GASTRIC BYPASS | PART III Santiago's new life

At 385 pounds, Louie Santiago missed out on a lot of things. One thing he didn't want to miss was being around-- for his children.
CORTLAND -- When Luis Santiago first considered gastric bypass surgery to lose weight, his wife, Cathy, was very much against it.
"She was supportive, but I could understand her concern. We have two young children. The closer we got to surgery, the more she verbalized her fears," Santiago said.
"Yes, the surgery has risks, I said, but at this rate, I'm going to have heart problems. If I needed open heart surgery, there are risks with that, too. I truly did not feel I'd be here in five years if I didn't do something about my weight."
At age 40, as the father of Luis III, 12, and Chelsey, 10, he had many reasons to stick around and live a better life. "My daughter is an insulin-dependent diabetic. I want to be here for her in 10 years. I want to teach her to eat healthy, and yet I wasn't a healthy eater myself."
Stuck in the cycle
Santiago, who lives in Cortland, had been overweight and on a diet treadmill most of his life.
"Eating truly was a vicious cycle. I lost and gained numerous times," he said. "When I was dieting, I was always hungry. Eventually, you just give in. You can do it for six months, a year, then you gain the weight back, plus more."
His worst eating habit, he believes, was nighttime snacking. "If my wife made spaghetti and meatballs for dinner, I'd eat that, then an hour or so later I'd fix another bowl of spaghetti and meatballs."
In restaurants with friends, he recalls, other people would stop eating.
"I'd look down at my plate and think, 'I know I can finish this,' but I didn't because they'd all stopped. So instead I'd just come home and eat again."
Weight's repercussions
At 385 pounds, his weight was the factor around which his life revolved.
"I took medication for high blood pressure, I had swollen ankles, and I had sleep apnea. I'd sleep for 12 hours and wake up exhausted.
"I couldn't fit into airplane seats, I had to squeeze through turnstiles. At Cedar Point, the kids would ask why I didn't ride the rides. I said it was because I was too old, but the reality was I didn't fit. Once at the Cleveland Zoo I wanted to take the kids into a treehouse, but the weight limit was 325 pounds. I had to sit that one out.
"When I walked into a friend's house, I'd check out the condition of their furniture before I'd sit down. Sometimes the bottom line was, I'd stay home."
At work, he sometimes felt like a bad example. As manager of cardiac telemetry at Forum Health Northside Medical Center, one of his duties is to discuss a healthy lifestyle. "I don't do much direct patient care anymore, but when I had to talk to cardiac patients, I felt guilty, absolutely. I had to tell them that obesity is a major risk factor in cardiac disease."
Santiago experienced some discrimination as an obese man, but he believes obese women have a tougher time. "To be big as a man is more socially acceptable. I'm almost 6-2, and my weight is proportional. I'm fat, but I don't have a huge gut. I believe women are affected more by that discrimination."
He definitely felt stereotyped, though. "Some people said they hoped my personality wouldn't change after surgery. Now I have a good sense of humor, and I didn't take it personally, but that's still a stigma -- you know, jolly fat people. I'm healthier and I weigh less, but I'm still me."
As the pounds began to come off, Santiago's life started to change. "Two weeks after the surgery, my daughter said I should have done it long ago because I didn't make noise anymore when I slept. Even my wife checks me sometimes when I'm sleeping because I don't snore and gasp all night."
He has stopped taking blood pressure medication, and his ankles no longer swell. His activity level goes up as his weight goes down.
Setting new goals
"Before, my goal after work was to sit in my lounge chair, then eat supper, then go to bed. Now I put up wallpaper, paint the dining room, go to the mall, hit the bookstore. Nighttime is no longer a dead end. One weekend we actually went to the lake for a bike ride."
Santiago has a closet full of clothes from all stages of weight loss and gain. "I stacked them up -- the 54s, the 48s, the 42s. I'm down to the 48s now, and they're big. They're all coming out of the closet, eventually." He wears a size 12 shoe now, down from a 13, and has had to put away his rings until his weight stabilizes.
The biggest change, though, is in his eating habits. "The kids tease me about it. One will say, 'What's Dad having for supper?' The other says, 'Oh, he's having a French fry, then he'll be full.'"
The kids aren't far wrong. After a gastric bypass, the stomach is reduced to a 15-20 cc pouch. The most Santiago can consume at one time is one-half to two-thirds of a cup. On a typical day, he might eat a hard-boiled egg for breakfast, 10 grapes for a mid-morning snack, a small plate of leftovers for lunch, and a protein shake for a mid-afternoon snack. For supper, he tries to eat a combination of protein, vegetable and starch.
Dealing with the old image
The future is something Santiago hasn't been able to face, as yet. "I believe -- but I don't know -- that I will always think of myself as a fat person. When I look in the mirror, I see me as I always was."
There's at least one good reason for hanging onto that old body image.
"I don't want to forget how uncomfortable I was, how I couldn't sleep and couldn't do things with the kids. The 15-year studies say that 90 to 95 percent have maintained their weight loss, but it's not foolproof. Other statistics say I could have a 20 percent weight gain."
To forestall future problems, Santiago is taking positive steps now, while his fat memories are still fresh. He attends support group meetings regularly and has made serious lifestyle changes.
"I'm trying to eat smarter. Looking back, I guess I ate a lot of food high in saturated fat. I make healthier choices now, and I can exercise now."

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