Describe your behavioral and emotional battle with weight control before learning about bariatric surgery.

Today is the 27th of December, 2011. Since I no longer do resolutions, I thought I would take the time to reflect upon the past year. This has been an eventful year filled with many changes. I try to avoid hyperbole, but it has truly been an exceptional year. I have made decisions in my life that have resulted in a vast improvement in my health. I have put off other decisions that would probably improve my outlook and attitude, but I am just not ready to take those steps. I think I can divide 2011 into five distinct blocks of time. There was the “I’m sick of this crap and I’ll just ignore it,” period in January and February. Then I moved into the “Hey, this might be the thing I need to change my health,” phase in early March. From March 15 to September 13, I entered the “I’ve gotta do what in how little time? It’s time to take charge,” time period. My surgery happened on September 13, 2011. At that time I entered the “I’ve made the choice, time to implement changes,” stage of my recovery from obesity. Early in December, I encountered a bump in the road to recovery called “Unplanned gall bladder removal crisis.” Since my return to work, I have picked up at the previous stage and have made up some weight loss numbers goals for the rest of the year. Again, I make no resolutions. When January comes, I’ll enter another stage of my development, “What’s next, will I succeed, and what will success look like?” I’M SICK OF THIS CRAP AND I’LL JUST IGNORE IT When the year started in January, I was morbidly obese. My body mass index (BMI) was 48.37. (The ideal range is 18.5 to 24.9.) My hypertension remained out of control, and I had pretty much made a conscious decision to ignore my diabetes. I was thinking that there was nothing I was willing to do to try to get my health issues into remission. I ate what I wanted, as much as I wanted, when I wanted, and removed all clothes from my closet that were too small (approx. 50%). I didn’t throw them away, mind you. I just moved them out of my sight. The dream of every fat person is that they will one day fit into those clothes. (Suffice it to say, they don’t fit me today, they’re all too big and they’re all gone!) There were no major health changes in February. Blood sugars in the 200’s, A1C in the 8’s and 9’s. I was taking my oral medications, but had stopped my insulin because it was inconvenient for me to take it as prescribed. In February, I noticed that a co-worker had lost a lot of weight. I would see her from behind and ask “Who the Hell is that?” HEY, THIS MIGHT BE THE THING I NEED TO CHANGE MY LIFE In March, I learned that the co-worker had gastric bypass surgery in October, 2010. So, I thought, that’s how she did it. “J” was very open about having surgery. It got me to thinking that I should research the whole weight loss surgery thing and see if it was something that I would be willing to try. I learned that my HMO would pay for it if it were medically necessary and if my primary care physician were to refer me. I spent the first week of March looking up gastric bypass, lap-band, gastric sleeve, and every other kind of weight loss surgery on the Internet. Some sites are good many are not so good. I found if it is a reputable medical facility—Mayo Clinic, Cleveland Clinic, Johns Hopkins and the like—one is apt to receive accurate information. I tried to avoid web pages that touted “Weight-Loss Surgery are Us,”, and blogs that promoted “I had gastric bypass. It failed, and it’s my surgeon’s/ children’s/ husband’s/ employer’s (fill in the blank)’s fault.” After comparing the health issues I had, to what the expected rates of remission might be, I decided that gastric bypass—specifically the Roux and Y (R & Y) procedure—would more than likely put my diabetes into remission. On Thursday, March 3, 2011, I sent an e-mail to my primary care physician requesting to be referred to the bariatric surgery program. I received notification of acceptance on Tuesday, March 15, 2011. Life as I knew it was changing. I had nothing to compare it to except maybe, early sobriety. My official starting weight per my HMO was 306. My weight, per my scale was 309. I’VE GOTTA DO WHAT IN HOW LITTLE TIME? IT’S TIME TO TAKE CHARGE This is the ‘hoop-jumping’ part of my story. I received a letter spelling out what I needed to start and finish within six months in order for the majority of my expenses to be covered by my HMO. The first thing I remember seeing was some 15 or 20 blood tests and a 24-hour urine collection. Timing on the urine collection was dicey—how do I collect a day’s worth of pee without carrying a jug with me at work? Thankfully, my local clinic’s lab was open on Sundays. I got to do this discretely in the privacy of my own home. I did have to remind Bob, that the jug in the refrigerator was not apple juice. The labs were to be fasting according to the lab worker, but the RN case manager in the bariatric clinic said that was not necessary. Two ‘sticks’ and 20 tubes of blood later I was on my way. I also needed a pulmonary/sleep apnea study, EKG, psychological review, clearance from my cardiologist, and I needed to lose 3% of my body weight before I could shell out $1450.00 to a nutritional counseling/support company. Then there were the mandatory attendance at two Bariatric Surgery Support Group meetings, mandatory phone calls with my nutritionist, an additional 2% of my starting weight to lose, a mandatory orientation class, a pre-operative appointment with my surgeon, and additional labs and EKG within a month of my surgery date. In order to keep an official recording of my weight, I was required to see my primary care physician so the nurse could weigh me, to the tune of $25.00 per office call. Luckily I had some other medical concerns and well-care visits to see the doc for. I was given this list and told I had six months in which to complete it including surgery lest I start the whole process over again. Has anyone tried to schedule appointments with a variety of medical specialists in a large metropolitan HMO, while working full time, and managing a spouse’s medical care? I got the psych eval done early. The pulmonary function and sleep study was next. The sleep study indicated that I had severe sleep apnea. I would need a C-pap, Bi-pap or some other sort of –pap machine. Thus I was introduced to the wonderful world of respiratory therapy. I had to schedule an appointment in order to schedule an appointment in order to attend a fitting and orientation class. I tried the contraption for five nights. I was never able to keep it on the entire night. As soon as the ‘nasal pillows’ hit my nostrils, I would become a mouth breather which defeated the whole purpose of the device. Another appointment was scheduled. I received a nose-mouth (read full-face) mask, and was able to wear it through the night. I wasn’t thrilled with the prospect of wearing a mask to bed, but eventually I learned that since I had this infernal machine, I’d not be allowed to have surgery if I didn’t bring it with me. Those HMO’s have everything about you in their files, so that when Doctor C. in Tacoma, Washington orders a C-pap machine then Doctor L. (my surgeon) in Bellevue, Washington and his nursing staff know all about it. I have since learned that I should have rented the machine for 3 months and returned it after surgery. Anyone want a slightly used C-pap machine? The damned cardiologist was the most difficult to schedule because his schedule had a lead time of only three months, and there was a waiting list two months out from that. First they scheduled me with the cardiac physician assistant (PA), and then they cancelled that and scheduled me with my cardiologist. That was cancelled and again rescheduled with the PA. And, yes, it was rescheduled a third time and I actually saw my cardiologist. My cardiologist was more than supportive. He was the MD who diagnosed me with Type-2 diabetes. (That is a whole different story!) He was more than happy to approve it. I got the appointments made and completed. I had the lab work and EKG done. I had not forgotten about the required weight loss. I became a professional portion controller, nutritional label reader, and a food weighing fool. I bought kid-size plates, cups, bowls and eating utensils. I stopped going out for pizza, burgers, Dairy Queen® shakes, and Frappucinos®. White bread disappeared from my cupboards—butter vanished from the refrigerator. I even tried to like yogurt. I have always been able to lose weight—keeping it off has always been my failure. So, out came the calculator. Three percent of my starting weight was 9.27 lbs. The additional two percent came to 6.18 lbs. I needed to lose a total of fifteen and a half pounds in order to be scheduled for surgery. On the day of my surgery, I weighed in at 257 lbs. I lost 52 lbs on my own! I did not look at my last month prior to surgery as an excuse to eat everything in sight—a la “It’s the End of the World as We Know It.” I think Bob took me to Baskin and Robbins twice, and the Saturday before surgery we went to my favorite Mexican restaurant for dinner. I attended my first Bariatric Surgery Support Group (BSSG) meeting in April. My partner in crime, Bob, accompanied me. Initially, he was not supportive of my decision to have surgery. He went with me to the meeting insisting that I was going to the meeting for a clandestine tryst with a secret lover. There is no lover, but try proving that to someone who has depression with psychotic features. (Nothing new with the suspicions, he’s believed this nonsense for the past six years. Enough said, this is my story, not his.) There was a variety of people at that first meeting—most had their surgery dates set, three or four were post-ops, and the nurse manager of the bariatric surgery department was there to introduce the new meeting facilitator. On the surface, anyone in attendance could have been there for any myriad of reasons. There was no common physical attribute that linked the attendees. Some were overweight, some not so much; some appearing physically fit, some with mobility issues; we all ran the spectrum from morbidly obese to weight within normal limits (WNL). I took away from that meeting some great information. I learned that I was not alone in my need for weight loss to rid myself of some chronic health conditions. I learned that weight loss surgery (WLS) is not the miracle cure for obesity. I found people I could look to as positive role models, and those who embodied a lack of initiative, knowledge, follow through or perhaps lacked desire to make life-long changes. Again, I can only liken it to my adventures in sobriety—there were those who talked the talk, and those who walked the talk. The talkers rarely achieved the serenity they sought in sobriety. The walkers had the sobriety I wanted and needed. There were enough positive role models. I decided that I could learn from those who went before me. I continued with the BSSG meetings through the summer. I learned about healthier food choices, tips and tricks to cutting down on fats and sugars, food substitutions I should try, and found out that vitamin supplements would become a routine part of my existence. Bob never really came on board with my decision to have surgery. He kept insisting that I could lose the weight on my own. To an extent, he was right. I had lost weight—lots of weight—many times. I had never been able to maintain the weight loss for a year or more. While I hadn’t tried a twelve step program for my overeating, I knew I needed outside intervention if I were to lose weight and keep it off. I continued to research surgical options, results and expectations, pitfalls to avoid, success stories, and stories of failure. I continued to lose weight in order to join, hire, pay for—name your poison—the required nutritional counseling service. I paid for those services on June 1, 2011. One keystroke on the computer and $1450.00 disappeared from my checking account and instantly showed up in theirs. My suspicious mind could go on about the conspiracy theory I have about the common ancestor between my HMO and the nutritional counseling service, but that would be a digression that would be of no use to anyone. I tried, really tried, to learn to like yogurt—especially Greek yogurt. The protein to sugar ratio is better than other types of yogurt. I never acquired a taste for yogurt. It has always tasted like soured milk to me. A tip I learned at a BSSG meeting: stir in some sugar-free (SF) Jell-o®, SF Jell-o pudding mix, or Crystal Light® mix into the yogurt to disguise the flavor. It works in a pinch, but I still have not been able to report that yogurt is one of my favorite foods. I learned to add ice, flavoring, frozen fruit, Splenda® and yogurt to a blender and come up with something resembling ice cream. As a warning to anyone who likes coffee and chocolate together—it tasted disgusting to me when I blended it with plain Greek yogurt. I have kept trying to develop a taste for that crap, but I doubt I ever will. I began trying egg whites in lieu of whole eggs. I learned that fat-free shredded cheddar isn’t too bad. If you toss in some Jimmy Dean® turkey sausage bits, some fat-free cheese with the Kirkland® egg whites you get a helluva an omelet. I found a cute little skillet that makes the perfect sized one-egg omelet. I can cook an omelet in less than 3 minutes. I have no excuse for not eating breakfast anymore. The weight loss continued. In June, my outlook changed. My outlook and self esteem took a change for the better. I actually cared about my appearance. I started to take time in the morning to cleanse and moisturize my face and repeat it in the evening. Once I had those activities down, I started with a touch of make-up before work. In my recovery from alcoholism, the phrase “Fake it till you make it,” is used regularly. I never understood it. I put it to work with my appearance—I never thought I was pretty, so I’d go through the motions of skin care, make-up, and more skin care. I began to act pretty. I started noticing women at work who had bypass and the hair loss they were experiencing. I decided to tackle that before surgery and bought a wig. My mother has worn wigs since I was five years old. I never learned how to ‘do my hair.’ So, wearing a wig seemed like a good idea at the time. As is my habit, I research everything to death. I learned about fiber content, ease of care and styling, types of construction, and the total variation in price. I found a salon locally and the stylist helped me pick out my new hair. Two hours after I walked out of the salon, I was at DSW looking at shoes. I tilted my head to look at a rack of clearance shoes and my wig promptly fell off. The next day, I got my ‘real’ hair cut very short so that the wig would fit better. I thought about doing a Brittney Spears and shaving my head, but that’s a bit radical. I love playing with wigs and make-up! I learned from my mother about a mail order wig seller that offers deep discounts on hair. I now have five wigs in addition to my original purchase. This month I’m a brunette. When I returned to work after WLS I was a blonde. By the time April rolls around, I’m going to be a redhead. I bought a jet black long wig for Halloween—works for being a witch, a gypsy, or a hooker! In July, I achieved the second weight loss requirement. I was to have my surgery scheduled. That meant I needed a pre-operative appointment with the surgeon, the bariatric surgery orientation class, and I had to submit all the paperwork I was going to need for time off of work. I received an email from the bariatric surgery manager, informing me that I would be having surgery on Monday, August 29, 2011 with Dr. Jeff Landers. I would be attending the orientation class on July 29, 2011. I would meet with Dr. Landers on August 4, 2011. Initially, I was concerned about the surgeon to whom I was assigned. All I had heard from attending BSSG meetings was how great the other bariatric surgeon in my HMO was. Attendees at other BSSG meetings had all but deified him. I guess it doesn’t hurt when you been voted as a top doctor by a regional magazine for God knows how many years. So, I will say I was a bit concerned. I spent a great deal of time in July, working on the paperwork I needed to take time off of work. I had to figure out how much leave would be annual, how much sick leave, how much from furlough (time-off without pay in lieu of a governor ordered decrease in pay), and how much I would try to borrow from my co-workers. I needed paperwork for family medical leave act, paperwork for shared leave, and a myriad of leave requests would need to be submitted. In the grand design, I was planning to be off work from August 26, 2011 through October 3, 2011. I attended the orientation class on Friday, July 29, 2011. I had wanted Bob to attend with me, but he refused. I wanted him to get some of his questions answered, I wanted him to meet another group of people to understand why they [we] were compelled to have WLS. I attended alone. First, I got my picture taken. Then everyone introduced themselves. The surgeons were both in attendance. Unfortunately, the person who was scheduled to talk about her experience with WLS did not show up. I’d like to say it was an informative class, but since I had done so much research in advance, I pretty much had read the majority of the information on my own. It was an exercise in people observation skills, and learning to hold in the laughter at some ridiculous comments made by two young ladies in attendance. They wanted to know if it was OK to drink alcoholically on a trip to Jamaica they were taking post operatively. The surgeon did not think it to be a wise decision and suggested sipping iced tea instead. One gal responded, “The only iced tea I’ll be drinking will include the words ‘Long Island’ in front of it.” I smiled. I used to be young, too. Of course, there can’t be a class anywhere about anything where there isn’t at least one person who has “been there and done that.” This ‘expert’ took the form of a woman who had been unsuccessful with lap-band surgery and was now going to “do it right” with gastric bypass. She offered up all the do’s and don’ts of WLS. I smiled some more. In August, I met the surgeon for the first time. Bob came along to the appointment. Dr. Landers is younger than I expected—just another Doogie Howser, MD (They all start looking like that. Is it possible I’m getting older?). I brought a list of questions about bariatric surgery, and he patiently answered all of them. Bob didn’t say much. He did ask the doctor if the procedure was reversible if I changed my mind. Dr. Landers said that I wouldn’t be there if I were thinking of changing my mind. He also said that until he cuts into me, I can walk away from it. He reiterated that gastric by-pass is currently the only cure for type-2 diabetes. He further defined ‘cure’ as random blood glucose levels less than 120 and an A1C less than 6 without the need for insulin or oral diabetic medication. The orientation class and my pre-operative appointment nearly affirmed my desire to proceed. I had been fluctuating for a couple of weeks and truly could have decided to not go through with it. More than surgery, I was looking forward to taking time off from work, embarking on a new voyage, and taking control of my life and health… … Alas, the best laid plans… I received an email. I received a freaking secure message via myhmo.org. I was 2 ½ weeks away from surgery and I received an email. All the pleasantries aside, it said that through no fault of mine, my surgery on August 29, 2011 was being cancelled and could be rescheduled for September 13, 2011. The writer thanked me for my understanding, and hoped that it would not be too much of an inconvenience for me. A freaking e-mail, I received a freaking e-mail. I received notification of this secure message via e-mail while I was at work. I was being asked to be understanding about the change. Honestly, I took the news quite well. I phoned the woman who sent me the message. I got her voice mail. I did not leave a message. I work for a state governmental department—one of the largest ones in Washington state. I had forms completed, turned in, and approval granted for all the leave I was taking in order to recuperate from surgery. I had lived up to my end of the bargain and had lost more than enough weight. I did not understand. I was inconvenienced. In looking back, though, I was able to accept the change, probably better than many of the people I had met thus far on my journey. There was more than one person from the BSSG meetings who would have been devastated. The folks who were counting down the ounces left to lose before they could be scheduled may have used this news as a reason to resume eating as usual. I, however, did not fall apart. I did not cry. I did not write a nasty response. I gathered up all the serenity I could muster and left a voice mail for my supervisor telling him I needed to rescind my approved leave. I went to the computer that tracks our leave, and cancelled each day—one-by-one. I left a message for our human resources specialist and requested new copies of the necessary forms. I e-mailed the bariatric program manager and told her that while the change was a major pain, I would have no choice but to accept it. I did ask that she re-arrange my follow-up appointments accordingly. At this point in my story, I should point out that I was not wholly convinced I was going through with surgery. I was scared—scared of failure or scared of success—does it really matter? In a word, “Yes.” Failure can happen merely by refusing to choose available options. Success means you made the leap of faith, accepted the change and the challenge of living with the change. I needed to examine the reason I had thought about weight loss surgery in the first place. I was diabetic. I was not managing it medically. I did not want to use insulin anymore. I was tired of the vision changes happening regularly. I was afraid watching my renal lab values change for the worse. I was more afraid of doing nothing than becoming healthy. I made the firm decision to commit to the surgery and the necessary dietary changes on August 24, 2011. I worked up to the day before my surgery. I planned to take a full six weeks off for recuperation and returning to solid food before I went back to the office. On Tuesday, September 13, 2011 we started the trek to Overlake Hospital. I received a call halfway to the hospital that my surgery had been moved to the afternoon instead of that morning. We turned around. I went home and napped. I had been without food since midnight, I was not allowed to take in water or food prior to surgery, so napping became the obvious choice. I don’t think I slept, though. I was too excited, nervous, afraid—a whole multitude of emotions. One of my dogs, Dana, sensed something and she stayed on the bed with me. At 11:30am, we started out again. I packed my C-pap machine, my pillow, my laptop, some clothes and my teddy bear—Chibba-Ted. I was ready for the journey to begin. I’VE MADE THE CHOICE, TIME TO IMPLEMENT CHANGES Arrival at Overlake Hospital was rather uneventful. I checked in and was escorted to the surgical check-in desk somewhere upstairs. I know I’d never be able to find it again without an escort. Bob and I waited for what seemed like three hours—closer to thirty minutes. I met a couple of nurses, a phlebotomist, and then the anesthesiologist. The anesthesiologist was very good at describing what would happen. She was thorough and I appreciated that she did not talk down to me, nor did she not go into detail after learning I am an RN. I don’t remember a whole lot after that. My surgeon came in and promised me they would take excellent care of me. I believe that drugs were on board prior to the insertion of a urinary catheter, because I think I would have remembered that. The surgical suite was chilly. The next thing I remember was coming to in the recovery room. I don’t know if the readers have noticed, but I haven’t as yet discussed PAIN. Silly girl. Why would you [I] not think that there would be PAIN involved in SURGERY? Being a nurse can warp one’s sense of perspective. I knew I was having a LAPAROSCOPIC R and Y. There would be three little incisions instead of one big one. Doesn’t laparoscopic mean no big deal? Doesn’t no big deal mean no pain? “ABSO-FREAKING-LUTELY NOT!” One of the nurses in the recovery room was chastising me for swearing. I was swearing because it hurt like hell. I had never bothered to ask about pain. I knew I would be on a patient controlled analgesic (PCA) pump. I did not follow through with the reasoning that they would give me the PCA because the procedure would cause pain. I had pretty much forgotten that laparoscopic surgery is indeed SURGERY! The surgeon cut into me in three different places. There were incisions and staples inside of me as well as on the surface of my belly! Go figure, pain indeed. Lest anyone read this and get scared, many of the folks I met in the BSSG meetings reported little or no pain. Hey, I’m the girl who fainted in the Lloyd Center Meier and Frank store when I got my ears pierced. I fainted again when I tried to change my pierced earrings for the first time. I guess I just don’t do pain well. Any guesses why I never had children? (Well, there’s the pain aspect, the dirty diaper thing, and my belief in Karmic Retribution—that God would give me a child worse than I had been to my parents. I like to think that God has a wicked sense of humor sort of like mine.) The trick to recovering from surgery is to get up and walk. They had me up walking from the bed to the door, back to the other side of the bed, and back into bed within two hours of being brought up to my room. Note to the uninitiated—hit the PCA pump about five or ten minutes before getting out of bed—it makes it easier than trying it without it. Looking back, I should have been a little heavier on the PCA button, because when they took it away, the oral meds took a lot longer to work. I survived. They had me up and walking the halls the next morning. They took the PCA away on Wednesday, the day after surgery. I waved good-bye to my little friend. I had no food or fluids by mouth since 6:00am on September 13, 2011. I would not be getting anything by mouth until after a check of my stomach on Wednesday morning. They need to check that the staples are secure and that there is no leakage into the bypassed part of the stomach. After that was successful, I was told to drink as many 30cc cups of water as I could and to keep track of how many cups I drank. For reference, a 30cc cup is a little smaller than a shot glass. Initially, you cannot drink more than one every fifteen to twenty minutes. It sounds impossible to believe, but that’s life immediately after bypass. I remember being given some puréed crap after the test, I think it was scrambled eggs, one small bite and I was done. Lunch and dinner that day weren’t anything to write home about, either. It was like I had no interest in food. I tried to drink as much water as they wanted me to, but 30cc’s at a time is slow going. Besides, I would lose count after two or three drinks. My first day post-op—Wednesday—was pretty uneventful. I know I slept quite a bit. They removed the urinary catheter, but I could not pee—the anesthesia had done a number on my bladder and the muscles that control it. I was so happy when I finally peed without needing to be catheterized. I guess right now I’ll mention the gas. In order to see and move the instruments during surgery, they pump in air. What goes in must come out, and I had no control over when the farts would happen. Bob kept thinking I was doing it on purpose. I do not remember when the first bowel movement happened, but, when you don’t eat much, you don’t crap much. Apparently, it was not a monumental event in my post-surgery hospitalization. I had brought my laptop with me to the hospital. I was just too damn exhausted on that Wednesday to do much of anything. I got up, sat at the sink, washed up and went back to bed. Next, I’d get up, walk the hall, sit for a while, then back to bed, and repeat. I learned the TV stations and daytime shows pretty well. Thankfully, Food Network and the Cooking Channel were unavailable. There is, however, only so many times you can watch the three different CSI shows and Criminal Minds before they get boring. Sleep was my refuge from bad TV. When I wasn’t sleeping, I was sitting in a chair, when I wasn’t in a chair, I was walking the hall. Sometime on that day, I was told that I would be going home on Thursday. Taking medications in a post-gastric bypass world is challenging depending upon how many medications you were taking prior to surgery. The general rule was one pill at a time as long as it wasn’t any bigger than a baby aspirin. Capsules were OK. Large pills were split. The other rule was no more than one medication every five minutes. When you do the math, it doesn’t take long before your five minute morning routine has become a one hour routine over night. I took my last dose of Metformin—a diabetic medication—on the Friday night before surgery. I last gave myself a shot of insulin the Saturday evening before surgery. I received a shot of insulin in the hospital on Wednesday2 around noon. I have not received insulin since then. I lost several other medications after surgery, but gained some vitamins and supplements in exchange. It all balances out. I hate being in the hospital because they always screw up the times and dosages of my medications. I was becoming frantic because they were not giving me my anti-arrhythmic medication. It is a medication that needs to be started while in the hospital because of the potential for slowing your heart down too much. It’s also a medication that needs to be restarted after not taking it for three days. I became adamant with the nurses and the PA that I be started on it immediately. Immediately in hospital speak means sometime in the next four to six hours. It was restarted by that evening. Thursday morning brought with it some energy—enough to play on my computer between breakfast and lunch. I had to hit Petville, and Fishville to make sure my virtual pet and fish were fed. I scoped out some folks on facebook, ate lunch (No, I don’t remember what it was, I don’t think I knew what it was to begin with.) and waited for the doctor to discharge me. Wait is a very good word when describing the discharge process. One o’clock passed, two, three, four, then there was some puréed crap for dinner (Hospital food is bland to begin with, purée it and it becomes completely unrecognizable in form or function.). Six o’clock came and with it, the doctor. There was a heated discussion between him and a nurse about the ineffectiveness and lack of thoroughness on the part of a PA. Apparently, the PA did not write or submit discharge prescriptions to the HMO pharmacy. The doctor could not use the preprinted forms because they were specific to the hospital’s bariatric program, not the HMO’s program. Bob and I got out of the hospital by 6:30pm, and we spent thirty or forty minutes across the street picking up my prescriptions. We made it home by 7:30pm. What is it about dogs? They instinctively knew that there was something going on physically with me. They would normally bark and jump all over me when I came home after an extended absence. They barked, but didn’t jump. Dana was sniffing me all over while Jodi and Rosy whimpered, whined, and wagged their tails. The cats, of course, paid little or no attention. I was home. I was exhausted. I was in pain. Real life was ready to begin. Prior to surgery, someone told me, “Puréed steak still tastes like steak.” I can’t tell you if it does or not. Puréed Stagg® Chili does however, taste like chili. Chili has protein. I lived on Stagg Chili. I also discovered that navy bean and ham soup when blended goes down well as does well blended split pea soup. At a BSSG meeting, someone suggested puréeing your food and freezing it in ice cube trays. After the cubes are solid, you can store them in freezer bags. Yesterday, I found a bag of split pea soup—I tossed it. The bag had not been sealed well, and it looked to have freezer burn. One puréed cube made a full meal in the beginning. I ate some of my yogurt, fruit, and ice purée. I even tried to purée macaroni and cheese (Hated it!). Rachael Ray talks about always having “stock-in-a-box” in the pantry (She’s never had bypass surgery, I just like her phrase.). Beef and chicken broth helps puréed crap (er, food) keep its flavor. Some folks warned me that I might not enjoy the same tastes in food, especially regarding spices. I found I needed to add more spices to my food. I learned to like curry powder, and extra-hot chili. I still liked garlic, onions, pepper, and the usual spices I kept in the kitchen, but I found the need to heighten the flavor in just about everything trying to do so without too much salt, without sugar, and with as low of a fat content as I could get. I started cooking with wine again. My thinking is if you have to eat less, you might as well taste it more. Cream of Wheat was good for breakfast (It’s good for dinner, too!) Stagg chili was good for breakfast, too! Real food. My nutritionist kept track of my weeks post-op, and told me when I could eat soft, but solid food. She warned me that there was a strong possibility I would throw up. She told me she expects it from all her clients. She said that if it happens, to blend my food—but not to the puréed state I had been using—into a coarse chop. I had the day marked on my calendar. I chose pot roast. No particular reason except Bob was in the mood for it. I cooked it with onions, carrots, potatoes, and mushrooms. Two carrots went down fine. A quarter of a potato was no issue. The meat, however, was an issue. It tasted great. It did not go down very well. I tried to chew it twenty times, it just got bigger. I spat it out and divided into smaller pieces. I was able to swallow two small—very small—bites. The food hit my stomach and was dead on arrival. It felt as though I had swallowed two stones. I was done eating. There was no room for anything else. After about ten minutes, the ‘stones’ decided to move back up. It wasn’t retching. It just moved up into my throat, and popped out of my mouth—easy enough. I mashed up two more bites of carrots and potatoes. Those stayed down. I was done eating for the day. I started grinding my food for the remainder of the week. I was eating bites of meat the following week. Bypass surgery really screwed up my daily routine. I used to eat breakfast right after I woke up. After I ate, I’d take my pills. I had to reverse the order of those activities, or else wait one and a half hours after I ate before I took my meds (Pouch Rules!!). It was suggested that until I was back to solid food, I take my pills as I had been doing in the hospital—one pill at a time as long as it wasn’t any bigger than a baby aspirin, capsules were OK, and large pills were to be split. The other rule was no more than one medication every five minutes. Nine pills in the morning meant forty-five minutes. Ten medications at night took fifty minutes. These time frames are minimums, most of the time I’d lose track of time, and the task could easily stretch into an hour or two. A shot glass of water with each pill turns into a major pain. There’s never a good time to bring up bodily fluids and other substances, but it’s time to broach the issue. Someone at the first BSSG meeting I attended described dumping syndrome as feeling like stomach flu, food poisoning, and getting punched in the gut happening all at the same time and all within minutes of eating the offending substances—high fat and high sugar. Aside from throwing up, there is one action I’d rather my GI tract not engage in and that would be diarrhea. The dude at the meeting had me convinced. Hell, he had me terrified. Another woman who had been at that first meeting came to another one after her surgery. She reported tasting a cream puff sample at Costco and literally running to the bathroom. Shit, two stories about shit, I’m not gonna do that. To this day, I have not experienced dumping syndrome. To this day, I have refused to eat high sugar/high fat foods. I learned a lesson about trusting my gut (pun intended) instincts quite by accident. I was heading to a medical appointment about two weeks post-surgery. Bob was driving. The car needed gas. As I walked out of the house, a passing thought suggested I return to the bathroom for a backdoor job. I ignored that fleeting thought. Bob has never filled the tank in any of his cars to the top as long as we have been together. He has never topped the tank off either. I’m sitting in the car; he’s pumping gas. I get cramps; I’m tightening the butt cheeks and starting to squirm in my seat. Bob is filling the tank. The only thought coming into my conscious mind is, “Oh Shit!” Bob is now topping off the tank. Was it “Oh crap, I shit?” Perhaps it was “Oh shit, I crapped.” In the IT field they say “Garbage in; garbage out.” In my bariatric world, it was “Purée in; purée out.” Thank God we had left the house plenty early; thank God the gas station was only a block from the house. I made it to my appointment; my clothes made it to the washing machine—not necessarily in that order. The moral of the story: if you even think you might need to go, by all means go! Another bodily function I mentioned earlier, expelling gas. It happens; you frequently have no idea when, where, or how loud it’ll be. Enough said. Life after surgery is absolutely a personal experience. There are generalities of course, but each person has their own experiences and differing perspectives. For the most part, I took off the full six weeks because I hate my job. Yes, it helped me get back to normal food so I would not have to take my blender to work. I enjoyed my time off. I spent the first full day puttering around in my pajamas. I was still bothered by pain, and taking my oxycodone liquid every 4 hours. On day two, Bob wanted to drive to Cabela’s to finish paying on a rifle he had in layaway. Saturdays at Cabela’s is a cluster f___ (fill in the blank). When we got home by 1:30pm, it was bed time for me. What I miss most from my time off was my 1:00pm to 3:00pm naps. From the third day forward, I gathered more strength and endurance. I was not ready for exercise per se, but was walking in the mall, at Costco, and through the grocery stores. Journaling. I hate to write down anything with pen and paper. I had not emailed the forms and charts I developed at work to my home computer. I did not record anything except my weight and my measurements. Kindle® Fire entered my life after I had started back to work and I discovered Loseit.com. I have been tracking my food, nutrients, weight and exercise since the first week of December. Support groups. I went to a BSSG meeting in September—the one I go to is on the fourth Tuesday of the month—I was the most recent ‘post-op’ in the bunch. I was still having pain, but it was getting better since the staples had been removed. That’s when I learned that some of the other folks did not experience pain to the degree I did. They had all given birth before, so I think they’ve experienced pain that I never have. I missed the meetings in October and November because I forgot what week they were held. I made it to meetings since then. I like the support and advice given and like to share some of my own. I’m considering attendance at Overeaters Anonymous because I now have to deal with the food addiction. I don’t think you can have too many support people to bounce things off of. I started going back to my AA meetings on a more frequent basis. I started noticing weight loss after the third day. I think it took my body that long to clear the IV fluids. I have never experienced noticeable day-to-day weight loss. I loved getting on the scale. I was wearing size 28 prior to surgery. Within one week I was into my size 26 jeans. As I mentioned earlier, I had removed all clothes that did not fit from my closet but did not get rid of them. I had jeans in sizes from 28 to 20. The nicest jeans I had were size 24. What size did I skip on my weight loss journey? Size 24. One day I tried on my 22’s and could not zip them up. Two days later, I dared myself to try ‘em again. They fit. I have been in love with shopping ever since. After Thanksgiving, I tried on a pair of size 20 ‘slim-cut’ pants. I’ve never worn ‘slim-cut’ anything in my life. I bought ‘em. I have experienced two major food-fest holidays—Thanksgiving and Christmas—and two potentially sugar-packed holidays—my birthday and Halloween. I survived them all. Holiday survival for me depended upon development of a plan and sticking to that plan. My birthday was the first holiday I had to contend with. Bob bought some sugar-free caramel flavored pudding and lit a candle in it. He took me out to lunch, and I ordered fish that was grilled instead of fried. The waitress was concerned that there was something wrong because I did not eat all of it. Back then, three ounces of fish was two meals for me. Halloween came next. I did not buy candy until the day before. I asked Bob to keep it in his closet. I did not try any of it. I think it helped that I ate dinner before the trick-or-treaters came around, and shut it down at 9:00pm, again having Bob keep the leftovers in his closet. We eventually gave the remainder to our friends’ daughter. I usually bake cookies and make fudge for the holidays, take it to work, and mail some to my sister. This year, I didn’t. I told everyone that I could not trust myself around sweets and thus would not tempt myself by making any. Everyone survived not getting treats! I had a boneless turkey roast in the freezer and cooked it for Thanksgiving. I gave Bob the option of sweet potatoes or mashed potatoes but not both. I made stuffing with a third of the butter, turkey sausage, and more celery than usual. I also added carrots to it. Bob picked out a slice of pie at the store, and I did not have to make one. Avoidance of my former favorite foods, kept me on track. Christmas was pretty much the same. I cooked a small turkey, and made the side dishes healthier than in the past. I also continued to eat from small plates, and weighed or measured everything. UNPLANNED GALL BLADDER REMOVAL CRISIS Something was wrong. The Sunday after Thanksgiving, something was very wrong. I woke up feeling painfully full. It felt as though I had eaten two more bites of food than I should have. Problem was, I had not eaten. I woke up feeling like this. I was hungry, but knew if I ate anything I’d throw it all up. I was barely able to take my medications. Bob was dealing with the flu, and I thought perhaps I was getting it as well. I didn’t eat anything on Sunday. Monday, I went to work—business as usual. I was still in pain, still felt “full,” and did not want to take the chance of eating. I came home from work and went straight to bed. Tuesday was a repeat of Monday. Got up, felt like crap, didn’t eat, and went to work. While at work, the pain got a whole lot worse. I broke down and called the 24-hour consulting nurse service provided by my HMO. I started to tell the nurse about my symptoms. I mentioned having had gastric bypass and was immediately transferred to the surgical clinic. It was faster than telling the ER triage nurse that you’re having chest pains. The bariatric nurse manager spoke with my surgeon. It was agreed that I would drive to GHC’s Bellevue facility, have a CT scan of my gut, and then get squeezed into a meeting with the surgeon. Everything went well except meeting with the doc. I arrived at the facility by 11:30am. The CT scan was completed by 12:30pm. I got to see the surgeon at 5:00pm. Yeah, just a little bit of a wait. I had many thoughts about what was wrong—from stomach flu to the outlet of my pouch sealing itself shut—the BSSG facilitator had told of many issues she had, so naturally I shortened her list and determined that I was dying. There’s never any in between for nurses! I sat in the waiting room for over four hours. At least I had my Kindle to keep me entertained. How many games of Montana or Scorpion solitaire can you play in four hours? I lost count after twenty apiece. Finally, I was taken to an exam room. Dr. Landers arrived, asked me where it hurt, pushed exactly where it hurt, and told me the CT scan showed an inflamed gall bladder which was significant in that the scan wasn’t even focused on the gall bladder. Whew! I wasn’t freaking out over something minor. There was actually a reason that I felt so crappy. The literature reports that something like twenty to thirty percent of gastric bypass patients end up with gall stones. Thus I had been put on a medication to prevent that after surgery. Guess what? It didn’t work. The doc said we could treat it conservatively with antibiotics and pain meds. It was 8:00pm by the time I got home. I was exhausted. By Friday of that week, I was still sick as a dog. The doc and I exchanged voice mails. It was decided that I would get my gall bladder removed that afternoon. I called Bob, so he could drive me home after the surgery. I arranged to park my car in the office parking lot overnight. I was ready for the trip to Bellevue. As I waited for Bob to drive up from Tacoma, Dr. Landers called and said he could not do the surgery as we planned—my protime/INR was too high. Those lab tests are a measure of the blood’s ability to clot. Since I have a pacemaker, I take the medication Coumadin to prevent any blood clots related to the functioning of the pacemaker. While the levels were good for preventing clots, it was too high to risk surgery without having blood available. Dr. Landers suggested that we plan to spend quality time with my gall bladder on the following Monday. I was told not to take my Coumadin over the week-end and have the labs repeated on Monday morning. He would have some blood typed and cross-matched in the event I bled too much. I didn’t go back to work on Friday. I drove home. I had to tell Bob that he had driven up to the office from home for nothing. He was not too happy. My gall bladder and I parted ways on Monday, December 5, 2011. I was glad that the surgeon who yanked my gall bladder was the same one who had rearranged my GI tract. I didn’t want another doctor getting lost and taking a right in Albuquerque when he should have gone left. Dr. Landers did tell me that when he did my bypass, he had scoped out my gall bladder and it looked fine. Since I had never had issues with my gall bladder prior to bypass, he did not remove it. Lucky for me! The doc wrote me a note to be off of work for two weeks. Hell, I planned to go back by Wednesday. Wednesday came, did I give work another thought? Oh hell no! This surgery was worse for me than the bypass. I had my post-op the following week and asked the PA if I could go back to work earlier than the doctor ordered. She told me “No. If he wanted you back to work after only a week, he would have excused you for a week. You have had two major surgeries in three months. Your body needs time to heal. Take it. Take off every minute you can!” I thought no more about work until I returned on December 19, 2011. After gall bladder surgery and recovery from it, life returned to business as usual. I continued to lose weight. I continued to have contact with my nutritionist. I changed sizes so much, I could not keep track of it. I donated seven trash bags of clothes to Goodwill® in November. When I shop for clothes, I do have to try things on. I am amazed when I try on something that didn’t fit a week ago and have it fit today. As I said when I started this story, I don’t make resolutions for the New Year. I needed to reflect on the past year and acknowledge the positive changes I made in my life. I need to continue this story of my journey. I want to know where the road will take me. WHAT’S NEXT? WILL I SUCCEED? WHAT WILL SUCCESS LOOK LIKE? Here it is, 2012. Actually, it is Monday, February 27, 2012. Don’t ask me why this keeps coming up on the 27th. Today, I weigh 125 pounds less than I did on March 14, 2011. I wear size 14. My BMI is 29.0. My bra size decreased by six inches and went from a DD to a C. (That’s all I’ll say about that.) I can no longer shop at Catherine’s. (I really never did, but now I absolutely cannot.) I bought some clothes this month that should get me through the summer. I have ‘skinny’ jeans that I’m not afraid to wear. I bought some blouses that are large—not extra-large, 2-X or 3-X. I am amazed. I have had to reel back my shopping trips and clothing expenditures—the real world has reared its head and I have had to purchase a washing machine—the jury is out on whether or not a dishwasher is needed. In January, I signed up to do the Susan G. Komen 3-day Walk for the Cure. The Seattle walk is going to be on September 14-16, 2012. It starts one day after my one year WLS anniversary date. I am looking forward to training in earnest for this event in March. How many years have I thought about wanting to do this, but knew I was too fat to even consider it? Yeah, I know about the political crap that happened this year, but I need to demonstrate to myself that I am able to commit to something and follow through with it. They’ve restarted funding Planned Parenthood’s breast cancer screening program and the right-wing Vice-President resigned. That’s good enough for me. Bob still thinks I should not have had the surgery. Bob started drinking again in December. He says he is done drinking after a trip to the ER during a black-out last week. I weigh nearly 100 pounds less than he does. That has been a major role reversal. He used to say I needed to lose weight so I could ride on the back of a motorcycle with him. I never wanted to ride, and now, he can’t. I want to help him learn the skills necessary for weight loss, but he is not ready. The dynamics have changed somewhat, but he still insists on telling me I have been sleeping around, and cheating. I haven’t, but the truth is immaterial to him. I mentioned there are changes I need to make in my life that I have put off, that would most assuredly improve my outlook and attitude—maybe this will be the year. Have I achieved my weight loss goal? When will I consider myself to have been successful? Is a size number or a weight proof of success? Is this where I get philosophical and blather on indefinitely? I hope not. I have described the first twelve months of my journey. I’m on a journey that won’t end until I do. I have scheduled a photo shoot for March 18, 2012. It will be my one year anniversary of this miraculous journey. I need to express my thanks and admiration I have for my FB friends and my co-workers in their support of my decision to have bariatric surgery. Even one or two who were sure that surgery was too radical and risky, have been supportive of my weight loss mile stones. It has meant the world to me. I had let my co-workers in on my decision early on. They listened to me fret over whether or not to go through with it. They listened to my bitching when the date was moved. They were extremely thoughtful at Christmas by giving me a poinsettia and other non-edible items when they brought in sweets. I have received compliments from women in the office that I didn’t even know they knew who I was. I have been blessed with family members who supported my decision. I was wise enough to avoid those who did not support my decision. While this has been my journey, I have not made the trip alone. I made the decision early on in the process to let my family, friends, and co-worker know what I was contemplating. It is purely a personal decision and you choose what is right for your situation. I do not regret my choice. My mother and sister, KB, have been two of my staunchest supporters. My sister is starting her own journey. I have met people on this journey who went before me and I learn from them. I have met people on this road who are coming behind me and I try to light the way. I would never push someone down the road I’ve taken. I would never dissuade anyone from this course of action. I do tell folks to research, research, and research until their computer keys are worn out. After researching until you’re sick of it, research some more. Gather people in your circle who are supportive of your decision. Cultivate new friends if need be. Avail yourselves to any and all tools available. Good Luck and God Bless as we travel the roads we lay down for ourselves. Catch y’all next year!

What was (is) the worst thing about being overweight?

I hated shopping for clothes.

If you have had weight loss surgery already, what things do you most enjoy doing now that you weren't able to do before?

Shopping, walking, bicycling.