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

When I was 21, I was having difficulty conceiving a baby and I was, subsequently, diagnosed with PCOS (Polycystic Ovary Syndrome) and my physician recommended, as a treatment, that I loose weight. When I went home, I went on a web search to try to find a decent diet that I might actually be able to follow. After typing "weight loss" into a search engine, I, inevitably, came across bariatric surgery. I was intrigued and attended a seminar. A couple years later, my sister-in-law had the surgery done and she looked and felt fantastic! Needless to say, that's when I got serious about it.

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

I had no problems with the insurance company at all. My problems were more-so with my PCP (primary care physician) and the bariatric surgeons nurse. My PCP was very against the bariatric surgery and thought I was taking the easy way out. Subsequently, she (I believe purposefully) mis-recorded things, in my chart, that were neccessary for my approval. For instance, I was required, by the insurance company to have 18 consecutive months of physician assisted dieting (meaning, I went to my PCP once a month, for 18 months). She was supposed to record things like, my weight, blood pressure, co morbidities, BMI, and the type of diet I was on. Needless to say, for almost every month, my PCP failed to record at least one of the required information. My bariatric surgeon was very kind and helpful. However, his nurse was not. I was required to gather all of my records myself, she refused to get any. At one point, I needed her help to get some records (the doctor had a policy that she would not release records to the patient, but only to another doctor). Even after explaining my situation, she refused to help, telling me that it wasn't her job. I finally got it taken care of when I told the surgeon what was going on and he forced her to fax the release form (yes, that's right, all she had to do was fax a release form). A week before my surgery, the physician had still not sent the records and so I asked the nurse to resend the release and she yelled at me, saying that it was rediculous that she had spent so many hours on my case alone (a rediculous statement, since I had done all the work myself. I had even made my own appointments for preop evaluations. My suggestion for people in this stage... get yourself an accordian file and keep EVERYTHING. Keep a notebook and record appointment dates, and what happened in the appointment. Then get a copy of the office visit notes and make sure they are accurate and have everything that you need recorded on them. When you speak to someone on the phone, record their name, the date, the time and what you discussed. Alot of insurance companies make their emplyees give their ID number to callers. Write that down too. Record and keep everything. For bariatric surgery, it is the patients responsibility to collect all the info needed and to attend all pre op tests, seminars, etc that are required. Some surgeons or insurance groups require patients attend a bariatric support group. Record that info too. For these meetings, what was discussed is not required and may be a violation of confidentiality laws, however, the date, time, location and moderator (group leader) would all be good info to record.

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

My first visit with my surgeon was great. It was at the seminar that I was required to attend. There had just been a hurricane in Galviston, TX and I was the only person who had attended the seminar, so I got lots of one on one attention, had all my questions answered, and got the chance to know my surgeon. I had attended another meeting several years earlier when I first learned of bariatric surgery and there was probably 200+ people there. In those situations, I would recommend bringing something to take notes on. They often cover both LapBand and Roux En Y in these seminars and it's a good time to get an idea of which surgery you prefer. Make sure you ask questions. Write down any questions you might have at home and bring them with you to ask in the seminar. As the seminar progresses, write any other questions that come to mind. If there is a question period, don't be afraid to stand up and ask. The more questions you ask, the more the nurses and doctors will notice you. If you have additional questions that have not been answered, wait until the nurses or doctors are free and most of the people at the seminar have gone. Make it a point to introduce yourself and ask your questions. This will be helpful and benefit you in the long run, when you need someone on your side to guide you through insurance approval, insurance requirements, and pre-op requirements. If the nurses are familiar with you, they are more likely to help you get former medical records, help you get in for pre-op evaluations (such as psych evaluations and pulmonary evaluations).

What made you finally decide to have the surgery?

My daughter got a 24 piece puzzle for her second birthday. I set up a broken down cardboard box in the carpet for a even place for her to put it together and so we could use glue so we could frame her first puzzle when she finished it. Then, she asked me to sit with her. I hated getting on the floor. It hurt and it was hard to get up, but I did it anyway. Needless to say, I threw my back out as I was getting on the floor. We were by ourselves, because my husband was at work. It took me 3.5 hours to get up, call my husband and take a motrin. As I sat there, with my daughter, I thought, I can't let this happen. I'm missing my baby's life! I wanted to be around to see my little girl graduate high school and then college. I wanted to have the honor and privilage of walking her down the isle with her daddy. I wanted to witness the birth of my grandchildren. At the rate I was going, with diabetes, high blood pressure, sleep apnea, arthritis, I was going to die before any of that happened. I wanted to be able to take my kid to the part and play with her, to get on the floor and build a puzzle with her. I didn't want to be that mom... the one that my daughter was embarrassed to have at her soccer game (or cheerleading, softball... whatever) because I was so fat. I wanted her to want me in her life. After years of dieting attempts, I knew that something else had to be done. That there had to be another way. Some way that I could get the weight off and keep it off. So, the idea of gastric bypass was planted into my head. The more research I did, the more I wanted to have it. I knew that gastric bypass surgery was my chance to be healthy again!

How did you decide which proceedure to have?

Basically, it was a numbers game. LapBand has less chance of complications, statistically, than the more invasive Roux En Y. However, the RNY has a higher success rate than LapBand. Although I liked the adjustability and reversability of the LapBand, the RNY had a 85% maintained weight loss (statistically) as opposed to the 65% maintained weight loss of the LapBand. I figured that if I was going to have an invasive surgery to save my life, I was going to use the method in which I would get the best results.

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?

I'm a numbers person. Statistics, percentages and numerical likelyhoods make sense to me. There is a 1 in 200 chance that a bariatric patient will have complications. Thats one half percent (.5%). I was, honestly, not concerned, about the complications. I think of it this way... If 199 people out of 200 would win the lottery, would you play? If there was only a 1 in 200 chance you would loose, you'd be willing to gamble, right? I know I would, and I did. I took my chances. I had a 199 out of 200 chance of winning! That means that I had a 99.5% chance of winning and I was very willing to take those odds to save my life!

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 husband was very much against me getting the surgery. He was just concerned for my safety. I found alot of my friends and family seemed to think that bariatric surgery was an elective surgery and that I was taking the easy way out. Reguardless of how I explained it to them, they could not seem to comprehend that bariatric surgery was a medical necessity for me and that the battle I would endure would be far from the easy way out. After my surgery, I had a few people who were very supportive. My mother-in-law, especially. I was very sick after my surgery and she took wonderful care of me. She helped me bathe, helped me to the bathroom, even helped me with phenergan suppositories. She was so wonderful. I stayed with her for several weeks and she took excellent care of me. And now, whenever I pass a major milestone in my weight loss journey (ie: When I lost 50 lbs, 100 lbs, when I could walk a mile, when I could cross my legs, when I didn't have to wear plus sizes anymore) she has shown her support and how proud of me she is! As I loose weight and my husband can now see the results of the surgery, he is becoming a lot more supportive. He even eats healthier foods with me now, rather than eating a big greasy hamburger and tempting me. So, in his own little way, he is supportive and I totally appreciate that from him, because he's just not that kind of guy.

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

I'm self-employed, so I don't have to worry about work. However, I am a full-time student and had to withdraw due to some complications. My school has been very difficult to work with. I have been out for 8 months. I told them the truth, although, they still believe that I chose to have this surgery and that it was completely elective, like a nose job or something. It's very frustrating to have people who have no idea what it's like to be obese, make a judgement like that. Due to my surgery, I was refused financial aid to go back to my school and may have to attend another school to finish my degree.

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

My RNY required a 4 day stay in the hospital. There were a few things that I had that made my stay a little easier for me. First, I had several pair of cotton sleep pants with a very soft, not too tight drawstring/elestic waistband. My favorite pair come from Old Navy. The legs are super wide and the waistband is drawstring and very wide, so it didn't dig into my incision. I wore them under my hospital gown, especially when walking in the halls, so my tushy didn't show. Also, you might be NPO (nothing by mouth) for a day or two, while your stomach heals. Having a toothbrush and my favorite toothpaste (Tom's Natural Cinnamon) kept my mouth moist and kept the yucky, sticky spindlies out. Also, being NPO can make your mouth and lips dry. Having my Burts Bees Wax Soothing lip balm. Bonus for the Burts Lip Balm, it has peppermint. Peppermint has natural nausea soothing properties. Both the smell and taste can help ease nausea! Also, when you have any kind of abdominal surgery, they cut through your muscles and that can cause pain when you cough, sneeze, laugh, or even change positions. Bringing a throw pillow to hug against your belly can help quite a bit. I use a teddy bear that my husband bought me when we first started dating. He is the perfect size and does double duty for a nighttime snuggler! Whatever else makes you feel good is a plus... I bring lavender essential oil to scent my linens, my favorite big huge terrycloth bathrobe, my houseshoes, my laptop computer for something to do during the day (I also subscribe to Netflix, who has an abundance of movies that you can watch instantly if your hospital has WiFi), a book, a sudoku book. I also bring my favorite clear liquids, so I don't have to live on hospital broth, jello, and apple juice... yuck, yuck, yuck! I bring my own, homemade broth (add little or no salt and pepper and NO sugar!), Miso Soup Mix (you can get it dry in the soup or oriental section at Walmart!), crystal light to go mixes (I hate plain water), my favorite herbal teas (decaf green, mandarin orange green tea, Celestial Seasons Tension Tamer, Peppermint tea (again, is known to decrease nausea), and a fruit sampler). I also brought a couple full liquid foods for the transition to full liquids... things that I already knew I liked, in case the hospital brought something icky. I brought a few Soup-To-Go... the kind that you can heat in the microwave and drink with the top still on it. I brought tomato and cream of potato, but you can use any kind as long as it has NO solid chunks in it (not even stuff you can chew) and no sugar (sugar substitute is okay) and I brought sugar free pudding snack cups (lemon, chocolate, rice, and dulce de leche). The soups, you can keep in your room as they are shelf stable. As for the pudding, get some white labels and write your name and room number on them and your hospital will, most likely, let you store them in the fridge on your floor in the pantry/nurtition room. Most people don't bring all this, but I sure did enjoy having it all!

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

I did have complications, and lots of them. I had my laprascopic RNY on December 23, 2008. I stayed 4 days in the hospital, recovering, and was discharged on December 27, 2008. After about 3 hours at home, I began to vomit blood. After RNY, a small amount of blood and vomiting is normal, especially if you are eating or drinking, it's very common to get nausous and vomit small amounts. However, I was not taking anything in and was vomiting enourmous amounts of blood and couldn't stop. I was also in excrutiating pain and my pain medication was not helping at all. My mother-in-law, rushed me to the emergency room. I was admitted back into the hospital and was given IV meds for nausea and pain until the morning. I was then given a CT scan. It was discovered that I had a tear that was leaking in the intestine that had formed an abcess. The leak and abcess were repaired laprascopically. Four days later, my blood work showed a problem, so I had another CT Scan. That showed a new leak and abcess and I had that repaired laprascopically. I stayed in the hospital for 37 days. I had my surgery done in Houston, Texas because my mother-in-law lives there and I knew she could help with my baby while I recovered. While I was in the hospital, my mother-in-law had brought my daughter back to Arkansas where my husband had stayed. The day after being released from the hospital, I drove home to Arkansas. When I returned to Arkansas, I frequented the Emergency room with nausea, vomiting and pain. I had a follow-up appointment with a surgeon in Arkansas who would be taking care of my post-op care, but had to wait until Feb 18, 2009 for that appointment. So, in the meantime, I was in and out of the ER for pain and nausea meds. Finally, it got so bad that I couldn't even keep down my own spit. I was finally admitted to the hospital in Arkansas. I recieved all the regular tests... x-ray looking for blockage, CT looking for a multitude of problems and an upper GI with a small bowel follow through to see the function of everything. The upper GI showed that things were moving slowly. So, I had an endoscopy and the surgeon suspected that I had built up too much scar tissue (this condition is called stricture) that was causing the pouch to be a little too tight. Treatment for this is a dialation- during the endoscopy, they put a balloon type thing into the small spot and stretch it. When I awoke, I was told that I had formed so much scar tissue that the outlet was only .7 mm (the size of a mechanical pencil lead). I was going to need a revision. However, I was only 2 months out and the surgeon wanted to wait longer to give me time to heal. He tried to give me a tube feed, but one made me violently ill and the other caused an enourmous amount of pain. Needless to say, I had my revision on Valentines Day. After the revision, I speant 67 days in the hospital. After my revision, I contracted VRE in my open wound (the revision had to be done open) and had to have a wound vac for several months. Since my revision on February 14, 2009, I have formed stricture 17 more times. Luckily, these were caught on time and I was able to have the outpatient dialation proceedures. I have spent a considerable amount of time, since then, as an inpatient with nausea, vomiting, and pain. Today is August 8, 2009 and I am in the hospital as I write this. I am scheduled for another surgery next week, and I had another dialation yesterday morning. As you can see, my complications are far from over, but I am optimistic that I will be well again someday and all this will be past me.

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 had one week from my pre-op/introduction appointment with the surgeon to my surgery date. I mostly felt excitement. I had been trying to have weigt loss surgery for 8 years. I had done so much research that I didn't feel scared or nervous at all. I felt very well prepared and felt like I knew exactly what was going to happen. My biggest fear was that my surgery would be cancelled for something small that was overlooked or something. I was worried that I could have missed one of the requirements or something and that they were going to call and cancel my surgery. The day before my surgery was the most worrysome about this for me. I was so close and couldn't bear the thought of having this cancelled on me! Otherwise, it was all excitement and anticipation. I even bought a pretty red dress that was on sale and totally not my size. I said to myself, "I'm going to wear this next year for Christmas." I was very excited!

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

My first few weeks home, were far from normal, so I'm not sure I can give you what most people feel. I can describe how it was for me though. First, as I was forming stricture, my stomach would contract (like I was having labor contractions, but in my pouch instead of my uterus) and it was very painful. Also, I was extremely sleepy. I would fall asleep just about anywhere. I wouldn't even drive, out of fear of falling asleep behind the wheel. I was always nausous and vomitted frequently. I also got very bored with vegetable broth and cream of potato soup. I frequented several websites looking for different foods I could eat on my restricted diet, just for something new. I really wasn't hungry and had to force myself to eat. The scale, however, was a great reminder of how good I was doing. In the first few weeks, though, I didn't notice much of a difference, except on the scale.

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

I traveled 404.14 miles (6 hours and 54 minutes) to have surgery. Since this is a fairly significant trip, I have a follow up surgeon, close to home (about 45 miles) who also did my revision. In addition, my family and I travel to Houston 2-4 times a year to visit with my in-laws. When we are there, I make an appointment for a follow-up appointment with the original surgeon.

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.

During the clear liquid phase, I didn't have much of a problem (except when I got my stricture). My go-to food, whenever I'm experiencing nausea and vomiting is sugar free popsicles (not milk based like creamsicles or fudgsicles, but juice based like Icee Pops or Crystal Lite Popsicles). I also enjoyed Miso Soup and Decaf Herbal Teas. It wasn't until the full liquid stage, that I began to notice things that I couldn't tolerate. However, let's start with the things I could tolerate... I did VERY well with dairy. I could eat yogurt (one sweetened with Splenda), fat free cottage cheese, skim (fat free) milk, and part skim ricotta cheese. However, I am told that most bariatric patients have a problem with dairy from the natural sugars. Before surgery, I really disliked cream of wheat and grits and found that I enjoyed them at this point. I find myself not really enjoying grits again, but I eat cream of wheat almost every morning for breakfast. I added sugar free jam or marmelade. When I went onto reglar foods, I also added walnuts for a crunch and some protein. I did okay on most creamed soups, but it was in the full liquids that I founds that chicken flavor (cream of chicken) made me nausous. I found that I can eat cream of potato soup (although it's kind of yucky), but I cannot eat mashed potatoes, or in soft foods, scalloped, boiled, baked, french fried or any other type of potato (they make me desperatly ill). I can't eat any pasta yet (I try about once a month), it seems to come up also. I can eat rice though and also eat couscous and lots of quinoa (a grain that is VERY high in protein). I also eat oatmeal from time to time. When I was eating soft foods, I had to peel fruit and veggies or the skins would get stuck in my pouch and I would throw up. I still can't eat raw skins, but can eat cooked skins (ie: zucchini, tomatoes, eggplant, apples, pears, peaches, grapes, etc) When I moved to regular foods, I have discovered so very real aversions. I have an aversion to fowl (chicken, turkey, duck, etc), beef, and pork. I now eat alot of beans and alot of fish. On my fish, I find that I need some kind of sauce. I often use figs from our fig tree, tomatoes from the garden with lemon, raisins, and pine nuts to make a mediterranean sauce, pesto, or a milk based sauce. I really enjoy my leafy greens now (spinach, collards, etc) and eat some with almost every meal. I still stay away from sugar and eat very little fat. I never eat anything breaded or fried and I read ALL food labels. Also, I have developed an aversion to many of the sugar substitutes and the only ones tha I can use are Splenda, Stevia, and Apriva. My biggest thing is that I have had to learn to chew my food very well, eat very slowly. Also, my appetite has started to return 9 months out and I find myself fighting the urge to eat, late at night, while I'm watching Conan or Letterman.

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

Just after my surgery, I didn't do much activity at all. I was always tired and in quite a bit of pain. However, once I finally healed, I began to walk often. Now, I walk 3-7 miles a day, work in my flower and veggie gardens, do Tae Bo Cardio, Pilates, Yoga, and the Firm Wave. I participate in charity walks often, and we hope to get a swimming pool soon.

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

I take 1 Centrium Chewable Multi-vitamin, 2 Calcium 600+D, and 1 does of B complex daily. I also take a vitamin to help strengthen my hair and nail (both have been very brittle, falling out and breaking, since surgery).

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?

So far, the worst side effects have been nausea and vomiting. I am still living with these, 9 months out. I am coping with them with phenergan or Zolfran. My hairloss and brittle nails are quite bothersome. The surgeons nurse says it will stop doing that soon. In the meantime, I use a special vitamin for hair and nail growth.

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

The worst part of the entire process was the complications I had. If I haden't had so many complications, the worst part of the process would have been dealing with the rude nurse back in December.

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

I don't use an official support group/program. I use my surgeon and his nurse for any medical support that I might need. I have a friend who had the surgery in October, so she has been good support, in having someone to talk to who is going through the same thing that I am. My husband and mother-in-law have been great emotional and self-esteem support.

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

Originally, my scar was just a few dots from the laprascopic RNY. The revision had to be done open, so there is a HUGE scar that runs from breast bone to belly button and is about 2 inches thick.

Please describe any plateau experiences you have had since surgery.

I have plateaued serveral times. Everytime I got on the scale for 8-14 days, I was still the same weight. I would stress out, thinking that that was all I was going to loose, but then I would start to loose weight again

Do you notice people treating you any differently now?

People treat me very differently. Before, when I was obese, people didn't take me seriously, they were rude to me and and would comment about my clothes, size, what I ate and every other part of my life. Now, People take me seriously, listen to me respecively and not feel they have the right to comment on what I eat or wear.