jeanlewis
10/15/04 Well, today I got a call from the nurse at the Center for Weight Reduction at Mercy Capitol. She scheduled our phone interview for next Wednesday. I am at the very beginning stages of this process, and all I have done so far is to go to the community lecture on 9/30/04 and I filled out a lengthy health questionaire and mailed it back to them.
I have been on diets most of my adult life. I always considered myself chubby, even as a child. on my wedding day in 1982, I weighed 130 and I thought I was fat. I had my first child and regained my figure more or less, then when I was pregnant with our second child in 87, I gained a lot of pregnancy weight. I had a c-section and I never felt as though I completely recovered from that. But that is when I got more serious about looking into how to lose weight. I remember having the baby in her baby seat on the floor while I worked out with Richard Simmons on the TV. It was fun and I was able to manage my weight fairly well, but I never did get back down to 130. I suppose I was about 150-160 by this time. Then we moved when my husband got out of the Army and I could feel and see myself balooning. I got up to 199 and I hovered at that 195-199 range for years. I fought my weight constantly during that time, determined I would NOT get over 200. I also had another baby during those years and I was able to keep my weight down to 199. Then in 1997 I had our fourth child and after he was born, I skyrocketed. When he was a newborn baby I took him with me and went to Weight Watcher's. This was my first SERIOUS and public weight loss attempt. Or I should say first organized attempt, although I'd done deal-a-meal and counting calories and susan powter. This was the first time I revealed to anyone else I needed help with this. Since that time, I have joined and failed at WW seven times and spent hundred of dollars.
Some and this is just some, of the things I have tried during the last seven years are as follows: WW; Atkins (twice); Sugar Busters; Carbohydrates Addicts Diet; The Zone; Beyond the Zone; Protein Power Plan; I have taken all kinds of medications. Some antidepressants (to try to curb that eating compulsion), xenical, phentermine (awful!!! Never slept), meridia (twice), metabolife. I've done it all. In fact, and I am not joking here, I have done everything except throw up and that was next on my list to try, then the weight loss surgery became so popular and here I am. No matter what plan I did, or what medication I took, I NEVER could get below 200 pounds. And every single diet I did 100% and I exercised. Until now, my feet can't handle the strain.
Although I will say, WLS was never a serious option for me until just now. I thought that WLS was for really sick people. I mean, I do not have any life threatening illness. I don't have diabetes or heart problems, or anything like that. But I know that bad things are right around the corner. I do have sleep apnea that is starting to scare me. I have reflux that is annoying and also scares me at night once in a while (choking). I also have swelling in my right foot that is unexplained. I have arthritis in my knees and feet (supposedly -- I now think this is all just part of the obesity). I was *diagnosed* with fibromyalgia syndrome, but again, I really think now that this is all due to my obesity. I am feeling kind of confident that I will be cured of many or all of these ailments once I lose weight.
10/20/05 I had my phone interview today and it went very well. It has been exactly two wekks since I mailed in my health questionaire. Susan, the nurse, said my BMI is perfect for surgery. I have a good diet history detailing all my attempts, I have good medical records to back it all up and she doesn't expect any problems getting insurance approval. Now, I just have to have the following things completed and they can submit it all to the insurance company: an echo of my heart (from taking phentermine in the past); a sleep study; and the ever famous psych evaluation. I have appointments for everyting except the echo already. I just have to stay on top of it all and make sure I can keep the appointments going. I was disappointed that the sleep study is not until Nov. 29, which is roughly 6 weeks away. I asked to be placed on a list for any people that cancel, I can come, even if it is last minute.
Susan said I could look to be having surgery in possibly three months time. She couldn't see any problem with anything. I go in next week for the "First RN visit". Not sure exactly what all this means, but I think I will be officially in the program then. I'll let you know what happens at that appointment.
10/27/04 Today I went in for my RN visit. There was another man hoping to have this surgery there too. They had a nice lady from the sleep study center come and talk to us about the sleep study and the CPAP. She also assured us both she could move up our appointments. I was barely in the car when she called letting me know mine got moved up 3 weeks. That helps a lot.
I learned a lot today about protein and how I will need 60 grams per day and in the beginning I have to drink it as to protect that new pouch and the connections, in an attempt to avoid strictures. I came away from the day feeling confident that if I follow the program carefully and completley, that I will attain sucess. I hope so. I have a good attitude about it anyway.
The next step in my psych. evaluation next week. I'd like to get approved and have surgery by the end of the year, but that may be pushing it. I will have to be on the CPAP for four weeks before they will clear me for surgery. But I hope they will send in for insurance approval during the waiting time.
10/31/04 I've been spending a lot of time reading people's profiles on this site. I have been frightened by some people and their re-gaining of weight. That idea terrifies me. Then I examine what exactly they are eating and I see what many people's problems are, as opposed to what our program recommends. CARBOHYDRATES!!!!! Carbs are the culprit of many of these people and their regain, I think. Now, who am I to make such a bold proclaimation? Well, I really know a lot about nutrition. I have counseled countless people in matter of healthy eating and nutrition over the years in my volunteer capacity as a breastfeeding counselor. It is a very well known fact that carbs promote weight gain. The answer is high protein. Not completely excluding healthy carbs, such as limited fruits and lots of veggies. But bread, pasta, rice, potatoes. All mostly empty calories. It seems to me that because the RNY surgery makes the person lose by both restriction as well as malabsorption, then what small amounts of food that you do put into your new pouch needs to have the most bang for the buck. PROTEIN! Protein is the most nutritionally dense food going. Why would I go through this horrendous procedure only to stuff my face with SHIT again? I know that even on my most recent diet attempts, doing Protein Power, even though I only lost 8 pounds in 3 months, I felt decent. My insulin levels were low. I had more energy. No heartburn. I just felt much better than when I am eating carbs.
The program at Mercy has these four rules for sucess: WATER, Protein First, Exercise, and NO SNACKING. I can live with all four of these. When I read profiles of people who are complaining of weight gain one and two years post surgery, I see that they are eating "six mini meals" and when I see what foods they are eating it usually consists of pasta. I see no meat (I suppose because it is harder to tolerate meat after surgery), I see no protein supplementation.
I know all this is easier said than done. But I know about healthy eating. I have learned from the best. I now need the energy and the motivation to carry it our once again. I think I will attain the energy from getting the sleep study under my belt and getting on the CPAP, and the motivation will continue to come to me as every pound drops off. I just cannot imagine not thinking that no food will taste as good as thin will feel. If that makes sense.
Really, I'm not trying to sound arrogant. I think though, that my mental attitude will mean the difference between this being FOR LIFE and this weight loss being only temporary. And if I end up having to go to mental health counseling the rest of my life in order to get a handle on the head game that food plays with me, I will. Because this IS GOING TO WORK THIS TIME!!!!!
11/3/04
It seems like things are a real whirlwind. Everything is getting moved up and while that is great, in some ways it is a little scary. I do however want the surgery before the end of the calendar year to save on a whole new deductible next year. So I really am not complaining.
Today I had my psych. appointment. It was kind of wierd -- not quite what I had expected. Dr. Straight did more talking than me. It was almost like a lecture. Like he was re-emphasizing that my stomach will be the size of an egg....that I can gain the weight back if I don't change my habits that got me there in the first place (that kind of ticked me off, because I HAVE changed my habits more than once and maintained the new changes, and have still not lost weight), how I have to be comitted to exercise (like I haven't in the past?).....bla bla bla. I did not find the psych. appointment very helpful, but then my husband reminded me it was about him evaluating my suitability for the surgery, not about giving me any kind of therapy. I have to go back next week for some kind of computer testing to see what kind of problem solving skills I have and see what my personality is. I have no idea what all this is about, but if I have to do it, I have to do it. I am really embracing the idea that this is about a GOOD OUTCOME. Not about ever looking like a model or anything like that. Of course I hate the way I presently look, but really, for me, this is about health and long life. Not about wearing a bikini and lying around on a beach somewhere.
11/4/04
Had the sleep study last night. ugh is all I can say.
I have had one heck of a night. I can't even do school with the kids (we are homeschoolers here) and my husband is so disgusted with me that he left to go to the collge to do his schoolwork for his class (rather than do it at home). He thinks I stressed myself out over the sleep study. Nothing can be further from the truth. I was very relaxed and thanking God that it was happening so quickly and that I'd been moved up.
I was so tired last night. I followed all the rules, no caffeine after noon, no chocolate, no alcohol, no naps.
My technician lady was nice enough, but not real friendly or talkative, and I was somewhat anxious and she didn't do much to put me at ease, but I don't hold it against her. She did her job best she could. I can handle that. This is about me, not about her. It took an hour to hook me all up. I had electrodes all over my scalp, by my eyes, on my forehead, on my chin. I had monitors hooked up to my legs, my chest, my sides. I had a snore microphone taped to my throat. I also had the oxygen thing taped to my middle finger, I had two tight bands around my chest, above my boobs, and one tight one around my abdomen. the worst of all was the sensors in my nose. That is why I couldn't sleep all night. Well, I did sleep, but not well, and when I had my periods of awakenings, like I always have, I had to fight hard to get back to sleep because of those wires sticking into my nose that irritated me. Usually I just drift back into sleeping allright. They also videotaped me the entire night. That was wierd because it was pitch black in there, I don't know how they could record me.
THEN, just as I was really sleeping decent, she talked to me on the intercom, "Jean, it's time to wake up now.". Then pretty soon she came in to unhook everything. I just sat on the edge of the bed in a daze. I felt like I hadn't even bed to bed at all. I wondered how I had done, but I didn't have the frame of mind to even ask. I was tired.
I must've done ok because she said if anything wasn't registering right she'd be in through the night to fix it or maybe to tell me to lay on my back so they could get a really good reading of my apnea caused by obstruction from my overweight. That was tough, because I suffocate on my back, but I did pretty well with a big chunk of the night being on my back so it would be a good test. I really wanted a good test. She never had to talk to me in the intercom and tell me to roll over. And only once did one of the electrodes come undone from behind one of my ears.
I did sleep there, but not as well as I do at home, and not for as many hours. They let me go to bed at 10:30 and she made me get up at 6 this morning. I think the quality of the sleep was the same as at home, or nearly so, but the quantity. I mean, I think at home I make up for some of my bad sleep quality by being in bed more total hours, if that makes sense. At home, I go to bed at 8:30 and don't get up until 8 am. And still be exhausted all day. But at least I can function.
So now all I have done this morning is bawl. Nothing is *wrong*, just can't stop bawling. I am just so exhausted. This is how I am when I have a really bad night, and those happen about once a week under normal circumstances. Thank goodness I don't have the psych. thing today, then I know I would flunk. But this bawling really drove home for me that I don't think I have so much a problem with depression causing my crying as I do with sleep depravation causing my crying. It would be like making a normal person stay up for 5 straight days and then ask them to function normally on just that much sleep.
My adult daughter came over to be with the kids so I could just go to bed and get a big nap, which I slept three hours. I still feel headachy, but I took a shower and had something to eat and now I think I will live. I am very glad the sleep study is behind me. Now I pray they will score my test right away and get me going on the auto-pap machine by tomorrow.
I wanted to also say that I emailed the company that makes Isopure (Nature's Best, is their name) and asked for some samples to be mailed to me. This stuff is pretty expensive, but does seem to have the biggest bang for the buck. The most protein and lowest carbs per serving than any other protein supplement I've seen so far. They sent me a couple bottles of their already made drinks and one canned shake. I was more interested in the powders, but I'll take whatever I can get. I'm a little scared to try them, but I really need to. It's like I am afraid of not liking it and then it is wasted. But how will I know if I don't try them? Because I am going to need a supply of this stuff on hand for after surgery. I am going to try to get to a GNC soon too to check out what they have. I am not a big GNC fan. I think they are overpriced and I see a lot of unhealthy food supplements there. Ones with artificial colors, sugars, preservatives, etc. I know it sounds hilarious that such an overweight person cares at all about such things, but I really do know a lot about nutrition and while I am horribly overweight, I have tried for years to not eat artificial junk, and not to feed it to my children. It seems silly to be so concerned about it in the shape I'm in, I know. Almost hippocritical. But if you knew what kind of diet we have had in our house, organic, natural, whole foods, you'd think it is not possible for me to be so overweight. You'd be surprised at how natural foods can be culprits as well as junk food. Too much of anything is not good for a person, whether than be natural potato chips, or regular.
11/08/04
I had my surgical consultation with Dr. Mark Smolik today at the
My husband Jerry, who is a respiratory therapist at Mercy (at the main hospital) recommended Dr. Smolik to me. I could choose any of the three surgeons who do the surgery, but based on Jerry's observations of them, he thought Dr. Smolik best matched my expectations of a doctor. He was so right. Dr. Smolik was so polite. Not for one moment did I feel ashamed for being there, or ashamed that I was in this condition in the first place. He made eye contact with me so much that my contacts dried out. He wasn't mindlessly listening to me while he wrote in my chart. He seemed to care about *me* and listened to me. He very clearly spelled out the procedure, the risks and the potential benefits. He was not in a rush, he invited all of our questions. He was just great, and not at all hard on the eyes
So, this is just another hurdle I've jumped. I feel very pleased and relaxed with the choice of Dr. Smolik. Tomorrow I have my dietician appointment, and I am looking forward to that. It is my intention to do everything I possibly can to make this surgical tool a success for me. I have no other choice. This is my last chance at weight loss. I've literally done everything else.
Also on the sleep study ... I had expected to hear from that doctor (Dr. Fleugal) by now, and was getting annoyed at that, so I called this morning. The sweet lady who is the boss at the sleep clinic called me this afternoon and told me she had asked the Dr. to look at my test today and that she will look at it and call me after she is done seeing patients today. This Amy, has been so nice to me. So willing to do everything she could to get me in sooner, etc. So I should hear from the doctor either tonight or first thing tomorrow. That would be perfect, as I have the dietician appointment and I can get set up on the auto-pap while I am in
Everyone seems to be doing everything they can to help me feel comfortable and to keep the ball rolling on all of this. It is a lengthy procedure to follow and I have to be patient and grateful.
later in the day.......
I wanted to make a little addition to my earlier note.
It has been somewhat strange and somewhat hard to talk so openly about my weight situation. I have been so used to hiding my weight and my health issues for so long that being weighed all the time, and discussing my weight with health care people is really rough on me. And even within my own family it has been tough. We watched a show on Oprah today with a lady who weighed 550 pounds, and finally had the gastric bypass and now she weighs about 250. Previously, I would NEVER have watched a show like this out in the open. I would watched it in my bedroom behind closed doors. In other words, discussing this lady's situation and how I can relate to a lot of what she talks about, etc. with my family. My weight has been such an off-limits topic for so long and now it is the ONLY TOPIC
While I'm not sure I am crazy about Dr. Straight (the shrink), I do think that after surgery I may want to follow up with a psychiatrist to get a handle on my head issues, because obviously people eat for reasons other than hunger and if this is going to be successful for the rest of my life, I need to get in touch with what got me here in the first place.
11-10-04
Had the dietician lecture yesterday and there were some other potential gastric by pass patients there too, not just me. She concentrated on the first six weeks post op. I had a hard time getting my mind around the fact that carbs are not the same as sugar . With the Atkins nutritional approach I was led to believe that all carbs are sugar. That on the molecular level they become sugar when the body breaks them down. And they have the same effect on one's insulin levels. So, if a protein drink says it has 7 carbs, that does not necessarily mean I can't use it. Long as on the label under "sugar" that it says 2 or less grams of sugar, I am ok supposedly. This is not what I have been led to believe for a long time now. So I'll probably do more research on that myself.
Here's the deal. They want me to eat EXACTLY what they say, and ONLY what they say and take the EXACT vitamins they say and ONLY what they say. It seems to be with no exceptions, no variations. I understand that some people are blooming idiots, but I have a REAL and HUGE problem with this "we are the boss and you are not" mentality. Seriously, I am not trying to be difficult, but I am not going to have this surgery, only to pump in NutraSweet into my body and artificial colors and preservatives. I don't eat them now and I am not going to eat them then. I have been off NutraSweet (i.e., diet coke was my main problem) for almost one year now. I am seriously addicted to it if it even touches my lips. I just CRAVE sugar if I eat NutraSweet, that's how dangerous this stuff is to me. Not to mention it is a well documented fact that NutraSweet breaks down in the body in some very bad chemicals, such as formaldehyde. NutraSweet is bad, bad news for everyone. My husband Jerry, didn't even go with me to this diet lecture because I think he knew I'd be argumentive with the dietician and he didn't want to deal with it. Plus he had some college homework to finish for last night's class. I think that his view is, do I want to lose this weight or not? My answer is, of course I do, but I know very well, that there are products out there that are not loaded in artificial ingredients. All I am asking is that when I bring my products in to the dietician and asking to use them as alternatives, can they at least have an open mind and look at them? I hope that they are supportive in this way to me.
Bugs Bunny Vitamins are loaded in JUNK, not to mention are chewable, which makes me gag now, what is it going to make me do then? While Schiff vitamins come in liquid forms and have no art. stuff in them, and are liquid. What's wrong with that? Assuming of course the RDAs of vitamins are the same as the bugs bunny. I've got to look into this more and compare the two side by side and see.
OK, then I finally got the call from the sleep clinic to come and get fitted for my auto-pap mask and stuff. That took the rest of the afternoon. I used it last night, but did not make it to the four hour minimum. It is really freaky to have the mask on your nose when you are trying to get to sleep, and you must keep your mouth closed. No mouth breathing because you get light headed and dizzy if you try to do both. When I woke up at 1:30 am, I freaked out because the mask was on my face and I got scared. The air was really blowing into my nose hard so I must've been in an apnea episode and the machine senses that and increases the forced air pressure accordingly. But the goal is to NOT wake up during this. The machine was doing exactly what it was supposed to do. So, I am tired today. But what's new. I guess I was hoping for this miraculous recovery and instant results. You are supposed to feel some improvement with your daytime drowsiness pretty quickly. When I woke again at 6 am, I put the mask back on and turned on the machine, knowing I wasn't going to sleep, but in an attempt to try to condition myself in using it more. Getting more used to it so that maybe tonight it will be a little better. I have to have four hours minimum per night for 4 weeks before they will clear me for surgery. The smart card computer chip deal will tell the story to them. So there is no way to cheat, not that I would want to. Remember, this is about feeling better, not just about the surgery. UGH.
Tomorrow I go back to the shrink to do the computer program questions. I'll tell you how that goes tomorrow night.
11-11-04
I had my last appointment with Dr. Straight today. We talked for a little bit, then he had me play some card game. it was about matching and sorting cards according to their shape or color or number. It led him to the conclusion that I have good problem solving skills. That when faced with a challenge I am able to use my reasoning to come to a good conclusion. Then when we were finished, Dr. Straight talked to me about how this tells him how I might act after surgery when I may be faced with certain challenges related to my food. For example if they say I can eat eggs, and I fry myself an egg, only to throw up, will I just give up eggs forever? Or will I try again another time and prepare them a different way to test my theory (of whether or not I will throw up again or not). Well, whatever.....I passed and he said he'd give me a good report on my problem solving skills.
Then he made me take a computer test of 567 questions. I had to choose TRUE or FALSE to all these questions. Some of the questions...no, MOST of the questions, were ridiculous. Such as, "I would like to become a florist someday". Or, "I laugh at dirty jokes". This was some kind of personality test that I have never heard of before. I wonder what the results will be.
Ok, I'm still trying the auto-pap. I wore it for two and a half hours last night until one of the dogs woke me up and I took it off. Then I put it back on early morning and slept another 3 1/2 hours. So it is becoming a little more comfortable. I hope tonight is even better. I have noticed no difference in my daytime drowsiness yet. I haven't had it on long enough during deep sleep yet I think.
Next week I have the heart ECHO, my first support group meeting and my appointment with the pulmonologist to go over my sleep study test results and to see how I'm doing with the auto-pap. After those three things, I think it is merely a waiting game. Waiting to get the final results back from all the doctors and to get the package compiled to send in to insurance for approval. I also need to call my nurse practitioner and ask for a better letter from her. They told me she just hand wrote a note on a prescription pad. They need much much more than that to send in to BC/BS. I hate calling her again. But I have to have it. UGH.
11-12-04
I wore the auto pap for 7 1/2 hours last night! YEAH! That is a lot. I put it on at 11:30 and took it off when I got up at 6:30 and so far, I feel pretty decent today. Oh I just now yawned, but I think because I was talking aobut it. I cleaned the whole bathroom, which could mean something, or not. I can't tell based on just one day. Because even before, I would have a good day now and then. Depends on how the next few days go and what my energy level is like. If my energy is still up and I have been able to keep the mask on at night, then I'll know it is working. Before the auto-pap, my energy would only be up once in a while, even though I'd get plenty of sleep. Not every day. So, I feel optimistic about it all. I just don't feel drowsy and depressed today like I usually do.
11-16-04
I had my heart ECHO today. That was not fun. It was uncomfortable to take off my top and bra. Thank goodness the tech was a woman. But to get good pictures of my heart she had to push in so hard. Well, thank goodness it is over and I can forget about that. Tomorrow is my appointment with the pulmonologist, Dr. Fleugal. The auto-PAP is going well. I think I finally have th mask adjusted right and I have had a few nights of sleeping 7 or 8 hours with it on. I don't feel so tremendously drowsy in the daytime when I've had it on that long the night before. I can't remember the last time I slept clear through the night like that.
11/17/04
I had my appointment with the pulmonologist who is a sleep specialist. I definitely have obstructive sleep apnea. She went over my sleep study with me on the computer and showed me all the occurrences of breath holding I have during the night. My apnea is related to when I am in the REM stage of sleep. That's why when I would wake up thinking I was dreaming of someone choking me, I really was choking and it came across as a dream. It was pretty scary sounding. My case is not severe, but it is getting to that point. My neck circumference is 16", and that is when it begins getting serious. Plus the size and shape of my jaw predispose me to apnea (even if I was skinny). I can't do anything about the jaw, but I can do something about the neck -- lose weight.
Dr. Fleugal was really nice and she spent a lot of time with us (my husband came too). We talked a long time about how the auto-pap helps me now and at the time of my surgery. I do not want to be in a position that I am stuck on my back after surgery and I can't breathe, and we get into some kind of crisis situation and they have to re-intubate me. So, by being on it NOW, by the time I have surgery, I will be able to use it and have no breathing trouble at all. The other issue is that she does not want me going into this complicated surgery in a position of severe sleep deficit and it will take the minimum of 30 days to get my sleep caught up after all this time of having apnea. So, my coping ability after surgery will be improved tremendously, not just in breathing, but also in coping and my emotions. We talked a lot about my excessive crying and how I don't have that now, since being on the auto-PAP and why. So, I am not depressed, I am sleep deprived.
I'm supposed to be using the auto-pap for 4 hrs. per night, and when they downloaded my smart card, it showed I averaged almost 6 hours per night this first week that I've had it. That's pretty good considering I had a couple bad nights in there, trying to get used to it. And the download also showed I had a bad mask leak on Saturday night, and so that explains why I was weepy and exhausted on Sunday. I kept thinking something must be wrong, because the machine is supposed to be working. Well, I know now I had a leak that night before. Very interesting stuff.
I see her again in March to see if I've lost enough weight after surgery by then to discontinue the auto-PAP. The smart card will tell what my air pressures are in the night and they will be able to tell by that.
OK, now we play the waiting game. As soon as the weight reduction center gets this doctor's notes, they should be ready to send in the pre-authorization to BC/BS.
I'd like to have surgery by the end of the year. I hope that is possible.
12-6-04
I'm fairly irritated and annoyed. I know I am impatient, but the not knowing makes me nuts. I have a lot of responsibilities at home and not know when the surgery is going to be, or even IF the surgery is going to happen at all makes me insane.
I've been calling every week to the weight reduction center and asking for an update on my case. By last week, they still had not gotten anything from the psychiatrist or from the pulomonologist (diagnosing my sleep apnea, which is a pretty critical point in my gaining insurance approval). So, I followed up with the shrink and guess what?? He'd lost my file. So of course he had not reported to them his approval yet. I go in two days from now to have my smart card read on my auto-PAP machine, and when I am there I am going to ask if that doctor has gotten her paperwork to them yet or not. UGH is all I can say.
The weight reduction center people sound irritated with me for calling every week. I am not being belligerant or anything. I am just politely asking what the status of my case is. No one has even informed me about the results of my ECHO a few weeks ago.
I have to somehow let go of the desire to get this surgery done before the end of the calendar year because of money and trying to avoid another deductible. I'll have to just figure out how to pay that when the time comes.
12/7/04
I finally got in touch with Melanie the gal who sends in the insurance paperwork. She was still complaining that my letter from my PCP was not good enough to get insurance approval. She said it had to document five years of medically supervised diet history. I've only been going to the doctor over weight issues for four years. BUT I called again and asked if she had written the letter yet, and she did it today and faxed it to them at the weight reduction center. UGH! In the meantime I called Wellmark BC/BS and talked to a really nice gal who is going through this same program herself, so she knows exactly where I am coming from. I wanted to know EXACTLY what the approval process requires to give me the go ahead. I only need three years of medially supervised diet history and if my BMI is over 40 for at least three years (it has been), then I qualify regardless of any other co-morbids. Thank goodness, because my only co-morbid is obstructive sleep apnea. But I could have gotten approval even without that.
Speaking of the apnea....I am struggling with the auto PAP. I keep having condensation build up in the mask and then when I roll over on my back, the water drips down on my nose and wakes me up. So, I raised the temp in the room and that helped, except when I try to use the humidifier and heater on the machine. Then it drips no matter what. So what good does it do me if it is waking me up?? It is supposed to help to stay asleep. I don't know....I am getting the smart card read tomorrow for surgical clearance (four weeks of at least four hours per night using it), so I am going to take it all with me and see what they can do about it. I really hate the way the mask fits as well. It rests on my top lip practically and that is really irritating. Apparently the thing is doing me some good however, because I do feel some better during the day. not so drag down tired. I think it could be a lot better though. I think it just needs tweaked.
12-08-04
I called Wellmark BC/BS to make sure that my pre approval request was faxed in. They said they got it first thing this morning and that it is in review right now. I asked the lady how long it takes for them to decide and she said it should only take A COUPLE DAYS!!!!!
So, I am going to call back on Friday and see what they say. Maybe at least by Monday I will have the answer. I'd love to have surgery during that week right before Christmas, or the Monday after. YEAH!!
I also went in to the sleep center to have my smart card read (gotta be on the auto-PAP four hours per night for four weeks) and to get some help on my mask. They downloaded the data on the card were very impressed with how compliant I have been with the whole thing. She said she had never seen anyone (in the gastric by-pass program) use it more consistently than me. I reminded them that I really do have obstructive sleep apnea, and for me, using the auto-PAP is about the apnea, not just about the surgery. My pulmonologist was in today, so they said they'd give these results to her right away so she can clear me for surgery and they said she would be highly impressed. YEAH!~! I also had to go to the medical supply store for a new mask, one that inflates around my nose more and not be so close to my nostrils so it doesn't tickle my nose so much and wake me up. They needed to read the download for insurance purposes, they have to make sure I am being compliant or insurance won't agree to pay. I said, sorry, you gotta get the info from the sleep center because they just downloaded it. They didn't seem pleased. OH WELL. I needed the download for my doctor for surgery clearance first. As far as I am concerned, they can all just fight it out amongst themselves now. HA!
12-10-04
Well, my staying on top of everything has paid off. I called Wellmark BC/BS this morning and they told me I have been approved. So I called the center for weight reduction and they didn't know about it yet, hadn't checked their faxes yet. So Susan is going to get back to me later today so we can schedule a date. I asked if she thought I could still get in this month and she said she thinks so. So, I'm am just sitting by the phone and waiting for her to call me back. She's gotta make sure all the i's are dotted and the t's are crossed.
I would like to have it on the 20th, if they operate that day. That way I'd be home by Christmas. Any day that week would work for me. Getting in this month would be such a blessing for us, because we could avoid a new year's medical deductible. That would help us financially so much. The facility fee is covered 100%, but the surgeon's professional fees are subject to the deductible. Then insurance will pay 80/20 on him. At least the hosp. is paid completely. And all these visits to the weight reduction center have been billed as facility charges and have been no cost to me. Same with the sleep study. That cost $2000 and insurance paid it all, because it was technically a night in the hospital.
Just sitting by the phone now......
12-13-04
Well, I am officially approved for surgery. All my paperwork is in and I am scheduled for roux-en-y gastric bypass next Monday Dec 20, 2004.
Tomorrow I go in for my pre-op bloodwork and teaching stuff. They also scheduled me for my pre op physical with my nurse practitioner for the afternoon. WOW! That is a lot in one day, but that is OK. This is a really busy week for me, so it is good to get it all done in one day. I do have to get my Christmas shopping done for our son. Everything else is done.
I'm trying to eat really light this week so maybe my liver will not be too big and heavy preventing me from being able to have my surgery done lap.
My husband is not crazy about me having this surgery right before Christmas like this, but between you and me, I am trying to avoid aunt Flo, if you know what I mean. And if we don't go for it soon, I will have to postpone and you know me, my deductible is met for the year and I want to get it overwith right away. I am ready to start losing weight.
12-16-04
This has been a really busy week. On Tuesday I had my pre-op teaching. They taught me how to use the Lovenox shots (blood thinner shots to prevent blood clots). They just covered everything I needed to know about pre-op and the hospital. I also had my physical that day, & a load of lab work done. I had a chest x-ray yesterday and it should all come together by Friday so that my nurse practitioner can sign off on my surgical clearance. When I was there, she reminded me that this is the best time for me to be doing this. While I am still relatively healthy. I'm not diabetic, I don't have high blood pressure, etc. She is confident that I will sail right through the surgery and come out the other end with all of my goals getting met.
12-17-04
I was told by the surgical nurse that I would need to be getting my wedding rings off before surgery. Man, was that a nightmare. I was not fat when those rings went on 22 years ago. I knew that the moment we started messing with them, that my finger would begin to swell, and boy did it ever. But between Jerry, and me, and two of our daughters, we were able to pull them off. He pulled down, while we pulled the skin up toward the direction of my wrist. It hurt so bad, and it is so swollen now and still is aching. But thanks be to God they are off. Now I can stop losing sleep over it.
My only other thing really worrying me at this point is whether or not I am going to be able to get that magnesium citrate down, or will it gag me? I got the only kind Wal-mart had, which is lemon. But when I was at Walgreen's yesterday I saw there is a cherry flavor too. I may go back and buy that one.
God has this terrific way of humbling me when it is necessary. I decided tonight to take my little boy and go out to my favorite Chinese restaurant while then girls were at swim practice. Being a Friday night, the place was packed and I knew a ton of people there. I am at my highest weight right now, of 265 (there, I said it out loud). I look just terrible. I look haggard, and heavy and old. I was mortified to see so many people I know. I am so done with food. I am so ready to take on the new way of eating this surgery will require. There is no turning back. I only have a few clothes that even fit me right now and I refuse to buy anything new. I have two nice tops and two pair of pants. I have plenty of t-shirts, but I can't wear those to church. UGH. Today I have been trying to just focus on all the things that I have to look forward to. By camping season I should be down a lot of weight. I should be looking pretty decent by then in shorts. I'll be able to ride my bike again. I'll be confident enough to put on a swim suit and go swimming again. I won't be wearing the auto-pap machine to bed at night because my neck will have shrunk a lot by then. My life will not revolve around food and the seeking of it, and the consuming of it and the dieting from it.
My nurse practitioner read all my labs and x-rays today and was supposed to sign off for my surgical clearance. Hopefully she did that, I didn't get a call from the weight reduction center saying they didn't have it, so it must have gotten cleared. I am ready. I have a new bathrobe, I need some batteries for my radio, but otherwise I am ready to rock and roll on this deal.
Three days to go until surgery.
12-19-04
Tomorrow is my big day. I did the bulk of my house cleaning yesterday so I could just go to church today (today is Sunday) and relax after coming home. I gagged down the magnesium citrate. Tasted like salty lemony drink. They said to drink it cold, and mine was so cold it gave me a brain freeze. Then I gulped down the two glasses of water and exactly one hour later I found myself in the bathroom. the diarrhea has not been terrible, but I would not want to be away from home right now. It has been 5 hours since I took the medicine, and I am down to going to the bathroom about once an hour. At first it was every fifteen minutes. I'm feeling OK though, despite my hunger. I know by surgery time I will have a doosey of a headache from not drinking since midnight, plus no caffiene. I just hope I don't wake up from sugery with a headache.
My bag is almost packed. My new huge comfy bathrobe takes up the whole suitcase practically. I am excited to wear it and start walking around the hospital right after surgery to prevent blood clots.
I will admit, I am a little weepy tonight. Sunday is one of my biggest eating days. Feasting on the Lord's Day is pretty common in our house. I miss my food and I miss looking forward to a big bowl of popcorn and watching TV on Sunday night. With LOTS of butter on it. YUM. I wonder if I'll ever be able to eat popcorn again. I am sure not for a long long while. Too many sharp corners. I asked God today to take away my hunger pain. Both in my head and in my stomach. Even if He just makes it more manageable, I can handle it. But right now and am hurting for something to eat. <
2005
1/9/05
It has been a very difficult time for me since having surgery on 12/20/04. I thought I'd be walking out of that place in the best shape of anybody seeing how I did not have a bunch of terrible co-morbids, and compared to most people undergoing WLS, I am fairly small. HA!
I had a terrible dreading feeling all morning on the 20th, not to mention a terrific headache from fasting and dehydration before surgery. Everyone in the pre-op was nice to me and I know the anesthesiologist, so at least there was one familiar face there. He saw how sick I was with the headache, so he offered me pain relief in my IV while I was waiting for my surgery turn. I also have to say that of all the surgeries I have had in my life, this was the most pleasant experience as far as anesthesia goes. I barely laid down on the operating table when I was already asleep. No time to lie there and be afraid at all.
I woke up in the ICU. I don't remember getting there at all. The ICU nurses I had were wonderful and very caring. Jerry stayed the night, but he was able to go get a room because I had such wonderful care.
The next day my ICU nurse made me get up and walk and it hurt so much. I had a gastric tube because that is the rule for all the CPAP users. Supposedly there is a risk of hurting the new stomach or hurting the staples in the old remnant stomach with air back-pressure, so by having a g-tube, it relieves any air build up you may swallow during the night. So, all CPAP users get a g-tube. Anyway, that is where my pain was, at the g-tube site. Terrible pain.
I moved on to a regular hosp. room late Tuesday afternoon. BIG shock in the level of care, let me tell you. When I got checked in down there, the PCT (patient care tech, or back in my day they were called nurse aides) took my vitals and I had a temp of 102, but he didn't go tell anyone. So I freaked out. It rose to 104 by the time my nurse did anything about it, like call my surgeon. (She was very incompetent, I could go on and on about things she did that were improper, but I won't). My doctor was in the hospital still, so he came down and said not to worry. He said if it wasn't down by the next day we'd do an upper GI to rule out a leak, but he was confident that there was no leak. I spent a miserable night worrying about myself. I had nightmares that I'd be that 1 in 200 that die of complications from the surgery. I thought I must have pneumonia or something. Or that I was getting a blood clot that would kill me.
Next morning (Wed.), my temp was gone. I ran it all night, but it did break by early morning. Dr. Smolik wanted to do the upper GI anyway. Since that test requires an actual radiologist, and Mercy Capitol doesn't have a fulltime one, one of the docs from Mercy main had to come over to do the test on me. Everyone was really nice despite my crying and worrying that there was something drastically wrong with me. He told me right on the spot that he saw no leak and that all my new connections were just fine and air tight. I was very relieved. However, I did run a temp on and off the rest of the day.
I got to go home on Thursday late in the afternoon. I was glad to go.
I continued to have a tremendous amount of pain at that g-tube site. I spent a very rough Christmas weekend. I was determined not to call anyone, since it was a holiday weekend. I managed to barely control the pain and survive. My kids were great. Jerry had to work, so I was completely dependant on the girls, particularly Emily. My mom took the younger two in shifts just to get them out of here. My 17 year old (Emily) had to do so much for me, including helping me in and out of my recliner and even going to the bathroom and bathing. It was terrible, terrible terrible.
To make a long story short.....I developed an infection at the site of the gastric tube. Not deep down into my belly, but between the layers of fat and skin. They took out the sutures holding the g-tube in place and that relieved a lot of the puss underneath the skin. And did it ever drain and drain and drain. And then it began to smell really really rank.
They finally took the g-tube out and I've been going in to the weight reduction center every couple of days to let my nurse work on the wound. We have to express the infection (puss) and pack the wound with this sterile ribbon like material to keep the wound from healing closed on us. We need the puss to come out. The idea is that we need the wound to heal from the inside out. So every day either Jerry or my daughter Emily works on the wound for me, by expressing the infection and re-packing it. I saw Dr. Smolik a couple days ago and he says that the worst case scenario would be that if it doesn't get healed up, we'd need to make another trip to the OR to "clean it up", whatever that means. I think it is to cut it open and make it start re-healing after cleaning out any infection. I'm trying not to be scared about this. I'm taking a high dose of an awful tasting antibiotic that I have to crush and put in refried beans to choke it down. I pray that between the antibiotic and the wound care we are practicing, that it will heal on it's own. It is sore to be sure, but there are several improvements. It is not so sore I can't move anymore. And it is not draining to heavily that it soaks my clothes and pajamas.
This has been really tough on me emotionally. I went in, at the advice of weight reduction clinic nurses, to my nurse practitioner, Susanne, and asked for an antidepressant. They say it is not uncommon at all to need something to get you over the hump after surgery, especially when there are complications you are dealing with. At this time, I have only had four doses of liquid Celexa and I already feel it kicking in. I don't feel nearly as hopeless and regretful as I did a few days ago. I feel like I will survive now and that I can deal with whatever comes my way. I am so glad I took that advice and got some medicine.
I had a scary incident the other day. In my attempt to gag down the antibiotic, I had Jerry crush it into applesauce (which is not on my list of foods to eat). I gulped it down in three bites, trying not to taste it. Well, it irritated my pouch and made it start swelling. I got the famous frothy vomiting for 12 hours. I was so sick and the nausea continued all day Thursday and I got behind on my fluid consumption. I ended up needing an IV with two bags of fluids and they also gave my antibiotic IV so I didn't have to gag that down again that day (Friday). I am OK now. So now I am pretty sensitive about eating too fast, etc. Lesson learned, huh?
Weight loss.....as of Thursday, which was 3 days ago, I have lost 24 pounds. Tomorrow is my 3 week post op anniversary, and I am going in to to the clinic to have my nurse look at my wound, so I'll ask to get weighed and see what the new total is. My body is really just consuming itself, because I am not eating enough to keep a bird alive. The only think I have been able to eat since day 11 is cottage cheese, eggs, and refried beans. Tomorrow is day 22, and I can advance my diet further by adding soft lean meats. Jerry is planning to make chicken and noodles and I can eat a little of that soft yummy chicken. I can't wait.
1-11-05
It seems as though I take two steps forward and one step back. My wound seems a little better. Jerry thought it was much less drainage when he worked on it this morning and I think the pain is less. BUT I feel like butt today. Totally exhausted, like wanting to lie down and sleep all day. No energy at all. They called from the weight reduction center saying that my potassium is low. SIGH. Well, maybe that is the cause for the lethargy. So I got a prescribption for potassium to take twice a day. It is a pill that dissolves in water and doesn't taste too bad, so I can hack it. What is next??? I want to be well.
Last night I ate a tiny piece of chicken from the chicken and noodles pot. It was heaveny. Very delicious and filling. Today I had a string cheese for lunch and it took me forever to eat the one piece. Tonight I am going to try a tiny piece of frozen fish fillet.
I see Dr. Smolik tomorrow. I hope it goes well. I think that overall, I am somewhat better, so I hope he can just change my antibiotic and take the wait and see approach a while longer.
1-12-05
Well, here is today's situation.
I saw my surgeon, Dr. Smolik, today. Despite the fact that my wound is better, he seemed eager to just take me back to the OR and "clean it up". This is like a mini surgery of sorts. I'm having a hard time reconciling why I should agree to this when I have shown big improvements just over the last week. He says the healing by doing what we are doing now is going to be much slower than if I just let him go in and do whatever it is he wants to do (he cuts it open bigger and gets the infection out). But like I said, I am better. I'm not ready for the OR again.
So, we are trying another antibiotic, Augmenten, even though I have a small penicillin allergy (I just start itching). Although antibiotics aren't really all that effective with this type of wound. I don't have infection inside of my body, but kind of on the outside, between the layers of skin and fat. I can't stand the other antibiotic crushed, it made me so sick. I am just so limited on what I can take and making sure it is a liquid. He also said to start packing the wound twice a day instead of just once and see if that doesn't help a bit more. Jerry & I agreed that as long as I am showing any improvement at all, that we will keep on keeping on. I am just not an invasive type of person. I'd like to avoid the OR again. Dr. Smolik agreed that it is fine to take a wait and see approach for now, as long as there is improvement. I don't have to see him for another two weeks, unless I decide I am sick of this wound healing slow and want to proceed with the procedure, then I am to call him and he'll set it right up.
I started my potassium yesterday and I think I feel a little more energy. It seems like all I do all day is take medicine and it takes me double the time of a normal person because I have to be careful about my new pouch stomach. Not putting too much into it at once. It is like a fulltime job taking all of this stuff. I take Prevacid (to prevent ulcers), two multi-vit., three calcium chews, Celexa (anti-depressant), antibiotic twice a day, potassium twice a day, four doses of liquid protein (Pro-Stat), and liquid pain med when I need it. ENOUGH!!!!!!!
1-22-05
It seems as though I go through so many ups and downs. The happy thing is that I am losing about a pound per day. Actually, it averages a little more than a pound per day. I've lost about 36 pounds so far, and I am about 4 weeks and five days post-op at this time. I am trying to only weigh myself once or twice a week. But it is tough not to be obsessed with the scale. So far the weight loss has not outweighed my desire to eat and my mourning that has accompanied my inability to eat.
I have regained most of my strength and energy I think. Two days now I have walked a mile on the track at the Y. Today my daughter Emily took me into the weight room and had me work my arms with 3# weights. She is my new personal trainer. On Monday we are going into the Nautilus room and she is going to teach me how to use all the machines so I can start some toning. I'd really like to avoid needing plastic surgery someday, and I want to try to tone my own abdomen and arms and thighs. I'll never be able to afford plastics and I don't even want to think about trying to get insurance to cover anything like that. So, maybe between vitamin E cream and some toning through exercise, maybe I can avoid all of that. I did not have this surgery in order to become a model. I'll never look smooth and tight and ripped like a superstar. I just want to be healthy and look half way decent in my clothes.
My g-tube wound healed. I know it was due in large part to the prayers of a special group of my friends on an email list that I own. When the surgeon was talking more surgery in order to "fix" it, I got right down to business and asked urgently for prayers. You should have seen his face when he examined my wound last week. He could not believe the healing that had taken place. Thank you GOD!
I struggle with occasional vomiting. Yesterday I overate some hot and sour soup and I threw up for a couple of hours. I am constantly learning what I can eat and not and how much. I usually weigh and measure all my food in order to not overeat, but I didn't do that yesterday and I paid for it.
Some things that I can eat at this time are: the usual cottage cheese and refried beans; small moist pieces of chicken, although that is a little problematic as it takes so long to eat and it kind of sits in my pouch like a big lump, no matter how much or how little of it I eat. I love hot and sour soup from the Chinese restaurant, with wonderful little bits of tofu and tiny amounts of meats in it. I eat a lot of string cheese. It is a great thing to take on the road. I can also tolerate some tiny cut up bites of deli turkey. This is about all I have been eating for the last week or so. It is important to just eat high protein foods. I am cautious to take it slow. I hate being sick with the throwing up. I try to get the required 64 ounces of water in every day, but some days that is tough. I struggle with my protein supplements. I am so sick of Pro-stat. It is so strong and is starting to make me gag. But I can get at least two doses down pretty good, but that is only 30 grams of protein. I have tried some Isopure, dressed up with some add-ins that other people have reported good luck with, but I am just not a milk-shake type person and I really don't like it. I got some other samples in the mail today that I will try. Mixing it in with liquids is tough. But I really need a change so I can get away from Pro-stat a little bit and at least switch off. I will be happy when I can eat the amount of protein I need each day instead of having to supplement. But I want to feel good, so I am really trying.
As far as medicines go, I am still on the ulcer medicine (can't think of the name--oh yeah--Previcid). I have to take that for three months. I'm done with my antibiotics and potassium. I have to take the chewable vitamins for another week and a half, then I can make the change to
So, I think I am finally out of the woods. As long as my wound continues to heal and no infection pockets remained behind, I will be OK. I'm still not at a point where I am glad I had this surgery. I regret it in some ways. I think the complications have inhibited my ability to be happy about it. But I keep plugging along, because I can't turn back now.
2/2/05
Well, according to the my scale, I am down 43 pounds now. I should be really happy about this, but I don't feel impressed yet. I am just so miserable without food. So many things just hurt my stomach, make me vomit, or just sit like a huge lump. Every time I eat meat, it sits like a huge lump in my stomach and I am miserable for a couple of hours. Even if it is a small amount. It is very seldom that I can enjoy some moist chicken and not regret eating it afterwards. So, I try to stick to string cheese, cottage cheese, and Chinese hot and sour soup. The soup really consoles me and helps relieve hunger and it is low calorie and basically high protein (tofu and itsy-bitsy bites of ground meat in it). Plus it is high in flavor.
Since I am now six weeks post op I am supposed to be able to swallow whole vitamin pills, but when I tried, they irritated my pouch and made me throw up for 12 hours with the frothy vomit. SIGH.
I am just sick of feeling sick after I eat all the time. Maybe I need to give it more time. They all say once you get to three months, you are home free. I pray that is true, because I hate what I am going through right now.
The positive side is that I am feeling more energetic than ever. I am cooking for my family and enjoying every moment, even though I can't eat it myself. My house is decently clean and I feel very caught up on life. I've been exercising five days a week. Lots of walking on the track or on the treadmill at the Y and also resistance training three days a week. That has been good and I feel relatively motivated to go.
I need to give it more time and be patient. It has to get better.
2-17-05
Not much news to report. I was low on potassium, so I had round number three of supplements. It must be ok now, because they did not call me after my last blood test eariler this week. I know am down 52 pounds and that makes me pretty happy. My fibromyalgia flared up with all of the exercising, and so I went to my nurse practitioner, Susanne, to ask for a new prescription for Lortab. It is part tylenol and part hydrocodone. I feel bad asking for such a highly potent medicine, but liquid tylenol makes me vomit. There is just some wierd taste to it that does not sit well. And now, since I cannot take ibuprophen type meds, I am really stuck with no options. The ibuprophens are too risky to take with my new stomach, because of potential ulcers. My eating has not changed much since last report. Still eating the soup and cheese mostly. It is just too risky for me to venture out into other things. I am also still taking the Pro-stat protein supplements. YUCK. I just take it straight out of the bottle, because mixing it in stuff just prolongs the misery. I can't stand the shakes, so I just take the stuff straight. I'm feeling good in my clothes and am wearing things I had not worn in a long time. that is NICE. Suddenly, my wardrobe has enlarged GREATLY!! I am even wearing size 18 pants (down from a 24).
3/7/05
There isn't much to report since last time. I weighed myself two days ago and I weighed 205, which makes it an even 60 pounds that I have lost now. Today I am 11 weeks post op and other than frequent vomiting, I think I must be doing pretty well. I eat a LOT of cheese. I just can't eat much meat yet and I really have no appetite for anything. I have tried a few fried foods (like a few french fries) and did not experience the dumping syndrome. I have not dared to touch any refined sugar foods. I just don't even want to go there yet. I am also walking 5 days a week now. About 1 1/2 miles each time. no pain in my legs or feet or knees at all. That is a miracle. I tell people all the time that I still
