How did you first find out about bariatric surgery and what were your initial impressions of it?

I ordered a brochure some 5 or more years before I investigated it seriously as an option. When I first looked into it there was only an open, very invasive procedure, with high failure rates, and some fatalities. In 1999, I got on line and ran everything to ground in less than two weeks. My surgeon, even then, had an extremely comprehensive manual and Web site, along with on line chat groups of pre, post, and "just-looking" patients.

Describe your experience with getting insurance approval for surgery. What advice, if any, do you have for other people in this stage?

Humana, Preferred Community Choice No stalling or problems, once the correct person within Humana received my surgeons request. My surgeon had already done an exceptional job making me aware that the prayed for approval would likely require a complete list and documentation to support prior weight loss attempts, co-morbidities, probably hereditary problems on the horizon, detailed explanation of the procedure, and endorsement of not only him, my surgeon, but also my primary care physician, an Internist, and psychiatric evaluation to validate my motives and whether or not my expectations were realistic. Along with my request I included my surgeon's complete manual, the letter from my primary care physician endorsing me having the surgery and committing to be my doctor for all the post-op follow-up, and a very detailed letter with exhibits listing my weight loss attempts, when, where, how long I tried, how much weight I lost and also regained. I also included additional exhibits listing my co-morbidities at the time and my family medical history for anything that might be construed as obesity related. I ended my letter my telling the review-person that my mother's recent heart attack cost $16,000 for just the first day in the hospital. (My surgey cost approximately $11,500 at the time.) I also wrote, "If you do not approved this procedure, I will be applying for knee replacement, hip replacement, and breast reduction surgery." It worked!!

What was your first visit with your surgeon like? How can people get the most out of this meeting?

I had spoken both on line and by phone with Dr. Rutledge. His patient manual became my bible. I spent all my free time reading and asking questions of other post-ops, in SEG's on line. I'd even interviewed a local bariatric surgeon and attended his support group, so I had all my questions answered before meeting Dr. Rutledge. At the time I was EVP of a company and couldn't be off from work for any significant time, or two trips. I met Dr. Rutledge on Sunday, the 26th of December. He had me watch some video and asked me some questions. It was uneventful.

What made you finally decide to have the surgery?

I walked into my son's classroom on October 29, 1999, to bring cupcakes and candy for their Halloween party. When I walked in there was some laughter, but I wrote it off to the holiday excitement. That evening, at home, my son said, "Mom, when you came in the kids laughed. I thought they were laughing at you, but it was really because Bobby farted." It broke my heart. I got serious right then.

How did you decide which proceedure to have?

I would have rather stayed big than lose the weight only to regain it. I knew there had to be a way. I'd read about people eating around their surgery, rupturing their staple lines, and only losing 60-70% of their excess weight. That would have put me at between 180# and 218# at only 5'2". Of course that would have been wonderful compared to being 272#, but it would have still been very fat in the scheme of things. I still would have been a "fat girl". Not even taking that into consideration, at 180-218# I wouldn't have been able to do the things I've done from an activity standpoint. Maybe I could have, but I probably wouldn't have. My surgeon's statistics supported losing all my excess weight, no tiny anastimosis, no drains, no swallow test, no catheter, no tiny portions, a completely transected stomach to cause complete collagen activity and healing, so no chance of a ruptured staple line or slipped band. Even with the known risks and no rubber-stamp from the medical community I felt this was the best procedure for me.

What fears did you have about having complications or even dying from from the surgery, and what would you tell other people having the same fears now?

Keep in mind, my father's a lawyer, so we had to address all of this too. I had an advance directive for health care and I made arrangements as to who I wanted to raise my then-10-year-old son. I was married, to my son's father, but even now he isn't the most responsible character, so I made my wishes known and did what I could legally to make sure what I wanted to happen would happen, in case I died. I did the same thing when I had my plastic surgery. I know that any procedure can go wrong and things can and do happen, especially when general anesthesia is required. I worried, but I was so miserable at 272#, that I just wanted some relief. If I'd have died then it would have been very sad for my friend and family, but I thought it was worth the risk.

How did your family and friends react to your decision? Would you have communicated anything differently if you could now? How supportive were they after your surgery?

My son was only 10 and he cried and said he loved me just like I was. A few months after surgery, though, he hugged me and yelled, "Mom, my fingers touch behind you!" It was the first time ever in his life he'd been able to do that. My family was supportive in every way. They were worried, and they'd all been through so many other weight loss attempts with me, and watched me fail, only to get bigger and bigger. They told me all the time how brave I was for making such a drastic, life-changing decision.

How did your employer/supervisor react to your decision? What did you tell him/her? How long were you out of work?

I was the executive vice president, overseeing three divisions of a ocmpany, with just under 25 employees, and basically in charge of everything. My staff was very supportive. I had my surgery on Monday, 12-27-1999. I was back in the office on Thursday, 12-30-1999, for half a day. Friday the 31st was a holiday and the office was closed. I was back to work without incident on Monday, 01-03-2000.

What was your stay in the hospital like? How long where you there? What things are most important to bring?

I was in the hospital for 43 hours total. I really didn't need anything. The hospital provided the gown(s) (I needed two at the time), the pressure hose, and everything else I needed. It wasn't a "normal" hospital stay, in that I was either asleep or walking, post-op, and out of there before I felt like watching TV, reading, or even having any visitors, really.

Did you have any complications from the surgery? If so, how did you deal with them?

No complications. I have always had a tendency to be pretty anemic, and WLS didn't help. Before having plastic surgery I had to reschedule and have both whole blood and some iron infusions. My red count was down to 5 the day before I was initially going in! The plastic surgeon's office said they didn't know how I was up walking around. I didn't know and hadn't been sick or missed any work. Because it happened gradually I think that made a difference. I'm still a number of years from menopause, but I had to have a cauterizing procedure to stop the heavy menstrual bleeding I've always had. Since then it's been a non-issue.

In the weeks after you got your surgery date, how did you feel? How did you cope with any anxiety you might have felt?

I was anxious but excited. I felt that I had chosen an exceptional procedure and surgeon, so I wasn't really worried about anything. I did my homework and had all my questions and concerns addressed by the time I was scheduled. There was only three weeks between the date I was approved and scheduled, and my actual surgery date. Mostly I made it a mission to eat at all my favorite haunts and have the things I felt I would have to do without after surgery.

Describe your first few weeks home from the hospital. What should people expect from this period?

I had to go back to work right away, and since my procedure was laparoscopic that wasn't any sort of problem. I was anxious about the weight coming off, but it did, without a hitch. I was down 30# at the end of the first month and not far from goal by the time I was 9 months post-op. I joined the local YMCA and hired a personal trainer for a number of sessions. I tried to find ways to reward myself that were not food related, like having my hair done, manicures and pedicures, books, and eventually new clothes. One thing I used to do that gave me a lot of support, I learned somewhere along the way that a gallon of milk is almost the same in weight and volume as 8 pounds of fat. I would go to the grocery store, and before doing any other shopping I would put however many gallons of milk into my cart to equal what I'd lost to that point. One gallon is a lot of mass. Four gallons is a bunch! Eight gallons....I'm pretty sure you get the picture. That "exercise" was very empowering to me.

How far did you travel to have your surgery? (If far, how did this affect your aftercare?)

I went from Tulsa, Oklahoma to Raleigh Durham, North Carolina, about 1200 miles away. Airfare for my husband, child, and myself, three days hotel (the Doubletree), rent-a-car, meals, and incidentals ran less than $1,000. I also took my portion as part of my medical expenses on my taxes. (I'm not giving tax advice. Always seek the advice of a professional.) It was absolutely worth the added expense and work to have the procedure and surgeon I felt was best for me. Also, because the procedure wasn't offered any place else, and I build my case to insurance with this element specifically in mind, my surgery was covered, even though there were other bariatric surgeons in my own state.

Please describe in detail what things you could and couldn't eat in the weeks and months following surgery. What foods have been off limits? Please explain how your dietary tolerance changed week-by-week, and then month-by-month since surgery.

My surgeon requires a commitment to not drink alcoholic drinks at all for at least the first six months. I drank regular soft drinks up until surgery, so I wasn't keen on trying to get used to diet. Carbonation didn't feel good, either, so I stuck to juices, smoothies, V8, and other vegetable juices until I started drinking diet pop after almost a year. I am lacto-intolerant post-surgery. That's one of the only bad things that happened. I can still have cereal with some milk, but to drink a glass of milk or ice cream makes me feel pretty lethargic and just not well. Immediately post-op I ate lots of yogurt, soups, smoothies, refried beans, and beef jerky. I credit the beef jerky and refried beans with not losing any hair.

What was your actvity level in the days and weeks after surgery?

Not a lot of change immediately. I started walking some, after about a month. I joined the YMCA and started going 3X a week, seeing a personal trainer to do weightlifting and resistance training. Then, I would stay and do 20-30 minutes on the treadmill, recumbant bike, or other cardio machine.

What vitamins and/or dietary supplements have you taken since your surgery?

I take Fiber Choice chewable supplement, 3 Flintstones chewables, B6, and smoothies with added vitamins and other enhancers. Sometimes I "do" wheatgrass shots at the whole foods market. I try to make sure I get between 2-3X the FDA's recommended daily allowances for viamins, ORAC, etcetera, because of the malabsorption associated with the 6' bypass I had with the MGB.

What side effects (nausea, vomiting, sleep disturbace, dumping, hair loss etc.) were worse for you? For how long after surgery did they persist? How did you cope with them?

The bowel movements initially were very smelly and loose. I didn't have any nausea or vomiting, ever. I tried a small portion of pancakes with maple syrup a few months post-op. I'd learned I could eat about 24 grams of sugar, so I thought a couple of bites would be okay. I almost didn't make it out of the restaurant. I don't know if it's because maple syrup is so refined or maybe it was the butter too, but it was like taking a handful of tranquilizers. I also tried to have part of a grilled cheese sandwich too soon and after letting myself get too hungry. It felt like a rock in my chest. I didn't eat regular bread again until I was almost a year out. Pita bread, other flat breads, crackers, tortillas, all are much better tolerated. I eat sandwiches now, but not all the time. I can eat a small burger, a roast beef sandwich, even a grinder, but I have to take small bites, chew well, and I pinch away a lot of bread when there's just too much of it.

What was the worst part about the entire bariatric surgery process?

Being 38 and realizing I could have possibly done something sooner. I console myself with the fact that my procedure wasn't available for too many years before I had it.

What aftercare support group/program do you have? How helpful/important is this?

I didn't do much in this regard. I talked with other post-op and pre-ops on my surgeons egroup. I was too busy watching the weight come off, trying to eat right, beginning to exercise, and filling my life with events that didn't revolve around food.

What is your scar like? Is this what you expected?

I had five tiny, tiny little cuts. I can't even see them all now. They were pretty much gone before I was a year post-op.

Please describe any plateau experiences you have had since surgery.

The weight came off consistently and completely. I have what my plastic surgeon estimates is 15#'s of redundant belly skin. I've let 10-15#'s creep back on before, but I just got re-committed, actually using Dr. Beck's diet workbook very heavily, to identify some of the bad habits and things I was doing to prevent me from staying at my goal weight. I never had a plateau where I was worried that I was going to be left with any significant amount of my original excess weight. My surgeon's statistics just didn't support that being any sort of problem, usually.

Do you notice people treating you any differently now?

Of course! We are a very visual society. People judge whether they mean to or not. I am taken more seriously in my professional life and no one has to see through the fat or their own perceptions of how a morbidly obese person is different.