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

I had been aware of the early gastric bypass surgeries for many years, but the high rates of complications and mortality eliminated that surgery as an option for me at that time...after all, I was still young, only moderately obese, and not too physically compromised. However, when I first heard the publicity surrounding Carnie Wilson's surgery in the summer of 1999, my personal circumstances had changed dramatically from those early days, and I was elated to hear that there was a safer, more simple surgical solution available to me.

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

My experience with insurance approval was surprisingly easy. My carriers were Acordia and CIGNA, both of which approved my surgery within three weeks of my surgeon's initial letter. Neither company required any additional documentation or substantiating evidence from my PCP or consulting physicians, nor did they require a psychological/psychiatric evaluation.

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

My first visit to my surgeon was one of the most affirming events of my adult life. For the first time ever, I met a physician who genuinely understood the "battle", talked with me at great length regarding the genetic predisposition aspect of obesity and brought closure to decades of guilt surrounding my inability to exercise enough will-power to conquer this problem. He spent a great deal of time educating me to the process of laparascopic RNY surgery, the potential complications and risks, and the life-long behavioral changes that having the surgery would entail. I would advise that all potential patients go to this initial visit with the most complete set of written questions that they can put together and remember that no question is a foolish question

What made you finally decide to have the surgery?

I had made the decision to have the surgery even before the initial consultation with the surgeon of my choice. If he had not approved me, I was committed to continuing the search until I found a qualified surgeon who would. For me, this was the last resort and the final answer.

How did you decide which proceedure to have?

I was initially influenced by the publicity surrounding Carnie Wilson's laparascopic RNY. As an RN and an individual who had had four previous major abdominal surgeries, I was particularly interested in a surgical option which was basically safer and less invasive than an "open" procedure. The lap RNY also afforded me the opportunity to have a much shorter post-op recovery period and less time out of work.

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 had arrived at a physical, emotional, and psychological place in my life where the fear of continuing in the debilitated and generally miserable state in which I found myself was more overwhelming than a fear of dying as a result of the surgery. It was clear to me that if I continued on the same path, an early death from the complications of obesity would be the outcome. After years of weight-loss attempts and failures, the surgery represented the only viable opportunity for me to regain a healthier, happier lifestyle. As an RN, I would stress to all individuals the critical importance of having a Living Will and Health Care Power-of-Attorney in place, particularly if considering any surgical procedure. The surgery will be the greatest gift you give yourself; having Advanced Directives in place will be the greatest gift that you give your family and loved ones. If you do not have these items in place, all hospitals are mandated by federal law to provide personnel at the time of hospital admission to assist you with this valuable paperwork. As a Christian, I was at peace with leaving my life or death in God's hands.

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 adult daughters and my mother were completely supportive of my decision. My younger daughter had had her completely successful lap RNY two months earlier, so my decision was somewhat anti-climactic. My husband, however, was less supportive of my surgery than he was of our daughter's. He also is obese, and perhaps felt threatened by the possibility that I would lose weight and consequently lose interest in him. Our daughter, aside from her obesity, was basically very healthy whereas I had diabetes, hypertension, and significant joint problems as co-morbidities. I think that he was concerned that I was a greater surgical risk and considered the surgery to be more life-threatening in my case. I ultimately said to him that "even in a worst-case scenario...even if I died during or as a result of complications from the surgery...this (decision to have the surgery) would still be the best decision for me". After that, he never made another negative statement regarding my decision, was with me through the entire surgical experience, and now is a total WLS advocate! Family and friends have to be "helped" to understand the critical importance of this decision to you as a person...and you must be equally understanding of their innate fears or anxieties for you, and then attempt to find a common ground for all your feelings. However, the bottom line is that this is your body and your life...only you can decide where and how you go from here.

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

My surgery took place at Emory-Dunwoody Medical Center in Atlanta, and I could not have asked for it to have been a better experience. The hospital is small, immaculately clean, quiet, and staffed with health-care providers who have comprehensive experience with the obese patient and bariatric surgery. I had surgery on a Tuesday morning and was discharged two days later, on Thursday. I took more to the hospital than I used or needed, but would recommend favorite personal toilet articles, a blow-dryer/curling iron, several special nightgowns, a robe and slippers, and a pillow to hold against your abdomen if you're taking a car-ride home (it really helps when you hit those pot-holes or bumps in the road). A "luxury" for me, but not a necessity, was a portable CD player with earphones. It was a great relaxation tool and helped me avoid conversation in the room and the overhead paging system.

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

I had no complications at all from the surgery.

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 assigned a surgery date within a month of my initial consultation visit, so I didn't have as long to wait as many patients. During that time, I was so excited that I could hardly think of anything but the surgery, and don't recall ever feeling any anxiety regarding the surgery itself.

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

I returned to work only eight days following my lap RNY. I have a full-time office position and, aside from general tenderness across my upper abdomen, experienced no problems. My surgeon's instructions were to resume all activities as tolerated, but no lifting of any items weighing more than 15 pounds for the first six weeks. I think that most patients having laparascopic procedures could expect a "comfortable" return to work within 1-3 weeks depending on the job responsibilities. Patients having "open" procedures should expect to require a longer recovery period. All patients, regardless of the surgical approach, should remember that any WLS is a major surgery generally requiring general anesthesia. This in itself results in an intense "shock" to the body which will result in post-op fatigue and often depression, or a feeling of "let-down". It is critical to get enough rest and sleep during the first weeks as well as to follow your surgeon's instructions to the letter. How you care for yourself during the initial post-op period will determine how you feel in the coming months.

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

The hospital was only a three hour drive from my home; therefore, returning for routine post-op visits is not a problem. My surgeon provides a packet of comprehensive information to the PCP which better enables them to participate in after-care, and also allows all subsequent labs to be drawn by the PCP and FAXed to his office. He has been readily available to me by phone in the few instances that I felt a need to speak directly with him during the post-op period.

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.

Dietary regimens seem to vary dramatically from one bariatric surgeon/nutritionist to another. My surgeon has an easier and more simplified approach than most, but it has worked very well for me and I was very grateful for it. I received clear liquids during the two-day hospitalization, then was advanced to a full liquid diet on the day of discharge with instructions to continue that until my first office visit three weeks post-op. I was instructed in the lifetime restriction of concentrated sugars and limited fat intake at that time. The intake of concentrated sugars can result in "dumping syndrome" for some patients (nausea, vomiting, diarrhea, sweating, rapid heartrate), and fat intake simply adds unwanted calories which could diminish the optimal weight loss affect of the surgery. A full liquid diet as outlined by my surgeon includes all milk products, oatmeal, cream of wheat, grits, mashed potatoes, blenderized soups of any kind, sugar-free jello and puddings, etc... After the third post-op week, I was advanced to a soft diet which basically excludes hard/crunchy fruits and vegetables in addition to those high fiber/high residue meats such as beef and pork. At six weeks post-op, a regular diet was resumed which enabled me to add those items back into my diet as tolerated. The most important instructions for RNY patient are to sip liquids (especially during the first few weeks), eat slowly, take very small bites, chew thoroughly, and stop eating immediately when a feeling of fullness occurs. To ignore or forget these instructions will only result in nausea, vomiting, and/or an intense discomfort or feeling of pressure just behind the breastbone. In addition, there is the instruction to drink liquids only before a meal, never during a meal, and to postpone drinking any liquids for 45 minutes to an hour after the meal. This perhaps is the hardest habit for patients to break, but after two to three weeks it became much easier for me and now I never give it a second thought. RNY patients have a very small pouch and need to take in as much protein in their meals as possible; then that protein needs a period of time to stay in the pouch so that maximum absorption of nutrients can take place. Drinking during a meal will fill the pouch and limit the needed protein intake; drinking too soon after the meal will prematurely "flush" the needed protein from that area. Food tolerances seem to vary widely between patients; the only food that I have been unable to tolerate is pork, but other patients report no problem with that. Some surgeons/nutritionists adamantly restrict items such as rice, nuts, popcorn, etc..., but my surgeon has none of those restrictions in his regimen and I have had no problem with those items

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

I was instructed not to lift more than 15 pounds during the first 3 weeks post-op and to get plenty of rest and sleep. At 3 weeks, I was asked to begin exercising "as tolerated" 5 days a week. My surgeon expects his post-op patients to start a walking program, starting with each patient's individual tolerance level and building to a minimum of 20 minutes/day. I had pre-existing knee and hip problems which initially made this regimen very difficult, but over a period of months I was able to increase my tolerance substantially. I now belong to a health club and exercise 4-6 times a week. I have more energy now than I can remember at any point in my adult life.

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

During the first 3 weeks post-op, I was instructed to take one Flintstone's Chewable Vitamin with Iron daily, and one TUMS 3 times a day as a calcium supplement. After 3 weeks, I was told that I could change to any high-potency vitamin with iron of my choice, and any calcium supplement of my choice which could give me the same milligrams of calcium as 3 TUMS. At 6 months post-op, my serum iron and B-12 levels were in the "low normal" range. My surgeon asked that I increase my multi-vitamin to twice a day, and since that time my lab values have been perfect. I have taken Centrum vitamins, uncut and uncrushed, without any problems.

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?

I experienced no nausea, vomiting or sleep disturbances post-op. I do experience dumping with refined sugars, so I avoid them altogether. I believe that every RNY patient will eventually "test the waters" and try some sugar-containing foods...some will experience dumping and others will not. I considered it a wonderful "gift", because it has removed all temptation for me. The symptoms of dumping were so unpleasant that I have had no desire to repeat the experience. Giving up sweets is such an insignificant trade-off for the new health, new energy, new attitude and new life that WLS has given me. I experienced mild hair loss beginning at 5-6 months post-op, and it lasted for about 2 months. I had experienced the same thing following childbirth and every other major surgery in my life, so I was expecting it and wasn't alarmed. The hair came back after each of those experiences, and has again.

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

My surgeon moderates an on-line support group of his patients. It is closed to patients of other surgeons, but that has been very helpful to me because I can share experiences with patients that have had only the same procedure and are participating in the same post-op regimen as myself. He also facilitates two monthly support group meetings for patients who live close enough to attend, as well as moderating a monthly "live" on-line chat with patients. He is available to his patients by telephone or direct email. It has been wonderful to establish such a close, personal relationship with my surgeon and to know that he is so accessible.

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

Following my lap RNY, I was pleasantly surprised to have only six 1/2" incisions "scattered" across my upper abdomen...no tubes, no drains, no external sutures or staples. The incisions were covered with tiny strips of tape which fell off by themselves over a period of 2-3 weeks. At 6 months post-op, I could only locate 3 faint lavendar lines...the other 3 sites are "invisible".

Please describe any plateau experiences you have had since surgery.

I have experienced weight loss plateaus at frequent and regular intervals since my surgery. Initially, it was very frustrating and anxiety-producing. Later, I began to trust the reality that the body needs periods of time to "adjust" to such rapid losses, and that even when the pounds don't disappear...the inches do! I stopped depending on the scales and learned the trust the process. I only weigh once a month...on my new "birth"-day...and now, it's always a pleasant surprise instead of a disappointment.

Do you notice people treating you any differently now?

I really have not noticed people treating me differently. Those who knew me before the weight loss, also knew the health problems that I faced, and are happy that those issues are behind me now. People still frequently compliment my appearance, but general attitudes were always positive in the past and remain so.