continued to yo-yo, mostly YO.

I found that as I got older it became more difficult to loose weight. Was the difficulty due to a total lack of activity or a metabolic reason? I was convinced that it had to be metabolic even though I had done little to prove otherwise. Yeah, I joined a health clubs at different times and for a while I would work out. I would stick to diets and lose a few pounds but each time I found myself changing and putting the weight back on.

At age 59 I wrote to myself the following:

Over my life I have lost a hundred pounds or more a couple of times with everything from danger diets - medically controlled liquid diets - to sensible eating diets. I found that it made no difference how I lost the weight, each time I would put it back on as I returned to my old habits.

As I got older the extra weight has become a real handicap.

• My blood pressure remains high even with medication.
• I tire easily and my body is in constant pain.
• I sleep part of the night in a chair and part of the night in bed.
• At the Movie Theater I am extremely uncomfortable without an empty seat next to me.
• On an airplane I am only comfortable in first class or when in coach if I have an empty seat next to me.
• I am unable to keep my pants up without suspenders.
• Pants that are big enough to go around my waist sag in the butt and have legs big enough for elephants.
• I need to exercise but hurt so much and am so tired that exercise is almost impossible.
• Several times each year I start on a diet and am lucky if it last through an entire day.
• I dream of the perfect pill that is going to make me feel good again and it keeps refusing to come along.
• I complain to the doctors that I have something wrong with me and they tell me that the problem is around my waist.

Here I am at the age of 59, terminally obese, Halloween has just past, and I am surprised that I didn’t go to a party disguised as a pumpkin. All I would have had to do was take off all of my clothes and wear a paper bag over my head. I have once again decided that it is time to put this obesity into remission. Whether you or I like it or not, obesity is an illness that kills but as C. Everett Koop says, it is a preventable disease. It is also a disease that is within our own control.

I have owned many businesses, some of these companies have been a success and others have failed. A couple of years back, Dr. Brian Kennedy my doctor said to me, “Terry, you are a successful businessman but you also need to treat your own body as a business.” I heard what he said but did not have the motivation to do anything about it. Now just short of age 60 and in constant pain and with time running out, I not only have heard what he said but have also started to understand what he was saying. I am ready to slow the clock and hopefully turn it back several years.

I am a closet adventurer. For a long time I have wanted to skydive, take a hot air balloon ride, go on a rapid water raft trip, go deep-sea fishing for giant halibut, marlin and sailfish. I have thought about hiking back into the hills and camping. I would like to ride a mule into the Grand Canyon. I would like to ride some of the blood curdling rides at the amusement parks and much more. I am also 300 pounds, out of shape, have high blood pressure and am scared that in my morbidly obese condition any of these things could kill me.

So what am I going to do about my terminal obesity? What a great birthday present I can give myself by once again loosing weight and this time keeping it off. I have given this lots of thought and realize that while the charts say that I should weigh less then 180 pounds, if I am going to successfully maintain my weight it will probably be in the area of 200 pounds to 225 pounds. This is still obese but I eliminate the word morbid and in doing so my obesity is put into remission.

While coming to my decision to loose weight I performed research and learned some interesting facts. Many of these truths I already knew, but seeing them again makes them more real to me.

• Obesity is commonly defined as being 20% or more over ideal body weight.
• Obesity affects an estimated 34 million Americans.
• Morbid obesity is when a person is 100 or more pounds overweight.
• Obesity is a serious disease that has been linked to shortened life expectancy and is the second leading cause of preventable death in America.
• Obesity is a condition, and morbid obesity is a disease and not a character flaw.
• The most important cause of obesity is a person’s genetics.
• The second most important cause is a person’s life style, which includes eating habits and exercise patterns.
• The third cause is a person’s psyche. Eating not only when we are hungry but also eating when our hunger is stimulated by psychological pressures.
• Science continues to perform research regarding the various chemical causes that contribute to obesity, such as those produced in the brain and other organs.

While all of these facts are interesting, the facts will not take off the pounds. While in a few years science may have a magic pill, at this time it is up to me to keep obesity in remission. Remission requires my change in life style, which includes proper diet and exercise. It is by following this life style that even those of us that may have a genetic excuse can prevent this terminal illness or put it into remission.

For the past five years I have experienced a lot of tiredness and body pain and have diagnosed myself as having everything from multiple sclerosis to cancer. One doctor after another has examined me and said the cause of your pain is the excess fat that I carry. I have had mixed emotions when hearing that my problem is fat. It is hard to convince myself that I do not have another serious illness. I now find myself mature enough to believe the doctors know what they are talking about and the serious illness I have is called obesity.

So what has happened to wake me up? What is it that has made me recognize that the doctors might just be right? What are it that makes me realize that being the weight that I am is very serious and not just a discomfort or visual blemish? I have a terminal illness and it is called morbid obesity and this is a major killer. And yes, what woke me up is called facing the facts!

Shortly after writing the above I found myself once again seriously confronting my weight issues. I started eating much healthier once again and increased my exercise. Unfortunately the weight was just not coming off to my satisfaction.

In January of 2001, I came up with this lame idea of using images to motivate myself and to my surprise it did help. I had photographs taken of my unclothed body. Views were taken from the front, back and both sides. What I saw in these photographs was disgusting almost to the point of vulgarity. This was not in a sexual sense for the photographs did not show the small details, only the gigantic torso and neck that I was carrying around minute after minute, hour after hour, day after day and year after year. Looking at these pictures I found my body downright sickening, in no way could I see how anyone could find fat beautiful. I selected one of these photographs in a large 8″. X 11″ size, not one of those tiny little snap shots. I hung this photo in the center of my bathroom mirror where I would have to look at it every morning as I got ready for the day and every evening while getting ready for bed. That photo remained in place regardless of how disgusting it looked.

Looking at the photographs it was easy to see why my torso, back and legs always hurt so much. I was carrying around this huge stomach that made me look like I was about to deliver quadruplets. On top of this gigantic stomach was these large floppy breasts that made me look like I could wear a larger bra than most women. When I saw my self from the back, the extra fat reminded me of wings. It was easy to see why I did not fit comfortably in a theater or airplane seat. I realized why fat people walk with their arms swinging to the side as the fat pushed my arms out at least 4 inches on either side. When I looked at my head and neck, I did not see a double chin in fact I saw no neck at all. This huge neck made me look like I had volleyball for a head. From the side my back appeared to stick out several inches, rounded with body fat. My back was curved making me look like a human “C”. I realized how all of this fat must have been compressing my body for at the age of 18 I was nearly 6′ tall and now I was 5′ - 8″ tall. The one thing that I had going for me was that I could see that my butt, legs and arms all looked pretty normal.

Why would anyone let himself or herself get this way I wondered as I viewed the photographs? Why is it that I have failed to do anything about it? Perhaps it was denial or perhaps laziness at not doing something about it when I was 5 or 10 pounds overweight. Regardless, just like every time before I had once again climbed back to where I was residing in this disgusting body. Why would I want to look this way? Why would anyone want to look this way? I don’t want to and doubt that few others do either.

With the photographs on the mirror I started to once again loose weight. After month one, I decided to carry it a step forward and have photographs made monthly so that I could graphically see the changes. I also used a series of tape measures with one around my gut, a second around my chest and a third around my neck. These photos allowed me to see the changes that were actually taking place. With this bit of added incentive I was slowly loosing a few pounds but still nothing dramatic.

Within months of starting this diet my wife who had been ill was entering into a time where she could not longer care for herself. Lynda had diabetes since childhood and had developed heart disease in later life. The Diabetes was now catching up with her and I had become her fulltime caretaker, as she could not easily get around and required constant assistance. In April of 2002, shortly after our 38^th wedding anniversary Lynda passed away.

Following Lynda’s death I was very depressed and lonely. I knew that I needed to do something about my own weight or I would soon be joining her in death. I have so many goals yet unaccomplished that I could not allow that to happen. I started working out 4 - 5 days per week and 2 to 4 hours per day. For several months I had a personal trainer 2 - 3 days per week. Later I cut back on the trainer to one day per week, as my finances were bad. I had learned during Lynda’s illness that medical bills could break a person as they had nearly done to us.

During this period of strenuous working out my weight never dropped much below 230 pounds but I lost a lot of body fat and was able to wear X-L clothing instead of tight fitting triple X. I felt so good that I went skydiving for my 63^rd birthday, something my neurologist was not pleased with as I have spinal neurosis.

I continued with regular exercise for over 2 years, during which period my finances continued to get worse for I was carrying huge debt occurred during the illness of my wife and I was nearing bankruptcy. I had placed my home on the market and eventually sold it and was able to pay off most of debts and move into a much smaller home. My son and grandson moved into the new home with me.

With the addition of my son and grandson my meals started to change again. I found myself eating a lot more meats, fatty foods and carbohydrates, all foods that I had avoided during the previous couple of years. Once again I started putting on weight and was exercising less. Soon I was finding it more difficult to work out as much as I should. The muscle I had gained now appeared to be turning to fat and my weight ballooned to 300 pounds.

Since Lynda’s death I had not dated. Much of this was due to the emotional issues I was still experiencing over her loss. When I was ready to start dating I was once again so obese that I found it embarrassing to go out to places where I might meet a woman.

Today I am lonely for the companionship of a woman and realize that for me to be happy I must loose weight and become active once again. I also realize that traditional diets have not worked for me. While I have been able to get the weight off I have never been able to keep it off. Perhaps bariatric surgery is a crutch. Perhaps it is more than that something I am not sure of. I do know that my sister and sister-in-law both had it years ago and have done well at maintaining their weight ever since. They had also spent years living like a yo-yo prior to their surgeries.

Now the irony of my story is that I am a sexuality writer that operates sexuality and relationships websites. Every day I spend hours at my computer writing and giving advice. I rarely publish my picture on any of my websites or with my articles for I am too embarrassed about my own weight. I have not had a date since the death of my wife and while lonely for the companionship of a woman my weight has kept me from seeking that companionship.

I am a goal-oriented person and like I previously mentioned I have many goals yet to achieve. Among these is to be here for my 8 year old grandson who I believe needs me in his life; to meet another woman and fall in love again and travel with her; to publish my book Sex From the Womb to the Tomb and feel good about promoting it. To let the millions of people around the world that read my sexuality articles or visit my websites actually know what I look like. I am tired of hiding behind the pen name and showing the occasional photograph of myself when I was thin. I want to go to my 50-year high school reunion and not be the fattest person there. I want to be able to hike and fish once again without being in so much discomfort. I have sleep apnea and want to get off of the CPAP machine, which has to be one of the most miserable, pieces of medical equipment ever invented. Most of all I want to see my grandson grow up and be here when he graduates from college and becomes the success in life that I know he will be.

To those that have chosen to read this I apologize for being so long winded but I felt that I must share my story.