Beards Over BarbellsThis blog is on indefinite hiatus.
I’m keeping the blog up to serve as a resource for persons interested in the skin removal procedures I had done in 2013-2014 and have deleted most of the training and diet/supplement posts I had written because I was extremely, extremely wrong about most of that stuff.
If you have any questions on post weight loss surgery, drop a comment below with your email and I will be happy to talk with you.
On March 20th of this year I underwent my final post-massive weight loss surgery. The surgery corrected excess tissue in my chest, a condition medically referred to as Gynecomastia. This complemented the prior two surgeries, a circumferential lower body lift performed in March of 2013 and dual bilateral thighplasties (recap links part 1 and part 2 here), and marks the end of my surgical excursions.
I’ll start this post off with two things that I’ve wanted to get off my chest (pun intended!):
As with the prior two surgeries my wife and I drove down the night before to be closer to the surgical center for an early 6am start time. Pre-surgical markings and evaluations were performed the morning of surgery with a consult a few weeks beforehand. You can imagine each pectoral as a sort of conical, deflated breast with nipples that were about 50 mm (2 inches) in diameter apiece. After being sedated and prepped, each breast is liposuctioned, and then the excess skin is trimmed away from the underside of each breast in kind of a long curve tracing along the bottom side of the pec almost fully to the armpit. The nipples are removed and trimmed down to about half their original size (about an inch each) and grafted back on after the chest is sewn back up (actually glued on the top layer with Dermabond, a flexible superglue) with a single French drain exiting near either armpit. The nipples are then grafted back on in the original orientation in the new smaller size. Bolsters are attached to keep them on (basically a kind of plastic gauze bandage to keep the grafts in place). Surgery takes about four hours and you’re under for about six total, home the same day, back in a week for drain/bolster removal and evaluation.
The truly squeamish would do well to skip the following paragraph. The surgery went off without a hitch, the only bummer is that I was kept under about two hours longer than I needed to be due to a complication with surgical prep. Whenever general anesthesia is employed, you’re typically catheterized because, y’know, you’re knocked out cold. This wasn’t an issue in the past two surgeries, but the OR nurse botched cathing me and grazed the urethra in one spot. They kept me under for about two hours extra and called in a urologist to scope me out and make sure that it was just a botched catheter install and not something more serious. Everything was clear but I had to keep a Foley cath in for a week while the scrape healed, which is not a particularly fun thing. Luckily no permanent damage was inflicted and there are zero long-term side effects from the mishap.
Freshly home from surgery, I looked like this… you can see the drain exits and the bolsters pretty clearly:
Nine weeks out, I look like this:
Overall not bad. The scars are still fairly obvious, but my six-ish month old thighplasty scars are almost as faded out as my 15-ish month old scars from the circumferential, so I should be able to go shirtless at the beach without getting a bunch of odd looks after another couple months.
As for the post-op, the drains (and catheter) came out a week later and I was only off work for about a week and a half. Pain meds were identical to the last two surgeries and I didn’t have withdrawal as bad as the last two either. I did develop a seroma, or fluid pocket, in my left pec that had to be manually aspirated with a large syringe but only once. Seromas are fairly common with chest surgeries and often take a couple visits to drain completely, but I lucked out and only required one visit.
So yeah, that’s done. A difficult and expensive year of surgeries, but zero regrets.
Not much to report with the thighplasty. The right leg took longer to heal than the left, doctor thinks he probably knicked part of the lymphatic system in that leg so the drain came out four weeks to the day after surgery. That’s about twice the average drain time. Not a big deal and chronic lymphadema in that limb will not be a concern, though it’s visibly more swollen than the left leg at the time of this writing (about five weeks out). I’m still holding on to about five pounds of fluid which should gradually dump out over the next 2-3 months. Everthing healed beautifully and should smooth out real nice long-term.
The third and final surgery is on the books and it’s actually the easiest of the three that I’ve elected to pursue: I’m having my chest reconstructed in late March. It’s the shortest procedure (about four hours) with a one-week recovery time. This is admittedly a vanity-based procedure (I used to have HS on my chest as well, but it’s the only area where it’s gone into full remission) but I’ve come this far so I figure I’ve earned the right to be able to walk around shirtless in public without feeling self-conscious.
Goals for the next two months are as follows:
Training: Use the squat as an assistance exercise so as not to aggravate the incisions. Use RDLs/Good Mornings as the main movement on most heavy lower days, which should help nuke the last of my kyphosis issues and strengthen the glutes/hamstrings. I’m more of a quad dominant squatter and would like to try to widen my stance out long-term, so this should help with that as well. Upper body work to remain roughly the same, just continue to work lockout and triceps strength/mass.
Diet: Run PSMF by-the-book and cut to 220 once and for finally. I’m currently sitting at 245-250 at about 22% body fat, and I think I would look a little better and stand a better chance of being competitive at 220-ish. I have been admittedly frenetic about cutting weight and have tried a bunch of stuff over the last few years, including crashing on long bouts of PSMF, packing some serious mass on before the circumferential, carb cycling like crazy, and being generally a bit too orthorexic for my own good. Ketogenic diets seem to work well for maintenance/satiety as well as keeping my HS in check but it takes forever to gain strength using keto. I’m going to give carbs a second shot after the chest surgery and weight cut is over but for now they’re staying out of the picture.
The hard truth here is that historically, any serious fat loss has always gone hand-in-hand with fairly heavy caloric restriction. It’s the one tool that I know works, and I know how to use it to my advantage at this point without getting into any real trouble. The surgery also means I’ll be getting some bloodwork about 2/3 the way through my planned diet so I can keep an eye on things there.
Weekly weigh-ins on what is hopefully my last run of PSMF to follow starting this Saturday.
Warning: this blog post contains some fairly graphic imagery of incisions and bruising. If that sort of thing skeeves you out, consider yourself warned.
I have been remiss in not updating the blog regarding my recent surgery. On December 12th I underwent bilateral inner thighplasties to alleviate excess skin and a long history of hidradenitis suppurativa. Here’s how it went down.
The evening before the procedure I went in for markups. This involved standing pantsless for about 45 minutes while the surgeon kneeled on the floor in front of me and doodled ellipses on my legs and pinched stuff together with calipers to determine margins. This is what the markings looked like:
My wife and I live about an hour and a half from the surgery center, so we decided to stay locally in a hotel the night before since the surgery start time was 7:30 AM. After a nice meal and some ice cream (Ben & Jerry’s “Ron Burgundy’s Scotchy Scotch Scotch” limited edition is pretty great FYI) we retired. I awoke at 5 AM and gave myself an injection of blood thinner (Lovenox) at 5:30, 2 hours before the procedure. I had to do six more injections, one each morning after the surgery… the thighplasties carry less risk of bleeding compared to the circumferential lower body lift but a higher risk of deep veinous thrombosis (DVT, or blood clots that can break loose and fuck you up real bad).
We arrived at the surgery center at 6:30 AM. I was in a gown and had an IV in at 7:00. I’m going to sound super classist here but if you can afford private surgical “boutiques”, they fucking rule. They treat you like royalty and are super clean and professional. Cash is king, as always. Met with the surgeon one last time and then met his assistant and the anesthesiologist… surprise, same team as did my circumferential, which was awesome!
At 7:30 they wheeled me in and it was lights out. Basically the extra thigh skin gets pinched together and liposuctioned, then the skin gets cut out, then stitched back together after a drain is placed. You’re split from the perineum all the way to the knee cap. Compared to just carving out fat, this method preserves various nerves, blood vessels, and lymphatic pathways and just gets rid of extra fat and skin. About 2.5 pounds of matter came off of either leg. I was catheterized during the procedure but luckily they pull it while you’re still under (unlike the circumferential).
I woke up in recovery with no issues at 1:30 PM. My wife had gone shopping during the procedure and I apparently made some lewd comments pertaining to the garments she purchased which was my only real gaffe (that I can remember at this point at least). An hour later I was in the car on the way home, no pain, easy.
Recovery was fine, no real issues, I was off pain meds within two weeks… still using ibuprofen but that’s not a big deal. Left drain came out a week after, right drain is still in but should hopefully come out within the next week. It’s mostly draining lymphatic fluid at this point. The surgeon thinks he just nicked part of the lymphatic system in the right leg and it’ll taper suddenly and be ready to remove. Incidentally I had the option of having the drain exits placed at the knee end or the crotch end of the incision… I opted for the knee end and have not regretted the decision.
The real weird deal is the water weight retention and bruising due to the lipo. I was 250 before the procedure and they removed five pounds. Two days after I was 270. I’m 16 days out and sitting at 260 and despite the holidays have been eating at maintenance.
Here’s what the incision, swelling, and bruising looked like two days after surgery:
And here’s what the worst bruising looked like about six days after surgery on the back of my right knee:
Diet: low-ish carb, running at maintenance. Once the last drain is out and I’m cleared to lift I’m going to do a run on PSMF (which I am dreading but whatever) and just cut down to 220 once and for fucking all. I won’t be able to max for a few months anyway so it’s a good time to get shredded before the final surgical adventure, which may be just around the corner (details on that as they develop).
Update when the drain is out and I’m cleared to lift in about a week and a half. Stay tuned.
So, it’s been twelve weeks since the circumferential lower body lift and I figure it’s high time for a recap post of the experience.
But first, here’s this week’s training log. As a general note things are going well but I definitely overdid it by hitting hill sprints today so I feel like complete crap. I hit 225x3x5 on squats and I may just hold here and focus on sitting back and getting reliable depth while keeping my knees right at my toes, perhaps moving out towards a slightly wider stance just to set myself up for success as the LP progresses. T-spine and hamstrings are the culprits with lift mechanics as usual. Diet is on point and I feel pretty comfortable working in the 250-350 g protein/day range at 2000-2500 calories. Upping the protein is getting me some good results, so I’ll just take a slow ride down to 220 and hold there. Should have an accurate weigh-in tomorrow AM, followed by my weekly carb-up.
06-11-2013
Squat: 45×5, 95×5, 135×5, 185×3 (felt heavy), 210x3x5. Depth wasn’t there and I’m losing lumbar extension.
Military press: 45×5, 70x3x5 (weak sauce but I have to remind myself this is an LP)
Ring rows 4×8, about 30 degrees
Dumbbell front raise (bro) 15sx4x8
Banded good morning 4×10
06-13-2013
Squat: 45×5,5 135×5, 185×5, 215x3x5, 165×8
Bench: 45×10, 65×10, 95×5, 105x3x5
DL: 135×5, 195×4 conventional, 195×5 sumo (back angle was much flatter sumo)
Incline DB bench: 35sx12,12,10,10
EZ Bar curl: 45x12x4
Rollbacks: 20sx12,10,8
Band triceps pushdown: 15×3 with holds at the bottom
06-15-2013
Squat: 45×10, 135×5, 185×5, 225x3x5 (first set beltless, second and third belted)
MP: 45×5,5, 65×5, 75x3x5
Cleans: 95x3x5, did not film but probably awful form
NHEs: 80×12, 60x4x20
DB row: 50sx5x12
Hill sprints: 30 seconds-ish, 100 yards or so, maybe 50 feet in elevation gain on concrete, five rounds.
Preparing for a circumferential lower body lift
The most important thing I want to recap on here is preparing for the procedure. In an athletic sense, my main goal in preparing for the circumferential lower body lift was to get as strong as possible and put on as much muscle mass as I could in the months before the procedure. I had good success in this endeavor at the expense of about 10 unwanted pounds of fat because I was a little too frenetic with my diet. In any event, I did end up losing a few pounds of lean body mass during recovery but this was expected and can be dealt with relatively easily. Regardless of your athletic goals, I strongly recommend that you consider trying to put some lean body mass on because you will lose some lean body mass during recovery.
I’ve touched quite a bit on the recovery process here and you can tell that it’s kind of a lot. The main thing I want to say is this: the most important thing that you can do for this procedure is to prepare and set things up ahead of time so you can just go on autopilot to the greatest extent possible. Unexpected things can and will crop up, and you had better save the strength you have for dealing with them instead of worrying about day-to-day stuff like grocery shopping, laundry, etc etc.
Here are the most critical things that need to get done in the weeks before the procedure:
And that, gentle reader, brings this series of posts about circumferential lower body lift recovery to a close. The procedure is now in my past; I am training again and feel much better with the extra skin gone. For individuals who have gone through massive weight loss of any kind, it is a bitter pill to swallow: after working tirelessly and doing everything “right” to correct a major problem, you’re smacked down for a couple months by a very invasive procedure that will very likely be paid for out of pocket without assistance from most medical insurance plans. It really, really sucks, but that’s life. The important thing to remember is that you are going to turn something like this:
Into something like this:
After flirting with 3- and 2-riser box squats in late May I decided that I felt good enough to restart a 3×5 template similar to Starting Strength, electing to start at about 50% of my pre-surgical 1RMs. I hit a point where I’d been feeling like crap with light lifting for a long time, and then a light switch flipped on and I was REALLY READY all of a sudden. I have occasional aching in the periphery of the incision but nothing major pain-wise. There are a few funky spots that open up occasionally but have been treating them with silver sulfadiazine to good effect.
As suspected, the surgery’s net effect on my strength training will be extremely positive. Squat depth has improved markedly with the excess tissue removed, but I need to mob a little more to keep the depth there (I am just hitting parallel on free squats). Current plan is to run an LP in conjunction with John Kiefer’s Carb Nite (a cyclic ketogenic diet) through the end of the summer. This will hopefully get me down to about 220 and hold there at solidly sub-20% body fat, ideally closer to 15%. Then I’ll restart WSB
I’m tracking everything on Livestrong again. Diet-wise I find that I feel better running a little more aggressively on protein (200 g/day on rest days, 300+ g/day on lift days) than fat (60-120 g/day, higher on rest days) when doing carb restriction. This means lots of chicken breast and getting 2-3 scoops of whey on lift days. Just had my first carb-up after the prep phase and I definitely feel the old familiar thermal effect. Nice to be back on track.
Sub-goals for this period:
1. Squat 315x3x5
2. Deadlift 315×5
3. Bench 185×5
4. Accessory work to correct kyphosis and improve bench arch: barbell rows, ring rows, thoracic mobility
5. Accessory work for pectoral and triceps hypertrophy
06-01-2013
Squat: 45×5,5 95×5, 135×5, 185x3x5
BB Row: 95x3x8
Good Morning: 95x3x8
Seated DB shoulder press: 30sx3x8
06-02-2013
Stationary bike 13.4 miles in 60 minutes (punishing my quads to get them re-adapted to movement)
06-04-2013
Squat: 45×5,5, 95×5, 135×5, 165×5, 195x3x5
Bench: 45×5,5, 95x3x5
Deadlift: 95×5, 185×5
Triceps pushdown, blue band: 3×12
DB rollbacks: 25x3x8
06-06-2013
Squat: 45×5,5, 95×5, 145×5, 200x3x5
BB Row: 135×5, 95x3x8
Military press: 45×5,5, 65x3x5
Good morning: 95x3x8
Hammer DB curl: 200sx12x4
Shrugs: 60sx12x4
06-08-2013
AM Saturday weigh-in: 233.4 pounds (+5.4 pounds from lowest recorded adult weight)
06-09-2013
Squat: 45×5, 95×5, 135×5, 185×3, 205x3x5, 135×10
Bench: 45×5,5, 65×5, 100x3x5
DL: 135×5, 190×5 (tried the “chair deadlift” setup, was actually pretty intuitive)
Incline DB bench: 30sx12x4
Banded triceps pushdown: 15×4 with hold at bottom (~1 second)
The first three weeks of being physically back to work are in the bag. The first week was rough, I was a little shaky and moving slow. Getting up and walking around (despite having an office job) proved pretty demanding and beat me down pretty good by Friday of my first week back. Second week back I felt stronger, actually started going out and walking a bit at lunch but I must have overdid it because between last Friday evening and this past Wednesday I felt like I had body aches from the flu. I think it was simple overexertion. With other life stuff going on I haven’t lifted weights in nearly two weeks as a result. But, today I was back on it and hit 135 for three sets of five off a high box and hit three sets of the same weight on deadlifts.
Pain-wise about 80-90% of the discomfort from the abdominal plication is gone, and it was really this week that I felt like a normal, mobile human being again. The scar is pretty much “dead” and will need to be re-sensitized as healing continues, so apart from the occasional poke from an undissolved suture, that’s not been an issue. My weight is staying in the 234-238 range, having finally stabilized there, and I’m basically staying protein/fat paleo only with a maybe a once a week true cheat here and there. The goal is to get down to 220 and stabilize there, and I may buck the fat intake a little bit to do so.
I’ll have some before/after photos at the 12 week mark, and am working up a recap of the experience including a laundry list of things that worked well, things I wish I’d approached differently, and overall thoughts on this procedure.
It’s been a week, folks.
I tapered down to 10 mg of Oxycodone on Tuesday split into two doses spaced 12 hours apart and took my last dose in the early evening. Had gnarly night sweats, nausea, malaise, flu-like symptoms for three days and then started to feel better on Thursday. Friday I was through the withdrawal and felt like a normal human being for the first time in six weeks. I was able to drive myself to my six-week evaluation at the surgeon’s office, where he cleared me to work out. That clearance came with the stern admonition to take it easy for the first four to six weeks, and to expect to occasionally bonk and feel like shit after heavy sessions for the next six months to a year. One year is the full healing time for the procedure, and now I just need to go back in a year for an evaluation, possibly sooner to look at some other plastic surgery options depending on where I end up at that time.
Body weight has been decreasing rapidly despite ramping up caloric intake markedly. Monday I was 242 in the evening and 239 in the morning and today I was 236 in the morning and 239 last night.
My first workout since the procedure was today. Six weeks to the day after being released from the hospital.
Short session, it was just a get in there and see what I’m capable of type of thing… 135 off a high box felt like 315 did before the procedure. To be honest, I was happy just to not be pinned by 135 and work through three honest sets of five with a decently wide stance. It was brutal and I am having IOMS as opposed to DOMS (immediate onset muscle soreness, a highly scientific term that I just made up). But, we all have to start somewhere.
Sorry for the relative lack of updates. Lots going on these days.
Drain #3 came out on the 18th and drain #4 came out on the 23rd. I pulled both myself. Apart from some minor pain around the exit wound for drain #3 both came out without incident. It is very liberating to not be hooked up to plastic tubing and have to keep track of drainage totals. Rear right incision’s funky bits are healing up nicely as is the bellybutton. I had one small area on the front right side that was a little bit open and actually had a loop of suture material coming out of it. At my doctor’s direction, I sterilized some scissors, pulled the suture tight, and snipped on each side flush with the skin. Very weird to perform this level of self-maintenance, but nice to not have the long drive to the surgeon’s office and back for every little thing.
I could have started sleeping in a bed flat two weeks after the procedure, but I elected to wait until all the drains were out so as to avoid ripping out anything in the middle of the night. Coincidentally, Monday I decided to see how long I could go without a painkiller and made it 17 hours before I started feeling any withdrawal-like symptoms. Tuesday, the day the drain came out, I took in about 30% of my normal dose of painkillers.
Bad, bad mistake to go cold turkey, then taper to such a low percentage of my dose, and THEN lie flat for 10 hours on my back. I awoke Wednesday in pretty bad pain in the abdomen and with some of the worst nausea I’ve ever had in my life (the nausea is a normal side effect of the pain from the extra stretch and the painkiller reduction). My only choice was to bring my painkiller intake back up to about 75% of my original dose that day. Thursday morning was only marginally better pain and nausea-wise. The only thing I could do to make the situation better was to try eating some breakfast cereal in the AM (antithetical to the carb backloading deal but w/e) to give my stomach something bland to work on. I felt better by that evening and worked down to about 60% of my original painkiller dose.
Today I’m down to 50% of the original dose and feel OK. I actually took a half-dose of Valium this evening to help with the abdominal discomfort and I have been working from my recliner the last three days to try to get more layback and stretch during the day. The positive thing here is that I am standing up even straighter and I can breathe full, deep, satisfying breaths as opposed to being limited because my abdomen is so freaking tight that it limits my diaphragm. I don’t “run out of wind” as easily while talking which is a major plus. So, kind of some unexpected setbacks with pain and nausea this week but some major progress forward: sleeping back in a normal bed, no drains, tapering the painkillers, back wounds are closing quick and I’m breathing much easier.
Woof, lots of stuff has happened in the last week. The anchors from last week held fine and dandy until yesterday, when both on drain #4 gave up the ghost. That was worrisome since it’s been the most productive lately. Today Dr. Pickart re-anchored #4 and put an extra anchor on #3 since one was looking weak. The longer the drains are in, the larger the holes get around them due to them just pushing up against the skin, hence making the drains more likely to pull out of the skin.
Drain #1 was holding fine with the electrical tape patch until the 13th, when a large crack opened up about 6″ up from where it entered my body. This was more like a stress crack/fissure, perhaps from stripping/cleaning the drain tube, and a fairly large one at that. My wonderful wife helped me try four different kinds of tape in various configurations at least twice each in the middle of the night (she’s been a trooper, to say the very least, during this whole thing). Nothing held, the fissure was just too big. I ended up cutting over 24″ of slack out of the drain tube and re-attaching the bulb less than 6″ from my body. Unfortunately, by the next afternoon the whole arrangement just wasn’t holding suction; I think the check valve on the suction bulb was boogered up. The bulb was on such a short leash that I was afraid of it ripping out. So, I went ahead and pulled the drain out myself at home.
Pulling a Jackson-Pratt drain is pretty easy. Sterilize some scissors, snip the sutures and pull them out (fairly painless) leaving them tied to the drain tube. Then, grab the tube firmly and just pull it out. No pain, no sticking points (unfortunately/fortunately no photos or video) but it was nice to have the “problem child” drain gone for good. It’s weird, there was literally no sensation: no pain, no tickle, just no sensation at all.
Drain #4 has picked up most of the slack since #1 and #4 are routed to the back and #2 and #3 are in the front. Drain 3 picked up a tiny bit of the slack and has been hovering around the criteria for removal, which is less than 30 mL/day for 2 consecutive days, for about a week now. Only had 25 mL from drain 3 today so there is a good chance that it’s coming out tomorrow or Friday. Drain #4 really took a nose dive today so I’m really hoping to be rid of all drains by potentially as early as next week, though I’m probably jinxing myself by saying that.
Apart from that, I feel a lot stronger and have more energy on the whole each day. Still sleeping in my recliner since I move around in bed quite a bit at night and am paranoid about pulling out drains. That has led to slow healing on my rear incisions, but still no infections. I tapered myself off of the Valium about 4 days ago since it wasn’t doing much as a muscle relaxant and I haven’t been anxious or panicky at all. This has been my first experience with Valium and I gotta say: I don’t like it much. It was making me feel very strung out and emotionally unstable (think Robert DeNiro watching the TV commercial in Analyze This type instability). Having that stuff out of my system has been really great. The painkillers have been working fine, they haven’t turned me into a jerk like I was afraid they might, and I haven’t fallen behind on taking them in a few days. Oh, and I was given pictures of the material that was removed. If there’s any interest in seeing what came off me… leave me a comment. They’re fairly graphic so I don’t want to just straight up post them.
Definitely over the hump and on the way back to being somewhat normal. It has been a rough month, but man, the results are really going to be worth it.
Beards Over Barbells 