An essay upon being mortal and forgoing PS: VERY LONG AND DETAILED

I have been trying to work my way through an avalanche of emotions recently.  I am still not clear on any of this, but I think mortality is at the core of the issue.

 

Background

I have been fighting for insurance to cover my reconstructive surgeries since my 4 year checkup in August 2007, when my DS surgeon (who does some recon work as part of his practice) suggested I was ready for it (I lost more weight the previous year).  Health Net approved the mastopexy, but denied everything else.  I appealed all the way to the CA Dept. of Managed Health Care and in December 2007, the DMHC ordered Health Net to cover all of the surgeries.  Health Net refused to comply with an order of their regulating agency (!?!) and the DMHC has been conducing a “non-routine survey" of their practices regarding reconstructive surgery ever since.  These are supposed to take 180 days, but there is no mechanism for enforcing this time limit.  I think Health Net is in bed with some high-ups at the DMHC, and they are delaying the resolution for as long as possible.

 

Because of this, I decided to also pursue another route, and convinced a class action attorney to file suit against Health Net, with me as the named plaintiff.  This case is winding its way through the court, and there has been a motion filed to certify the class.  It is probably many months from resolution, even if it settles.

 

In July, the biotech company I work for was acquired by a big pharma company.  In October, I was told that there was no job for me in the new structure.  This was fine with me, because I didn’t want to work for them anyway, and as a VP, I had a change of control agreement – so I got a nice severance package. They even sweetened things by letting me go right away, although I’m on the payroll until the end of January.  The sale of the company also triggered some stuff with my stock options, so I got a nice little windfall.

 

So I thought, OK, I have the time off, I have the money – why don’t I just go ahead and get my reconstructive surgery work done NOW, and hope to reimbursed later, when one or both of these cases settle?  In anticipation of this, I had been researching reconstructive surgeons extensively, and selected Dr. Agha in Newport Beach.  I even flew down for an in-person consult with him in September to be sure.  And I had the first of several scheduled reconstructive surgeries on November 1^st. 

 

The first surgery

I had first intended to do the lower body lift and thigh lift first.  But Agha suggested that it would be easier to do multiple surgeries if we did the face first, and then the LBL.  When I showed up for surgery, however, he decided at the last second to change things up – he wanted to add some fat to my cheeks, so he said he should do the arms (from where he got the fat to transplant), and most of the face except the lower blepharoplasty (because doing the augmentation would make my upper cheeks swell and make it too hard to do the lower bleph).  I was surprised, but agreed.

 

I had no frigging idea how hard this would be.  I don’t know if I didn’t read enough, didn’t understand, didn’t believe – I just don’t know.  I woke up from surgery in pain, and then was drugged as much as possible.  I was on a fentanyl patch and Demerol for about 5 days (the first two nights in a care center, and then in a hotel in Irvine (I traveled for this PS, who is a WLS patient expert).  On the 5^th day, I woke up feeling nauseous, and tried to deep breathe my way out of it.  But it kept building and building, and I was having more and more trouble breathing and I started thinking I was having a heart attack or had thrown a clot – I finally told my DH to call 911, because I thought I was going to DIE.

 

When the paramedics got to the hotel room, they very quickly figured out that I was hyperventilating.  How embarrassing!  It took a while to settle down, but I did.  I figured out that I needed to put on another Scopalamine patch for nausea, and to get off the Demerol – so I switched to percosets.

 

My post-op experience: pain and panic/anxiety attacks

For the next 3 weeks, I took percosets every 4 hours, pretty much on the dot.  At 3 hrs, 45 min, my face would start to tingle, my arms would start to hurt – it was miserable.  I felt horrible, drugged, weak, uncomfortable – OMG!  My face is numb, tighter than I could believe, from under the chin to where all the saggage is tied to all around my ears.  My upper lids are so tight, I can barely close them (I had the upper bleph and canthopexy).  I can’t turn my head normally (I have just started driving, but not more than a few blocks, in daylight, 6+ weeks later because of this).  I have tearing shooting pains in my lower arms from extensive lipo he did, and some tendons that appear to have been pulled VERY tight inside my elbow.  My armpits are so tight I have limited range of motion.  The incisions on my arms took FOREVER to close (and there’s STILL one little scab left).

 

Agha is one of the most renowned bariatric reconstructive surgeons in the business – this was not a result of anything he has done wrong, I’m sure of it.  This is just what it is, and my body reacted as it did.  I’m 56, and he did a LOT of lipo.  Lipo really really hurts.

 

I had scheduled the LBL and spiral thigh lift for November 30^th, 29 days after the first surgery.  I had been kind of annoyed that the two surgeries were that far apart in fact, because I assumed I would be ready for the next stage and wanted to get this all done as quickly as possible, so I could then have the arms and upper body lift in mid-January, and be ready to start my job hunt in mid-February.  These were my plans.

 

I was still taking Percosets the week before the second surgery was supposed to happen.  I could not believe how crappy I still felt.  But everything was already set up – in fact, already paid for.  Plane tickets bought, hotel and rental car arranged, hospital and care center arranged.  And then on Monday before Thanksgiving, what I now recognize had been vague low-level anxiety attacks got much worse, and became full-blown panic attacks (which in retrospect might have been what the episode in the hotel on day 5 was too).

 

I have never had panic/anxiety attacks before.  I think the next time I see my ex, who claimed that these were at the root of his drug and alcohol abuse, I might have to apologize to him just a bit for being so hard-assed about how they could not possibly be an excuse for what he did.  What an absolutely HORRIBLE experience these things are!

 

The anxiety attacks kept coming and coming.  One, which I think was a full-blown panic attack, lasted 5 hours Monday night through to the middle of the night, despite my having taken a Lunesta.  Every time I thought about the upcoming surgery, and even when I didn’t, waves of anxiety and terror would come over me.  Thoughts of death and dying and lying in a nursing home incapacitated and alone washed over me relentlessly.

 

WHY??  I don’t understand this.  Me?  Anxiety?  Afraid of surgery?  Well, yes, as a matter of fact.  PETRIFIED, in fact.  I was freaking out at the thought of the PAIN PAIN PAIN of the LBL, the thighs.  The incapacity for days and weeks post-op.  The risk of wounds opening up.  And the PAIN.  And the drugs.

 

I also was freaked out about the weakness I felt, the vulnerability, and the brain fog.  My husband has been doing EVERYTHING for me, including washing my hair and my body.  He took out the staples, and has been snipping stitches – and every time, I would get woozy. 

 

But it is the brain fog – OMG!  It feels like maybe I was brain-damaged by this surgery – I can’t imagine going on a job interview as I am now – I am aphasic, get lost in the middle of sentences, forget what I am doing.  This is scaring the crap out of me – what if it’s permanent?

 

Rescheduling and rethinking surgeries

The anxiety attacks kept coming.  I got my PCP to prescribe Ativan, although I still haven’t taken one.  I talked with Agha about it.  Finally, on Wednesday the 25^th, I canceled the surgery.  I then tapered off the Percosets (I took 1 tylenol #3 with codeine every 6 hours for 2 days; then ½ T#3 every six hours for 2 more days, then stopped – it was mostly OK – anxiety but not serious withdrawals).

 

The next week, I rescheduled the second surgery for January 8^th, only instead of the LBL and thighs, I decided to do just the upper bleph, upper body lift and boobs.  Keep in mind, my brachioplasty and face work were done in anticipation of this surgery being done at a later date – there is refining to do to my arms and my face.  The end of the scar under my armpit was supposed to be continued to the upper body lift (moving some remaining fat from my back to augment my boobs and to tighten the skin that overflows the side of the bra).

 

However, my anxiety attacks have continued.  I was hoping that once the narcotics were out of my system, they would go away.  They have not.  The brain fog continues as well.  WTF is going on?  Am I permanently f’ed up from this surgery?

 

I was fretting about this non-stop, in between attacks.  DH and I decided to go to Las Vegas for 4 days a couple of weeks ago to get away from the stress and try and break the cycle.  I kept having the anxiety attacks in Vegas.

 

The third day in Vegas, we went to see Menopause, the Musical.  It is a comedy revue, with all sorts of songs about – well, menopause and the changes a woman goes through and how we have to accept and embrace the changes.  Instead of laughing through the whole show (and it was funny as ****), there were several times that the songs caused my tears to well up, thinking about what I have been going through, for what is in essence vanity and trying to improve my appearance at the risk and cost of my health.  It was very emotional for me.

 

I should note that I have gone through menopause already.  I haven’t had a period in over a year, and have only had 2 periods since 2006.  My menopause was quite easy – no real hot flashes, no mood swings – basically, my period stopped and my feet sometimes get hot at night.  That’s pretty much it.  I had not considered menopause as a factor in any of this – up until now.

 

No matter whether what I was planning to do is reconstructive or cosmetic, the fact is, it is optional and elective.  I don’t have to do it.  This is not a knee replacement or a heart bypass or cancer surgery.  IT IS ELECTIVE.

 

Reconsideration of surgery and the underlying issues

The bottom line is that I have canceled any further surgeries for now.  I just don’t feel up to it, nor that the risk/reward ratio is low enough.

 

But I am still not sure about the source of my anxiety attacks.  Is it fear of the pain?  Yes.  Is it fear of being incapacitated?  Yes.  Is it fear of possible complications?  Yes.  Is it fear of being weak and dependent?  Yes.

 

I also think there is also something deeper that I’m not touching on.  Fear of death.  Fear of my own mortality in particular.  Fear of getting old.  Fear of becoming infirm and dependent.  Fear of not getting another job, ever, because I’m too old.  Fear of poverty.  Fear of not being able to travel.  These all have welled to the surface as a result of something (still not sure what) related to having these surgeries.

 

I have started seeing my therapist again.  And I had a check up with my PCP last week.  I was hoping to find a physical cause for the weakness and anxiety – perhaps my iron tanked with surgery?  Nope.  Both the therapist and PCP think that a confluence of events is the issue, and that I need to work through them before I do any further surgeries.  The anesthesia may still be impacting me, especially the frightening brain fogginess – although I am aware it is getting better.  The emotional part may reflect that the surgery itself was a real trauma to my body (I’ve had major surgeries in the past without feeling this way, but this one was longer and more painful than any other surgery I’ve had, even the C-section).  And I have been completely discounting the emotional impact my job loss has caused, even though I don’t have to worry about money for a bit.  Looking for another job at my level, the potential of having to move away from an area I love, where my kids live, or having to take a job I don’t like, or worse, not having a job at all – all of these are tapping some deep concerns as well.

 

Apparently, all of this has combined and is being expressed in the fears about death and loss of control.  As a mostly type A personality who never pays any attention to the possibility that things will be out of my control, this was unexpected and very traumatic for me.  Why it has come out as a fear of surgery, I can’t yet say.  I am going to explore this in therapy.

 

But I cannot emphasize strongly enough that my negative experience is as a result of stuff going on inside ME, and is NOT because of anything wrong with Dr. Agha or the care I received.  I went into this with what I thought was eyes wide open, and had an unexpected physical and emotional response to the surgeries.  I am taking the logical step of stepping back and putting any further surgeries on hold, and dealing with the issues that have arisen as a result.

 

Rationalization and reconciliation

I am 56.  I lost 120+ lbs., not 200+.  I have lots of saggage, but except for my face, most of it is hidden by clothes, and makes me about one size larger than I otherwise would be.  There is a lot I wish could be fixed, but none of it CRITICAL to my life or health.  My husband doesn’t care about how I look – it’s not THAT bad in the first place, and he just wants me to be happy.  The pain, anxiety, incapacity, risk of surgery and infection and wound issues, loss of weeks of my life to recuperation – right now they just don’t add up for me to be worth it.

 

There may be some physical things to consider next time, to improve my surgical experience.  I think I should not be on narcotics for as long as I was – I think those debilitated me, both physically and emotionally, either alone or in combination with the immobility that I allowed to happen (I barely got out of the recliner most days for several weeks, except to go to the bathroom or to take a shower every other day – my wonderful DH waited on me hand and foot, which in retrospect may have not been a good idea).  The LBL and thigh lift probably should be done in two separate surgeries, given my experience, should I decide to go forward with them at a later date.  I think maybe the sculpting skills of Dr. Agha are more than I need or want – his lipo and fat transplantation techniques, while resulting in fabulous esthetic results, are very painful (or at least that was MY experience), and while most of his patients go to him for those kinds of fabulous results, perhaps I would be happier with a less aggressive approach.  Agha and I are discussing this.

 

Getting my face done was the most important thing to me, because I can’t cover that with clothes, and at a time that I have to go job hunting as a woman of 56, looking older, more tired and less vital was a potential problem for me – the face work was the most impactful surgery I could have had, and my face looks very very good, despite not being “done" yet.. Getting the arms done wasn’t that important to me, but I’m glad they were done (and they provided the fat for my cheek augmentation).  All the rest is under my clothes.  Therefore, I think I will take a break for a while to recuperate and heal, both physically and emotionally, and then see what, if anything, I want to do from there.

 

If you have slogged through all of this, I want to reiterate – my experience is NOT typical and has nothing to do with Agha’s skills or care.  He has been great about it, and has supported my original intent to get things done quickly and safely, and then to back off when I started struggling with these issues.  He has endured endless emails from me, and me scheduling and then canceling surgery twice.  I need to work through my issues, and figure out whether further surgery is something I want, taking into account the experience I have had. 

 

And this in no way is meant to suggest that reconstructive or even cosmetic plastic surgery is not necessary or worth it to someone else.  I am disappointed by my own reaction to it, and I am posting this as a report of my journey, so that people can be either forewarned about and prepared for a possible negative experience, or can feel validated if they have had a similar experience but were not comfortable about sharing it.

Thank you very much for sharing this. I'm sure it wasn't easy for you to put it all down in writing - but it may also be part of your emotional healing process.

I, as well as others I'm sure, appreciate hearing the story from all sides - I haven't had my PS yet, but will be having my TT on Jan 15th.  I've had some anxiety because of it too and am trying to deal with it.

No one knows you like you know yourself. If it doesn't feel right then it just doesn't feel right. I know it seemed like the timing was just right as the events came about with your job and the finances. But, I think it happened so fast and all of it has just piled on as overwhelming events. Then to add to it the drugs and the anesthesia. I can totally understand the brain fog.

I think working with your therapist and taking the time to step back is the right choice for you. What you are feeling today could feel so different in a couple months from now. I know for myself that my recoveries have been uneventful and it just made me eager to move on to the next step. I'm pretty positive that would not have been the case if I had dealt with as much pain as you have and any complications.

It's not a race. Do what you feel is comfortable and go with your gut instincts, and if you never have another procedure there's absolutley nothing wrong in that decision. I hope you can work through the anxiety episodes. That has to be scary.

My surgeon told me that the effects of anesthesia (physical headaches, emotional swings, etc.) can last up to one month for every half hour you were in surgery.  My family and friends have been warned that I'll be in ***** mode for years to come, ha! 
Reflection is a good thing, and I wish you continued healing and health as you go into the new year.  Good luck with the job search too.
Cindy

Wow!  That would be both wonderful and terrifying to hear, because I was in surgery for over 6 hours, and each of the upcoming surgeries are as long or longer.  I can't afford to be mentally foggy for that long, nor am I willing to feel emotionally unstable!

Diana, I read every word, twice. Two things jump out at me. Trauma and guilt. You have been traumatized by the pain. Almost like PTSD. Trying to stay on top of the pain with the pain meds and have that backfire is something I went through and I was popping percocets every 3.5 hrs  too after having surgery on my wrist I broke in three places. That was my worst pain ever and that was in August. That's where your brain fog comes from. Wow, that was some crazy stuff. I was so out of it and emotional it took me months to come out of it.

I was so anxiety ridden and in tears before my panniculectomy having heard it was so excruciatingly painful I almost put my clothes on and left 30 minutes before my surgery. I told my husband, we don't have to do this. I am ok if we don't do this. He just looked at me nervously. I am no where near as strong as you and my enormous guilt for having fought to have insurance cover it and finding a surgeon that would accept the insurance payment in full wouldn't let me get out of the bed and run. I was sure I was going to die on that table or shortly thereafter as punishment for being vain, insisting insurance cover my surgeries, insisting a surgeon work with the insurance company and not try to milk me for another 8 thousand dollars. That is probably the reason she was able to talk me into not having a belly button. Guilt. Like I didn't deserve a damn belly button, who was I to insist on anything. Nobody made me fat but me in the first place, right? Nobody shoved food in my mouth and made eat anything. Nobody's fault but my own that I needed reconstructive surgery to feel better about myself.

I gave my son and husband all my pin numbers, passwords, banking information, anything and everything they needed to know because I knew I wasn't coming home. I cried the day before most of the day. I signed over power of attorney for the care of my youngest son who is severely disabled, insulin dependent, autistic and non verbal to my oldest son. crazy huh?

Get this..with my gastric bypass and my augmentation I woke up not being able to breathe worth a darn. Pain that made me take those pills fifteen minutes ahead of when they were due too!

Last wednesday I woke up out of surgery feeling tightness and pressure, no pain, they had me on a morphine pump releasing regular intervals of pain meds. I could pu**** every 7 minutes if I wanted. I did. Not because it hurt mind you. I think I knew it was too much when my blood pressure dropped scary low and I was naseous. I was waiting for the pain to hit. It never did. When the pump broke and my iv infiltrated, I started crying knowing in an hour I would be in the worst pain of my life. Five tries to put the iv back in, never did. I didn't care about that pain. I knew the worst was coming. Nothing. They gave me loratab just in case. Still nothing. I could walk to the bathroom, no pain, used the bathroom fine. no pain. I couldn't wrap my head around it. I wasn't prepared for the pain meds to work and for there to be no pain. I am 4 days out and ready to schedule my arms. =) just kiddin' I've babbled on.

I am so sorry your first procedures were probably the very worst and most painful. It's completely normal to feel how you do and you owe it to yourself to give yourself permission to be petrified and unsure. When and if you get to the place you are ready to do other procedures know that we will be praying for you, sending you good surgery vibes, and if you need anybody to talk you through it during, before after.. shoot me an email. I owe you for giving me the courage to be adament with the insurance companies and surgeons. I'd even go with you and hold your hand. Just wanted to let you know I care and tell you I have a good feeling it's going to be ok!  =) ((hugs))

Heather, thank you so much for taking the time to post this and to reassure me that just because I had ONE experience like this one, that the next one might be different.  And to give a different and more positive counterpoint to pre-ops reading my story.

I don't know how you managed to not bolt out of the hospital -- I don't think I could have gotten in the front door.  You were very brave and commited!  I am hoping for the recon surgery equivalent of "momnesia" that will allow me to forget this eventually and not be so unreasonably anxious.

Nothing unreasonable about it at all =) Guarantee you I wasn't brave but thanks for saying so. I am a control freak. I don't speed in my car, I don't jump out of airplanes, go on roller coasters even. I am not a risk taker. I just wanted to be normal so badly and had faith everything happens for a reason and that which is out of my control~ just is. "momnesia" is great, isn't it?

My grandma said you never get over the hurt of the one you loved until you are loved again.. unfortunately all your anxiety probably won't go away until you have an uneventful experience. I hope you get that =) You, my dear, deserve it.

 Thank you so much for sharing this - it is so valuable for everyone to hear the potential negatives too - the realities of each person's experience so that they can make an informed decision about their own journey.  I feel that taking the time to write this down has to be cathartic.  Thank you thank you.  

One note from my own experiences - I had a really bad fall in August that resulted in a double black eye and a bleed in my forehead that didn't go away until recently.  I was feeling really foggy and wondering if I had literally damaged my brain.  I was terrified because I am single and work in a very "brain" intensive job where my brain is the only thing I have - without it, I am surely on my way to a very bad end.  Bag lady fears, anyone?  My doctor ran a full panel and it turned out my B12 levels were really low - I did 4 weeks of shots once a week and take a B12 "nugget" daily in addition to my normal vitamins.  Within a few weeks I felt like the fog was lifting and am now sharper than ever.  Something to think about that frequently goes unnoticed by routine medical care...

Thank you for the reminder.  In fact, my PCP did a pretty full panel of blood tests on Thursday, and only some of them are back -- I was HOPING it was iron-related, because I had infusions prior to the PS to build up my borderline levels -- but my iron-related numbers look good.  We did do a B12 test too, but I was supplementing with a TON of B12 according to Agha's protocol, so I doubt that will show up.  But there are quite a few test results that haven't come in yet.  Wouldn't it be wonderful to find something that I'm low on, and all I have to do is pop some supplements and this would all go away??  I can only wish!