Thursday, December 22, 2011

Yes, Bariatric Betty, there is a Santa Claus...

***If you missed my last post, I found out yesterday that my primary care doctor didn't have a record of my weight in 2008 or 2009 because I had started declining being weighed.  Just because I was too proud to let other people see how much I weighed, I might not be able to satisfy my insurance company's requirements to be approved for the surgery.

First of all I must thank you for all of your thoughts and prayers.  They worked, and I got the information I needed today.  My husband had the wonderful idea of my trying to reach my old OB/Gyn to see if they had a weight for me in 2009.  I have been trying to reach them all day.  The nurses have been tied up (there must be a lot of pregnant women in labor today is all I can figure!) because I have been on hold for over 20 minutes twice before hanging up.  Both the medical record persons line and administrator's line went straight to voicemail.  On the latter's voicemail I started begging for them to just call me and tell me if they could just let me know if I had let them weigh me when I came in for my annual pap smear. 

Five minutes ago, the medical record person called me back and said I did indeed get weighed in December of 2009 - and (Thank you, God) my weight put me in at a BMI over 40.  She's faxing the info to Hospital C today.  All of the sudden, I feel like a boulder has been lifted off my shoulders.  I will be saying extra prayers of thanks tonight, and that includes to all of you who have been so supportive in your words, thoughts, and prayers. 

Great lesson learned - being too proud will cost you.  Maybe not now, but eventually.  Be honest with yourself and others, and take what's coming, it's the only way you will keep moving forward.

Wednesday, December 21, 2011

Bariatric Betty's pride goes before a fall...

So, today I reached my 90th day of supervised dieting.  Hurray!  I've lost almost 20 pounds and I'm very proud of myself.  I emailed my patient care coordinator at Hospital C to make sure she had received the records she needed from my primary care doctor from 2008 and 2009.  She wrote back and said she received a packet, but it only had records from 1998-2004.  This was a big problem, because I need multiple years of weight history showing my morbid obesity for insurance pre-approval of partial payment of my bariatric surgery. 

So I got ticked that my past doctor's office could have screwed up my request so badly.  I wrote out specifically what I needed on the record release request.  I calmed down enough to call them and explained that there seemed to have been a mistake.  The woman at first agreed and then pulled my file.  Turns out there was no mistake, except my own.

I remembered going through a phase where I declined to get weighed because I was so embarassed with my weight.  Apparently, that phase was from 2004-2009, because all of of my visits during then don't have weight recorded.  So now because I was too embarrassed back then I might not have enough documentation to be approved my my insurance company.  I have data from my doctors from 2011, late 2010, and then 2004 and earlier. 

This afternoon I was able to get a copy of my record sent electronically from my old weight watcher's location in Central Ohio.  That gave me a starting weight in 1/2008 and an ending weight in 11/2008.  During that entire 10 months I lost just over 20 pounds.  Versus the last 90 days when I've lost just under 20.  I hope my earnest trying helps.  But now I'm really worried that since we don't have data from 2009, I may have shot myself in my foot.  What if my reluctance to face my weight in 2009 results in my not being approved for surgery?

There's nothing to do about it, but pray and wait.  My P.A. that is coordinating my multidisciplenary diet will be writing up his summary and putting together the packet next week.  Then the hospital will submit and we will wait.  And pray.  And try to remember that things will happen the way they should, even if I don't get approved. 

So here's my advice of the day.  Don't decline to be weighed, or have tests done.  Because you can't predit what will be needed in the future.  I never thought I would be looking at having this surgery, and now look what happened.  Pass it on. 

Tuesday, December 6, 2011

Day 75 and Bariatric Betty has a bumpy ride

So today I've been on my medically monitored diet for 75 days.  Depending on whose scale you're using, I've lost between 13.5 - 19 pounds.  When I met with Drew, the P.A. supervising my diet, he was pleased to see that I had lost 6 pounds in just the last four weeks.  Plus, he was really excited about my latest test results.  My Hemaglobin A1C has gone from 6.8 (really good for a diabetic) to 6.4 (GREAT for a diabetic) in the last three months and my insulin doses have been cut in half.  Then, he said - the next step is that you're going to go off your Novolog (insulin I take with my meals) altogether ."  I'm already down to 3 units with meals.  The next comment was "6.4, that's barely diabetic."  Ouch.  I said I was lucky that my insurance company wasn't making me diet for 6 months, or I might have a hard time qualifying.  He said "Well, for now you're still on three medications, and still diabetic..."  Whew.  No more labs before my case is submitted to the insurance company, and I will consider my self lucky.

A couple of days ago I got an email from my trainer.  She's left her job, and is no longer working as a trainer, but following her other love - photography.  As much as I'd like to be happy for her, she hasn't written up a summary of our work together, so I'm scrambling to print emails that I hadn't deleted yet and a couple comments she made while following my training on  My three month diet only satisfies the insurance company requirements if there is documentation of consults (at least three), behavioral modification sessions, nutritionist sessions (at least three), psych eval, and working with a trainer.  It specifically says "work with trainer may not be entirely remote (i.e. - online)".  And what I have proof of is from online.  My PA says that he talked to her before she left and is aware that we met in person once, and that he will write it up.  Just to be sure I'm covered, though, I'm meeting with another trainer this Friday.  He works at the same gym - I asked if he had access to her stuff or if I should bring copies of the program she designed.  He said "Oh, please bring it" - just like I thought, she left nothing....  

Oh, and if for some reason the insurance company doesn't think I've satisfied their requirements, I can continue to diet and have consults for three more months - but at that point I probably won't qualify because my diabetes would probably be diet controlled and have a BMI under 40. 

On a totally different note, I feel very blessed today.  Yesterday my father in law called.  He had gone to his doctor about pain in one leg and was sent to the hospital to get an ultrasound immediately, because the doctor suspected a blood clot.  He's 87 and in marvelous health for his age - very active and health conscious.  We just lost my mother in law this summer, and the thought of the chance of losing him so soon after was just crushing.  I sent a message out to my friends on facebook asking for prayers and was touched by how many responded so quickly.  Two hours later we found out that the ultrasound showed it WASN'T a blood clot after all!  So he still has to find out why it hurts, and we're a little worried about that - but the chance of a stroke has been pushed far down the list and we're so grateful for that. 

I have to remind myself each day; I have great faith in God.  I believe that God will see me through my journey in the best way.  I think that will include weight loss surgery, but maybe God knows something better.  I will keep reminding myself of this while I go through the last couple weeks of my supervised diet and the weeks waiting for the insurance company to make their decision. 

Tuesday, November 29, 2011

Bariatric Betty is happy to still be diabetic, but faces a sad reality.

Today I went for my 3 month check-up with my primary care doctor.  She hadn't seen me since I started the medically supervised diet (this is day 67 of 90).  She was thrilled with how I'm doing.  She agreed that I was right to lower my nighttime (long-acting) insulin when my morning numbers hit the 70's.  According to her scale I was 17 pounds lighter than 3 months ago!  I love her scale.  But, it lies.  I weighed myself three times at home before the 9:30 appointment this morning.  Once before I ate of drank anything and I was still in my pajamas.  Once after I drank 12 oz. of water and 12 oz. of diet coke (I will miss you, caffeine) and scrambled egg beaters with whole wheat bread.  And a third time after I was fully dressed.  Either her scale is off or I lost three pounds during the 1/2 hour drive to her office.  My scale is weighs me 1.5 pounds lighter than the one at the bariatric surgeon's office.  I'm not normally one to weigh myself numerous times in a day - just was wondering how much my weight fluctuated between eating / dressing/ etc. 

Anyway, she was really proud of me, and said she couldn't imagine how the insurance company would turn me down as a surgical candidate.  From her lips to God's ears!  I stayed and waited to hear my Hemaglobin A1C number... 6.4!  That is wonderful in many ways - first, it's the lowest it's ever been since I've been a diabetic.  Second,  while it shows my diabetes is marvelously controlled, it also shows I am still definitely considered a diabetic.  If it was under 6, my insulin would have been reduced (possibly discontinued) and then the question of my qualifying with the insurance company would have come into play.  Since I now have  a BMI under 40, I need to have at least one co-morbidity to qualify.  Diabetes is my only one.  Now I'm breathing easier, because my last set of labs before sumbission for approval from the insurance company show I'm still diabetic as well as compliant.  Yay!!!

Last night I got to go to my second local support group meeting.  It was just as fascinating as the first time.  Bunches of new people to meet, each with their own story.  Two women had lap-bands and one just a revision to the vertical gastric sleeve 6 weeks ago.  The other had hers a year ago and hasn't lost much weight or noticed it helping. Everyone was very encouraging and positive with her, suggesting that she talk to her new doctor about running some tests to see if the band is functioning.  One woman was a "lightweight" (BMI under 40) like me 15 months ago but has lost 90 pounds!  Another accidentally got pregnant just two months after her surgery.  Whoa.  Not recommended, but she and the baby are both fine.  She lost all the weight (including not gaining any during the pregnancy) she wanted to, and shared some great recipes with us.  She also recommended a latte machine at Bed Bath & Beyond for $30 - she said it reheats and reblends the latte during the day, and has a great recipie book with it that included a mocha latter with egg whites (it heats it enough that there's no samonela risk).  If I liked chocolate or coffee I would have been all over that.   Another woman who had just had plastic surgery to remove excess skin (and looked FABULOUS) and shared this recipe:
Kate'a Frozen Protein Treat
2 cups skim milk
1/2 cup greek yogurt
3 scoops unflavored whey protein powder
6 packets of splenda (or other sweetner)
1 1/2 cups of frozed strawberries

Blend and then pour in a sealable container and freeze.  She eats it as a high protein snack and said it's super.  THAT one I'm trying for sure.

On the topic of recipes, I came to a realization.  I may not be able to handle baking next year.  This may sound funny, but it's a huge tradition in my family.  We decorate our christmas trees with gingerbread, have a new year's eve cookie party for our kids and their friends, and after 3 years of practice I've finally gotten down the art of slovenian potica (a nut roll) making.  I'm very good at controlling my consumption of baked goods - it's before the baking that I am tempted.  Licking fingers and taste testing can sabotage a diet.  I've found a good way to handle it is to have other members of the family join me in the baking and to chew gum while I do it.  That works well for this year, but next year chewing gum will be a no-no (too much air being swallowed and the possibility of gum blocking my stoma) so I'm considering things like wearing a mouth guard, sucking on sugar free mints, etc.  Several of the members of the support group last night said that they can bake for their families without temptation now, so that gives me hope.  However, I have realized that if I find myself tempted, it would be better to give up this part of my identity than foil my brain re-training next year.  So I'll try; with company, mints, and mouthguards.  But if I taste one thing, that's it.  No more baking.  It's not worth ruining my tool.  And my friends and family would rather I was around than a plate of cookies.

For now I'm hopeful.  Hopeful I will qualify for surgery.  Hopeful I will make healthy choices and succeed.  Hopeful that I'm setting up good habits and supports that will help me in my new life.  And just having had Thanksgiving, I'm thankful that I not only have such a supportive family but that I found a way to work through all of this by blogging.  My thanks to you for reading.

Monday, November 21, 2011

2/3 of the way there and things are changing... maybe too much

Today is day 60 out of 90.  I've stayed adherant to my diet and exercise plan, and been under my calorie goal every day except for one (my sweet neighbor brought over delicious, warm, homemade rosemary bread - I am human!).  Depending on the scale and time of day, I have lost between 11 and 14.5 pounds, and my BMI may be as low as 39!  Coming down from 42, that's awesome. 

Here's a weird thing - my insurance wouldn't pay anything towards my RNY if I went below a BMI of 40 if I wasn't diabetic.  So in this strange case, being diabetic is a good thing.  My next change - wait for it - my diabetes is improving.  Yup.  I've been lighter than this weight before (right after I was diagnosed with diabetes 17 months ago) and my blood sugar was out of control.  About two weeks ago I had a morning fasting blood glucose level under 100.  That was only perhaps maybe the 4th time it's been that good.  Then this last week, every reading has been in the 80s.  This morning, at 7:30 am my level was 78.  That was actually a little scary, because I wasn't symptomatic for hypoglycemia, and I don't normally take my levels or eat that early in the morning.  They both usually happen an hour later.  This morning, if I had waited another hour, I could have had my blood sugar levels crashing. 

So my levels have been stable since then, and tonight I'm going to take less long acting insulin (10 units instead of 15).  I see my doctor and get labwork in 7 days, and with Thanksgiving this week, I don't think I could get in any sooner.  She and I had discussed adjusting my insulin if my numbers were low, so I feel comfortable with doing this change now.  Here's what I'm not comfortable with...

What if I am no longer considered diabetic in the next 30 days???  

On one hand - it's a wonderful possibility.  It's the major reason I wanted the surgery - to not be diabetic any more or have to worry about those co-morbidities.  I would live longer, be healthier, etc.  There's no reason I couldn't keep on my current diet. 

On the other hand, if I'm not diabetic, my insurance will no longer approve the surgery.  As it is, I will already have to pay about $5000 for the surgery.  Paying the whole $22,000 is not a possibility right now.  So I could have done all of this work for 90 days just to disqualify myself. 

Why do I need the surgery if I'm losing weight so well now?  Because I've always been successful at losing 20-30 pounds over 6 months or so.  It's when it gets to 9 months and out and I'm still not losing any more weight.  I get frustrated, and feel like being on the diet isn't worth it if I'm still obese with all the co-morbidities that come with it.  I have stopped dieting, and eventually gained it back. 

Having been through that cycle several times on my own, with Nutrisystem, and with Weight Watchers, I just don't know how I could handle it if it happened again.  I really want the tool of my new stomach - with a tiny appetite (at least in my honeymoon period) so I can train myself for my relationship with food for the rest of my life.  I want to dump if I eat too much carbs - to me the RNY is like implanting antabuse in an alcoholic; if you eat (or drink) the wrong thing you get sick, so you reinforce good behavior.   I want my pancreas to start making more insulin the day of the surgery.  I want the reset button to get pushed on my stomach so I know what it feels like to feel full (and not WANT to feel full). 

Well, I won't know what's going to happen until it does.  And just because I'm lowering my insulin dose doesn't mean I'll be off it soon, or off the glucofage.  So I shouldn't worry.  But it's like a little itch saying "what if..." in the back of my head.  On the positive side - being stressed raises blood sugar, so maybe just stressing about my lower levels will be enough to keep me diabetic for sure?  It's a twisted world we live in, and with insurance requirements it's no reason we all go a little crazy.  And right now I'm queen of Looney Land. 

Wednesday, November 9, 2011

Bariatric Betty has an anniversary, an appointment and a dream.

One year ago on November 3rd, my family moved from Central Ohio to the Cleveland area.  The overwhelming reason was to be closer to family.  My in-laws were elderly and my mother-in-law was declining rapidly.  Both they and my parents lived within an hour of Cleveland, and my brother lived 15 minutes away from the suburb that had the best public schools in the state.  Moving was very difficult (not the least of which was selling our house), but we made it.  My husband's job situation turned out to be less than ideal, so about 6 months ago he took a pay cut and now works in a better, more friendly environment.  His mother died this summer, but at least we got to see her a lot more of her for her last 6 months, and now we talk to and see his father much more than we would have been able to do from Columbus.  The kids were definitely traumatized by moving in the middle of the school year.  Going from being around places and friends they had known since birth to a brand new everything was very hard, and they struggled the last spring and summer.  Now their report cards are glowing and they have made new friends, but they still miss their old ones.  I miss my old friends too, but I feel like I'm in a healthier mental state here.  I know I had the easiest time with the move of the whole family, but I don't know if I would have pushed for the move if I knew how hard it would be on everybody.  This one year anniversary in our new home felt like a freeing experience, being able to look back and say "whew, we made it through THAT", but it's still not easy.  Worth it, but not easy.

I had my second appointment with the PA who is supervising my diet yesterday.  According to his scale I've lost 9 pounds (aha! my adjust-for-the-lying-scale plan worked!) and he was pleased looking over my food and exercise logs.  I'm halfway through the 90 days, and going to see him again in a month.  Now to keep up the progress - through Thanksgiving, which presents many challenges to those of us dieting... And the newest twist on my vegetarian, some keeping kosher, me on a diet challenged menu - my brother is dealing with a pre-ulcerous condition so he needs low acid (no tomato products) and low fat items.  Well, he's always been easy going - it's his turn to make things a little complicated ;)

Now for the funny part.  This is the dream I had last night (no psych degree needed for interpretation):  I was driving from Columbus to Cleveland to meet the rest of the family that was waiting for me there.  I had the last load of things from our old house in my car.  As I go through a small town I stop for a drink and see really ominous clouds rolling in.  I asked the owners of the town general store if I could go in their basement.  The first wave of the storm passes over, causes a power outage but otherwise, not bad.  I decide to make a break for my car and head home.  As I'm pulling away from the general store, a tornado takes the top half of the store off  and then flattens several other buildings before it dissappears.  I drove back to see if I could help anyone in the store and end up pulling several of them out.  I leave them with some of the supplies I had in my car including coupons for a free meal at McDonald's - but not my nuts because I knew that I had to have protein soon.  I got back in the car and drove towards my family knowing I was blessed to have a safe family and home to go towards.

Like I said, my dreams are pretty straightforward.  Combining the leaving our old home with leaving my old unhealthy lifestyle, trying to hide and be safe in what turned out to be a dangerous place (hiding from the risk of more sexual harrasment and assault under obesity) but leaving it behind to go where I could really be safe and happy...and trying to help a few people get out from their collapsed building too - that's pretty much me.  I'm pretty happy this morning, because I feel like pyschologically I'm pretty healthy now.  I've got my focus on the future, and I'm letting go off the bad habits of my past.  I'm moving closer emotionally with my family, and now I really will feel safer because my health won't be endangered and I'm strong enough to move obstacles (apparently including fallen beams in a dream house) if neccessary. 

I wish I could bottle this feeling for the hard days.

Sunday, November 6, 2011

Bariatric Betty is halfway there in pre-op land

45 days down, 45 days to go.  I started my medically-monitored diet October 22nd, and have been adhering to it since - the diet, the exercise, the psych qualification, etc.  45 days in and I'm either 8 pounds or 11 pounds lighter (see earlier post on my lying scale).  Either way, I've lost a size.  My neighbors could see a difference in the first few weeks (I think when I was mostly increasing tone), and I have gotten several compliments.  Mostly I enjoy the fact that I can wear my jeans again (and without the waistband hurting 2 hours later), and my shirts are loser around my belly and arms. 

I had a morbid period where I couldn't stop thinking about "what if" - you know, the 1% mortality stats with the surgery.  I know that my remaining diabetic and obese is riskier than the surgery, and I've had laproscopic surgery three times before (ovarian cysts and gallbladder) and never had problems.  But that didn't prevent me from thinking about it a lot.  I've started letters to my husband and kids.  I've asked my brother to be there for them - maybe even co-parenting with my husband for a while.  I've even thought about recording a message to Ty Pennington at Extreme Home Makeover asking him to build a house for my brother and nephew next to ours in the case of my death. 

Mostly the morbid thoughts are over now.  I'm really excited to be halfway through the qualification period.  It hasn't been too hard.  My BMI has gone down 1.5 (or 2, see again lying scale) and I'm meeting with my nutrionist and the PA monitoring my diet this week.  Now when I worry, it's about the insurance.  What if they say I'm not approved after I've gone through all of this?  I know I would appeal, and I would keep trying, but I also know it would crush me. 

I planned a family weekend at a huge indoor waterpark approximately 1-2 weeks before I anticipate having surgery.  The date wasn't my choice - it's a fundraiser for our school district.  But I feel like it's nice to have something right before my body changes forever.  Something where I can spend a lot of time with my family, making memories for all of us.  And we'll have this AMAZING suite with a kitchen - so I'm going to be able to bring all the food (or liquid) that I'll be eating then and make sure I'm compliant the whole time.  In a perverse twist - it will also give me plenty of "before" pictures of me in a swimsuit to choose from ;)

Speaking of before pictures, I had my loving hubby take a couple of me, and I'm attaching them here.  At a suggestion of a WLS friend, I took them in front of a doorway, and I will take follow-up ones there as well, that way I can see more and more doorway around me. 

Wednesday, October 26, 2011

Bariatric Betty gets the blahs & considers Dolly Parton's wardrobe choices

No energy.  No drive.  I hate days like this.  I feel like I just ran a marathon or something yesterday and my body is recovering.  No such thing - I just walked the dog and mowed the lawn.  Today I forced myself to walk the dog for 20 minutes, ran a couple loads of laundry, and picked up a few things from the grocery store, but can't stop thinking about what I haven't done.  No strength training, no elliptical, no cleaning. 

Earlier this week I was doing great - I got to go to my first local WLS support group meeting and met several wonderful women.  They were super excited for me, and I loved having that jaw-dropping sensation of seeing their before pictures and then looking at them now.  They had good advice, and asked me all about myself and my plans.  It's hard to have a bad time when you have a room of women all wanting to get to know you.  I felt like I was going through sorority rush again :) 

I also took advantage of our Budget Bin sale - our suburb's PTA groups organize essentially a big community garage sale.  Most of it is consignment where the donors get half of the money back, and the other half goes to scholarships for graduating seniors.  On the last day of the sale they have Bag Day.  I paid $15 for three bags full of clothes.  About a third of them were potentially for me - pants in descending sizes (I'm currently an 18, so I bought 16s, 14s, 12s, and even two 10s).  I also got several tops and sweaters from Apartment 9, Jones New York, and Liz Claiborne (LOVE her).  Those I just got in Larges (I currently wear 2xl so that is a big difference).   Luckily, the support group ladies warned me that I will get cold (I am NEVER cold now) and that I will need things like sweaters.  I also got a Liz Claiborne coat.  Not bad for $5! 

It has been so long since I bought nice clothes.  It really struck me as I looked at the labels - I have been living in Target and Walmart's plus sections for the last couple years.  I've never been a fashionista, but these past couple years I just gave up.  You just can't FIND many beautiful clothes in plus sizes.  It's frustrating.  I would love to have flattering clothing.  With a style.  With structure.  Instead I end up wearing t-shirts and jeans, t-shirts and shorts, or (gasp) t-shirts and yoga/ workout pants.  Some department stores sell plus size clothing that looks OK on a plus size manequin, but when you try it on you realize it looked good on the manequin because the dummy has a flat stomach and is still only a size 12. 

Then I started thinking about what I will wear when I enter One-derland (under 200 lbs).  When I'm normal sized.  It started to be fun, until I remembered what it was like trying to find clothing when I was "normal" sized for a year by starving myself as a teenager.  At 115 pounds I was still a size 10 on the bottom, and a 14 on the top.  I have a hard time believing that I will get any smaller than that (although some of my new support group think I will).  But I remember trying to find clothing that was big enough on top and fit on the bottom that didn't make me look like a hooker.... it wasn't easy.  At one point my mom suggested I write Dolly Parton to ask where she gets her clothing.  NOT KIDDING.  Nobody in my family likes country music, or a lot of bling (remember the tie-dyed onesie?) - but that was the best my mom could come up with when we were looking for a prom dress.  Or when she told me that I shouldn't buy the sporty bikini "until I lost a few more pounds and firmed up my tummy".  

Well, those memories will always be there (and painful), but the thing I have to remember is that I'm not getting the surgery to fit into nice clothes.  And that even if I had the body for it, I wouldn't EVER wear a bikini in public at 41.  I'm doing it so I will no longer be diabetic.  So I will be healthy and live for a long time to watch my kids grow up into wonderful men like their father.  So I will energy to work and play more and enjoy life so much more.  I will now re-read this paragraph three times to fix it in my head...

The myth of the perfect body is just that.  I see and hear beautiful women stressing about parts of their body all the time.  Some women are larger on bottom.  Some are top heavy like myself.  Some have it equally distributed but no chest.  Some have broad shoulders.   The fact is that those airbrushed photos and body doubles in movies are toxic to people with poor body images.  Just this week I saw a tiny woman worrying about a little muffin top that you could barely see - and only when she sat down.  Um, everyone has a little something when they sit down - even models.  But to her, this is a very real concern.  She is dealing with having trouble getting a comfortable fit in clothing, and after losing over a hundred pounds she has a right to want to look good to herself.  Please God, let me accept myself and be pleased with how I look a year from now.  Even if I have batwings, deflated breasts and am not yet at goal.  I will keep my before pictures.  I will keep some of my before clothing.  I will remember where I have come from and say "I am in a better place."

I'm continuing to lose 1- 11/2 pounds a week, and MOST days I'm pretty active as well as adhering to the diet.    I'll shake of the blahs off tomorrow and be back to my normal positive self.  I hope I have less of these days when I am healthier.  Of course, I also hope by then I won't need medications for my depression any more - but I'll take that until a doctor tells me to stop.  Having a blah day is one thing, having non-functional days are another. 

Friday, October 21, 2011

Bariatric Betty sells her past and her deals with her lying scale

In my former life, I was very active with my sorority.  Many who know me find this amusing, because I was raised by liberal/ hippie parents (brought home from the hospital in a tie-died onesie, no less) and tend to agree with liberals in general.  I also tend to dress super casual and wear little to no makeup on most days.  But it's true.  I love my sorority - Phi Mu - and have served it in many ways over the years.  When I was in college I found that the stereotypes of sororities were false; the women were intelligent, down to earth, and willing to live by stricter rules than the rest of the college students while donating their time and money to local children's hospitals.  What's not to love?  After I graduated I traveled for a year representing the sorority as a chapter consultant.  I supervised and reported on dozens of collegiate chapters and advised them on risk management, recruitment, scholarship, and philanthropy among other things.  Was I skinny?  No.  I was overweight, but nicely put together and with the attitude that I could make a difference in women's lives.  And I did - it was fabulous.  After my term was up, I decided to serve in a different way (I missed having my own home during a 100% travel position).  I was appointed the National Music Chair, which I LOVED.  I have always sung, and apparently word spread of my teaching women to sing while I traveled.  I attended local and national conferences, created choir programs and directed performances.  Later I served for years as a local officer, supervising collegiate chapters (mostly from afar) but still attending conferences and conventions.  As a result I have accumulated a LARGE wardrobe of suits, semiformal, and formal dresses over the years.  Not only because of the number of teas, balls, and conference sessions I have attended, but because of my fluctuating sizes. 

I ended up resigning as an officer of the sorority mostly because of the overwhelming needs of my special needs son at the time.  But I have to be honest, part of it was because of my weight.  I had less and less energy, and dressing up was getting more and more difficult.  Trying to find semi-formal and formal dresses as a 5'2" size 22 was difficult.  Forget attractive, it was just finding things that fit and didn't break my bank account.  So the dresses and suits have gathered dust for the last 5-6 years in my closet.  I donated some of them when I moved about a year ago.  The rest I hung onto for sentimental reasons, and because I thought - someday I might need them. 

No more.  When our local PTAs held their fall community garage sale, I purged my closet.  50% of everything sold goes back to the consigners, and the rest goes to PTA scholarships for graduating seniors.  Best of all, anything not purchased is donated.  So many plus size women will be getting some new outfits - maybe for job interviews, maybe for nights out or weddings.  Mostly, it's me letting go of what was.  I would like to volunteer for my sorority again, and when I weigh less I will have more energy to do so - plus have more fun getting dressed up for parts of it.  I only kept two dresses and one suit.  All are smaller sizes than I current wear, and ones that I actually felt pretty in when I wore them.  6 months after surgery I'll get rid of them too, or take them to the tailor.  The day before surgery I will be donating 90% of my "fat clothes" - only keeping enough to wear for the first month.  And meanwhile I'm buying smaller pants in assorted signs at the same sale - an idea I got from one of the WLS support groups on facebook.  They suggested getting some at garage sales since I will be changing sizes so quickly - you don't want to invest much until you stabilize.  I'm letting go of my obese past - and using the money I get for clothes for my healthy future.

My lying scale.  Ughh.  I look forward to stepping onto my scale every morning.  Nothing in my stomach, I've used the bathroom, I'm only wearing pjs.  This is the lightest I will be all day.  I usually weigh myself and then step back on holding my shoes (which are 1 1/2 pounds).  Here's the thing, when I was weighed at the doctor's office I didn't have my shoes on but it was 5pm.  And it said I weighed 5 more pounds than I did that morning WITH shoes.  Phbbbblltttt.  That's harsh.  I know that you are always heavier later in the day, but ouch.  So I don't trust my scale, even though it is pretty new.  I add 2 pounds onto the weight I get in the morning with my shoes before I record it in log, because I don't want to have a bad surprise when I go back to the surgeon's office.  And I don't want them to look at my log and say "Hmmmm, you say you lost x pounds, but you also say you weight 5 pounds less than you do."  OK, would they do that?  I doubt it.  But it's my insecurity talking.  So I call my scale a liar, add two pounds before logging my weight, and just feel happy when  the number goes down.  And when my clothes fit better.  And when I get a complement.  :)

Lastly, I had to do a drawing project with my kids.  No matter how well I thought I had explained the operation to them, they kept thinking I would come home from the hospital skinny.  I wish!  So we traced my torso on posterboard, and then I drew in all the relevant internal organs.  I showed them the incisions that would be made, and how my Roux-en-Y bypass would rearrange things.  Then I said "When I come home, this outside line tracing my body will still be the same.  The surgery will not take fat away.  The outline will get smaller as I diet after surgery - the surgery just helps me not feel so hungry and lose weight faster."  Then they said "So, in a couple weeks you'll be skinnier".  Uhhhh, no.  "In a couple weeks I'll weigh less but still be obese.  In a couple months I won't be obese, I'll just be overweight., and in a couple of years I should be really healthy."  We'll see if the info sticks this time.  And I'm keeping the posterboard - because 6 months after surgery I want them to trace me again with a different color marker - so I can see how far I've come!

Saturday, October 15, 2011

Bariatric Betty meets with her surgeon, babbles, and bakes

Whew!  This last week was super busy, and the biggest best news was that I had my first appointment with my surgeon on Thursday.  Unfortunately, he was delayed by surgery, but that's fine with me - I would want him to take his time if it was me on the table!  That's how he keeps his complication rates so low.  Anyway, I got to chat with some other women who were waiting for their first appointments in the waiting room, so it was a win-win. 

He was incredibly friendly, open, and gave me as much time as I wanted to talk about the procedure and answer questions for me.  He says that he think that the RNY (rous-en-Y) gastric bypass is a great choice for me, and that just by the questions I asked he's sure I'm going to do well.  I was so nervous until he said that (like my systolic BP was 35 higher than normal, nervous).  He laughed and said they do that to everyone!  I was so worried that there would be something that made him think I was a poor candidate!!!  I was also worried about my blood sugar during and after the operation.  I've had some hypoglycemic episodes, and even though I know I will likely not be diabetic within a couple of days of surgery I'm really worried about them (or god forbid diabetic coma).  He reassured me that they will be monitoring my blood sugar during surgery, and will keep it slightly high rather than risk it going too low.  If I am on insulin at the end of the surgery then I will recover in ICU so that it is being checked constantly.  If not, then his partner that handles the inpatient care will continue to monitor and adjust my meds as needed until discharge.  I feel so reassured.  Here's the funny part - I asked when I should come back, and he said - as soon as your insurance approves you!  I don't need to see him again until after my 90 day diet is completed, the packet is submitted to my insurance, and they call me to set up the surgery date and pre-op tests! 

I have to give thanks for all my friends and family supporting me, but I especially want to thank my non-bariatric friends.  I have become self-obsessed with this.  I'm thinking about the surgery almost constantly - am I following the supervised diet well, did I do my exercises yet for the day, try not drinking while eating...  And my conversations include advice and stories from my dietician, trainer, psych, and even fellow bariatric patients and veterans.  My family is even taste-testing the Nectar protein powders with me.  My friends are learning more than they ever wanted to know about weight loss surgery, and I can't thank them enough for listening to me.  I promise I will try to remember to talk about other things and remember to ask about YOUR lives more. I was just visiting in Central Ohio for a few hours yesterday and was so grateful that I had the chance to talk to some of my friends who are so supportive.   Even knowing that others are reading this blog gives me a sense of a whole global community supporting me.  Who knew that I would have readers in 5 countries????

Now, for those who have not known me for long, there is something I need to tell you.  I bake.  A lot.  I love the act of baking - it appeals to the chemistry major in me.  Creating fun and delicious things that people enjoy.  I love sharing them - most of my long time friends are used to receiving cookie platters for Christmas and Hanukkah.  I even make some rocking gluten free cookies good for celiacs and during Passover.  It makes my day to hear that people enjoy my cookies, and it makes my year when a child asks "When are we getting your cookies again?"  Yesterday I saw a boy I haven't seen for over a year and as he ran by he stopped, pointed at me and said "LOVE your cookies!" and then took off again.  It's also quite a family tradition.  Growing up we always decorated our christmas tree with cookies, and now I put gingerbread on ours.  On new years even we invite friends, family, and kids from my children's classes to come and have a cookie party.  I have even been indoctrinated into the sacred order of Poticia makers (slovenian nut rolls).  Using family recipies is so much fun - and sometimes humorous; "You must use butter.  If you don't want to use butter, please do not make poticia.  If you use margarine the angry ghost of old slovenian women will haunt you!"  Did you know that you have to roll out the dough thin enough that you can see the print from a table cloth through it?  Paper thin.  What a sense of accomplishment when after 24 hours of work they come out well! 

So how am I going to balance diet and baking?  It's actually not impossible.  I start baking things for the holiday now and then put them in a downstair freezer.  I have baked while on Nutrisystem and Weightwatchers, and usually chewing gum while I'm baking is all I needed to get through it.  Then I let myself try a small piece of something when it's done (and count it in my food diary/ balancing it with exercise).  Next year I won't be able to have that small taste - but it will be SO WORTH IT.  And I won't be bringing any platters to my support group - sorry but I don't want to sabotage anyone!  In a couple of years when I'm at goal, maintaining, and not in danger of craving too much, I'll let myself have a bite or two.  If I'm not feeling full :)  I can't wait to feel full!

Tuesday, October 11, 2011

Bariatric Betty becomes a better juggler

Moms are used to multi-tasking.  It's our life. And often we give up things we enjoy to be the family taxi driver, playdate arranger, tutor, soccer and football coach.  Many give up social time with friends.  But being obese, I gave that up long ago.  I just don't have the energy to "go out with the girls" after a long day.  After walking the dog, exercising, doing dishes, laundry, and meals I am exhausted.  The house is always a mess.  I try to tackle the kitchen floors one day, the dining room table another, but it's tiring and as soon as I'm done it starts getting messy again.  I volunteer with the PTA, and try to meet a friend or my husband for lunch occasionally.  Going to evening soccer practice or football games the kids are in is something I make a priority, but otherwise I will often choose to stay at home. 

I know that I've given up more than social time over the years - I've given up time that I should have been getting healthier.  Some of that time I spent eating the non-healthy foods that helped get me here.  Some I spent sleeping to make up for interrupted sleep at night.  Some I spent taking my son to OT, PT, and speech therapy appointments.  Some of that needed to happen.  Some didn't. 

So now I need to use all that time I didn't use, but there's no savings account that has kept it for me.  Yesterday I met with my trainer for the first time who came up with a great strength training program to add to my cardio and will be documenting my exercise program for the insurance company.  Last night I missed a football game of my son's so I could use the elliptical and do dishes.  Tonight I'll take him to another football game while my husband takes my other son to his soccer practice.  Tomorrow I have my first pre-op educational class at Hospital C, which starts at 5:30pm.  My husband is already taking off work early on Thursday so I can make my 4pm appointment with the surgeon (yay!) and his team.  So I called in a favor with a friend who will pick up one son after school and take him to his Wednesday 4-5 kickball and then back to her house.  I'll get my other son to my husband's work at five and go to the class from there, and my husband will pick up my other son on the way home.  Friday, the day after the pre-op educational class, the kids are off school and we are all traveling back to Central Ohio for part of the day so my husband can have his rheumatology appointment and the kids can visit old friends. 

Did you actually read all that?  Just typing it makes me feel dizzy.  Busy.  Busy busy busy.  I feel like my life is one of those garbage bags that those garbage back they advertise that you can just keep stuffing more stuff in because it will STRETCH.  And my life WILL stretch, because I will make it. 

So now I need to work in 1/2 hour of strength training three days a week.  That actually shouldn't be too bad.  It's the appointments that throw me for a loop - traveling all over town to check in with different specialists. 

However, this is bringing up guilt (how can I miss my son's game and just stay home?) and concern (when and how will I be able to eat dinner before the game so that I don't crash blood-sugar wise?).  And I think about what it is going to be like around surgery time, with more appointments, going in for labs, x-rays, and then the hospital stay and recovery.  My mom has offerred to come over to help for a few days, which is wonderful - but three days is about our limit.  We love each other to death, but both of us being strong willed with different styles starts to grate on her nerves and she starts missing my dad too much. 

I've decided that I'm going to have to get some structure set up a couple weeks before surgery so that things don't start getting derailed by everyday needs when I'm gone or not yet functional.  First of all - the boys will need to start making their own breakfast.  They can do it, it HAS happened before.  Yet somehow every morning they expect it to be made for them.  On the weekend when I really try to encourage them to do it they often say "It's ok, I'll just wait until you have time."  Time for them to put their big boy pants on.  At 8 and 11 they are perfectly capable of using the toaster or the microwave, and pouring something in bowls and glasses.  They are going to have to help with laundry - one load a day is needed to keep up with our family of four.  One of them can gather and start the laundry, and the other can flip it and bring it back up.  I should be able to fold.  And if I take it slow I should be able to get dinner together.  My husband will have to shoulder taxi duty for a while, and get the kid's lunches made for about a week. 

I have to keep telling myself that this is all worth it.  Because if I don't get rid of the diabetes and obesity, I won't be around  for the long haul with any of them.  I need to do this for me - but I also want to do it for them.  Missing some moments now should help me be able to have years more with them later.  Having others help me with chores and other things now will be paid back in spades when I have energy to do more when I've lost weight.  My family is supportive.  I know my husband will do anything he can to make sure this surgery happens - he has seen me have laproscopic surgery for ovarian cysts and my gall bladder before, so he's not even that worried about it.  He knows this is going to be so good for me.  But when the kids start whining, or complaining, I'm going to have to be strong and remember.  Stretch.  Ask for help.  It is worth it.  Keep juggling, don't give up.  And get started on that Saturn halloween costume!

Sunday, October 9, 2011

Bariatric Betty gets shrunk

Well, this week I took my MMPI.  I told one of my friends before hand that I hope it didn't show that I was any crazier than I already knew I am! That was no joke - with my depression and PTSD, I don't expect a totally clean report.  I did joke with her that I was hoping my other 15 personalities kept quiet enough for me to focus on the test.  She said if they spoke up, just promise them a donut to keep quiet.  I love having a friend who's already had bariatric surgery.  She can say something like that and I KNOW that she is totally behind me. 

Before I started the test, my designated psychologist for the insurance documentation collected my co-pay.  He told me to take my time, and I assumed it would take about 2 hours.  Instead, 1 hour and 567 true and false questions later I was done.  If any of you have not yet taken the MMPI, it's alternatingly funny and sad.  It has statements like "I believe that spirits and/or demons control me" immediately followed by "I would like to be a singer".  Several times I read questions that made me wonder.  For instance when comparing "I would enjoy covering the theater as a journalist" and "I would enjoy covering sports as a journalist", what exactly are they differentiating?  Is there a condition that excludes theater appreciation?  Or is sports counter-indicative of another? 

When they ask "I sometimes lie to others" - don't you feel like it's a trap?  Who hasn't told at least a white lie to spare someone's feelings?  So you answer yes.  Unless you are a pathologically liar, in which case you would answer no.  Unless you are also an attention seeker - which I would imagine most pathological liars are - so you would answer yes. 

Here's what I think.  I think they should add two more questions. First, "I spent time thinking about possible reasons for different responses to these questions while taking this test".  Then, "I skipped at least one question accidentally and had to go back and correct my answers".  Hmmmmm, maybe my results will indicate I'm borderline obsessive compulsive? 

When I finished, the psychologist said "OK, so it will take me a couple weeks to write up a report, and then I'll send it to Diane at Hospital C".  Fine.  So I asked "When should I come back?" and he looked at me blankly for a moment before saying "Well, you don't have to.  Unless you want to come back?"  Huh.  I guess this guy is not part of my new lifetime commitment to a bariatric program - luckily Hospital C has their own that I can consult with forever if needed, I guess.  I ended up telling him that maybe after he reviewed the results if he felt that there was anything that would be useful for me to know from the results he could let me know and I would make an appointment.  No wonder he collects the co-pays up front - he doesn't think he's going to see you again! 

I also discovered something wonderful this past week.  Facebook has private groups for weight loss surgery patients and veterans.  Some of these veterans have over 10 years and hundreds of pounds lost under ther belt!  So I joined two lists and can ask other questions without all of my friends seeing them.  I also found several other blogs of current and past bariatric patients that I really enjoy.  Seeing the pictures of before and after is just amazing.  It inspires me to see that so many have taken this tool and used it to change their lives so completely. 

I have told several friends about my plans to have bariatric surgery, but I still feel hesitant to make it common knowledge.  It's hard enough to discuss it with friends who don't understand the committment involved, let alone having people I haven't seen since high school or relatives that I have nothing in common with question me.  They can ask when they see me in a few years and wonder why I look so good! 

This week should be fun!  I have my first meeting with my physical trainer, my first pre-op support group/ education session, and my first meeting with my surgeon and his team!!!  I guess I'm a little excited - too many exclamation marks :)

Wednesday, October 5, 2011

Bariatric Betty looks at Sticks and Stones

...but names will never hurt me.  Right.  I am confident that every person on this planet has been teased, tormented, or verbally abused at some point or another.  And we all know it hurts. 

Being overweight seems to attract insults like a magnet.  Somehow our society thinks it's acceptable to laugh at someones weight,and some even call them names to their faces.  I have always hated the train of thought that says people need to develop thicker skin, or take it as encouragement to make a change in their lives.  Yes, there is definitely something positive about being able to assimilate into society and it's standards.  But why is it so hard to accept someone overweight? 

I think that many people continue to think that people are fat because they are lazy.  Or stupid.  That we don't know that eating too much and exercising too little makes us fat - or that we don't care.  Don't they understand that nobody WANTS to be fat?  That all of us have dieted.  We have all lost weight.  And most of us have gained it back.  Plus more.  That many of us would remain overweight if we even ate just the 1800 calories in the USDA recommendations.  In the case of those of us looking at bariatric surgery, we will be committing ourselves to eating under 1000 calories for 1-2 years.  And even later, we will probably not eat more than 1300 calories for the rest of our lives.  That doesn't seem so simple, does it?

I think what really bothers me is that people make judgements about others without having a clue about them.  Do they know that you've been exercising every day for the last month?   Or that you are losing a pound every week?  Or that you are going to have surgery to try and have success for the first time in your life by sacrificing your diet, your time, your money, and addressing your deepest issues.  No, they make assumptions based on your appearance that you are less worthy of their respect and kindness.

This reminds me of a story I read a long time ago.  Paraphrasing to the best of my memory:  It was about a man riding home on the train or bus.  Some kids were running loose; screaming, laughing, and falling into other passengers.  Through it all, he notices that the father is sitting there, doing nothing about their poor behavior.  Eventually the father catches the upset look and quietly says "I'm so sorry, I know I should tell them to sit down and be quiet.  But you see, we've spent the whole day at the hospital with their mother.  She's dying.  And after they were quiet all day with her, I just don't have it in me to be mad at them and tell them to be quiet again."  I've always remembered that story - that we DON'T know the story behind other people.  What they gone through.  What they are going through right now. 

Instead of being viewing fat people as funny, disgusting, or sad - think of them as brave.  Every step they take uses more energy than a healthy person's step.  They have frequently gone to work or bed hungry even with food in the house, in hopes they could be healthier the next day.  Their brain has different reactions to even images or descriptions of food - behaving much like an addict's brain when it is on drugs.  Those of  us who have considered or gotten weight loss surgery like a gastric bypass have risked our lives with major surgery to get healthy.  Most of us would probably consider brain surgery if it could cure obesity. 

Instead, look at us and somewhere inside you, think "Good Luck". 

And if that doesn't make sense, think of it this way.  Most of the adults in the U.S. are at least overweight now, and unfortunately more are gaining weight all the time.  Hope it won't include you and your loved ones.  Or that one of us doesn't sit on you ;)

Saturday, October 1, 2011

Bariatric Betty gets down to business

OK, 1 week into my 90 day medically supervised diet, and I may have lost 1.6 pounds.  I say may, because my weight does tend to fluctuate a pound or so daily, so it might be less (I decided to lose my lowest reading).  The has been pretty easy to use, although unfortunately it doesn't give my "friends" a blow by blow of what I've eaten, it just says how much I've exercised and if my day was over or under my calorie goal.  But, it did let me print out a very detailed report of everything.  So far I've been under each day, but I'm only on day 8 :) 

Yesterday I had my first appointment with my psychologist and the nutritionist for the medically supervised diet.  Both seem to have a good sense of humor - that helps.  I go back to the psychologist for my MMPI eval next Friday (about 600 true or false questions to make sure I'm not crazier than we already know).  I'm going to see the nutritionist in about another month.  Her only suggestion was to keep an eye on my morning carbs with my breakfast - I guess I haven't been superconsistant - somedays I have twenty-something with breakfast and others I have fifty something.  I hadn't realized I was in the twenty-somethings, and as a diabetic that's not good - it can lead to me bottoming out.  Otherwise she thought everything looked good. 

I joined a weight-loss surgery support group on line through facebook, and it has been very positive.  There are people just starting their journey like me, and others are post surgery (and sometimes 10 + years out).  Everyone is very supportive (shocking, I know, for a support-group) and works hard to keep everyone pointed in the right direction.  I also got two books - EAT IT UP on Kindle and Weight Loss Surgery - Finding the Hidden Person Inside of You.  I've gotten through the first two chapters in Eat It Up, mostly because it's easy to access on my Kindle, but the other is written by the moderator of the support group, so I'm looking forward to hearing her advice as well. 

The only thing left to get started on is my trainer/ exercise physiologist.  My husband is hooking me up with someone through work and he's been off the last two days, so it's been delayed. 

I volunteered at my kids' Fall Fest at the elementary school last night.  It was a lot of fun and I was the caller for bingo.  I got to stand behind a podium and had a lot of fun, but it wasn't perfect.  After about 30 minutes of standing I started to "glisten" as my southern friends would call it.  In the midwest we would say "perspire" or just "sweat".  Not doing any work at all, or feeling tired, but just standing up for a half an hour is apparently a small workout for my body.  How sad.  It wasn't the first time I've noticed that, and it's very embarassing.  Sometimes if other's notice I say "oh, pardon me, my diabetes makes me perspire a little extra" or something like that (which isn't a total lie).  But the truth of it is, I just don't want them to realized that holding my weight vertically for a half and hour starts to make me sweaty.  I'm really looking forward to that being over when I lose the weight.  It doesn't even make sense to me - when I walk 40 minutes with the dog I sweat but I'm not even breathing hard when I get home.  My body shouldn't heat up just from standing, but I guess standing while holding 100 in extra weight will do that. 

Not for long...

Monday, September 26, 2011

Bariatric Betty Looks Back

Why am I obese?  That is a loaded question, and it's one that every obese person has asked themselves over time.  We all have different reasons.  Part of it is genetics, we know that some people have genes that make them prone to obesity - but it doesn't guarantee that they are going to be obese.  The rest is choices they make and that are made for them. 

I was born a normal weight (about 7 pounds) to wonderful parents who have always struggled with their weight, but they've never been obese like me.  As a newborn, my mom's doctor told her that "a fat baby was a healthy baby" and told her to feed me until I stopped and then try to get me to eat again.  So I doubt my body has ever understood satiety and feeling full.  From then on, I was always a big kid, but not obese.

My parents were very health conscious so we didn't eat fried food, or things with heavy sauces, or anything like that.  In fact, as a young child my parents had me believing that raisins were "candy" and graham crackers were "cookies" except at the holidays.  Unfortunately (or fortunately to me at the time), my babysitter didn't understand the drill and introduced me to our corner drugstore and gave me a quarter to pick out any candy I wanted.  The sugar that was just a ten minute walk from my house!  I couldn't go back to not knowing, and my parents had to deal with what became a constant craving.  When I was in elementary school I walked to school with some friends.  Being an early riser I often got to my friends house before they were ready to go, and one time they were still eating their breakfast of sugared ceral.  SUGARED CEREAL!  The mom kindly asked if I would like some, and after being raised on Cheerios and Raisin Bran I jumped at the chance.  Soon I was getting to their house extra early every day and eating a SECOND breakfast, unbeknownst to my mom.  Eventually the mom called my mom to ask why I wasn't eating breakfast at home and my plan was foiled. 

However, I found other opportunities to get forbidden food - joining the girl scouts meant we bought all the food for campouts as a troop - sugared cereals, poptarts, marshmellows...  It wasn't the only reason I was in girl scouts, but it was probably a reason I stayed in so long (until high school). 

In high school I started buying candy on the way to or from school.  My favorite mints were at a bakery on the way.  When I needed money, I started selling blowpops at school that I bought in bulk, and that gave me more spending money.  I hated being overweight, but when my parents would cut back on what I could eat at home, it just made me want to get it somewhere else. 

In my sophomore year I reached a point where I was disgusted by my weight.  Looking back I don't think I looked that bad - after all, being 30-40 pounds overweight now seems like small change, but as a teenager it was brutal dealing with teasing, exclusion, etc.  I had my group of friends, but I wanted to be accepted by more kids.  I knew I wasn't healthy and I wanted to do something about it.  So, I announced to my family that I was going to start eating healthy and asked them to support me.  I made all my own meals, packed my own lunch, and could recite the calorie content of anything.  I started exercising at a gym several times a week in addition to walking and biking to/ from school.  No junk food.  No desserts.  No candy.  The weight started to come off.  Then I plateaued.  So I ate less.  Exercised more.  More weight came off.  About 6 months in I had lost about 35 pounds, but I wasn't losing any more.  So I started skipping meals.  I would tell my parents I had already eaten.  Or I had eaten a big lunch.  I lost more weight.  But eventually I started getting dizzy and feeling like I was going to pass out.  After a few days of that feeling something clicked.  I had started this to get healthy, and if I was getting dizzy from not eating, maybe this isn't healthy any more???  I asked my mom to make an appointment with my pediatrician so I could talk to him about eating healthier and make sure I was getting enough nutrients with blood tests. 

I ended up gaining about 10 pounds back and stabilizing for a little while.  But, there was a big change going on OUTSIDE me.  I was getting a lot of attention from guys.  Being naturally endowed, I now wore a 32DD bra, and guys noticed.  A lot.  Some of the attention was rude, some flattering.  I had my first real job in the kitchen of a restaurant, and one of the guys there was pretty cute, and he seemed to be flirting with me.  That was new to me, so I wasn't sure. 

Then one day at work I had to run down to the downstair cooler - a room that is basically a giant refridgerator.  I noticed from the outside that the door was slightly ajar, but that the light was off.  I thought how lucky it was that I had come down here now - the whole cooler of food could have spoiled.  I went inside closing the door behind me and turned to flip on the light.  Suddenly I was tackled.  Someone was grabbing me, groping me, pressing me against the wall.  It was the boy I thought was cute, but this was NOT flirting.  It was an attempted rape.  He had heard me anounce I was going down to the cooler and waited in there with the lights off to force himself on me.  I fought back, found the door, and ran upstairs.  In the main restaurant, nothing had changed.  Nobody had noticed anything.  How was that possible?  Confused, upset, and totally overwhelmed I explained I was sick and rode my bike home. 

I didn't tell my parents.  I was so overwhelmed - had I invited this attack?  I didn't think so, but my appearance sure attracted a lot of attention those days.  I wasn't wearing revealing clothing or anything, but just walking around with a chest that big makes some guys think you're sexy.  I didn't want my parents to overreact.  I couldn't handle any more drama.  I imagined my parents dragging me to the police station.  I imagined the boy saying that it hadn't happened, that he had just flirted with me.  I imagined my parents crying.  I kept it inside, but it found ways to come out.  When boys at school paid attention to me, I freaked.  Sometimes I ran away.  My friends we worried about me, and I confided in them.  They tried to support me the best they could.  They went everywhere with me so I wouldn't feel scared of being alone and getting trapped by someone.  They made excuses for me when I freaked out at a perfectly normal boy.  I had PTSD, but I wasn't diagnosed for another 10 years. 

I gained about 20 pounds in college, but wasn't obese.  I traveled as a sorority consultant for a year and LOVED it, but I missed being by friends and having a real home.  At the end of my contract I found a job in Central Ohio that let me move into an apartment not far from some friends and started working as a clinical trial coordinator and gained a little more weight - I bought all my own food and made unhealthy choices.  That's where I met my husband - he was an outpatient pharmacist and he was the one handing out the study drugs for my study.  Then I went into hospital management.  Soon afterword, I was put in charge of opening up a new satellite for the hospital.  Unfortunately, the doctor I worked with the most was frequently more interested in going golfing than hanging around the office if there weren't any appointments - which made handling walk-in appointments tricky.  Then he started doing what I considered "playing cardiologist".  He started doing stress tests and running holter monitor studies on patients.  This seemed odd because most of these patients seemed very healthy.  Then I started hearing him tell patients "if anybody asks, tell them you had chest pain" and my mental alarm went off.  I told my supervisor and she arranged a "secret" meeting when the office was closed where we made copies of all the charts that we could find of his patients that were having these tests run and then she forwarded them on to the hospital administration so they could investigate the potential fraud. 

Meanwhile, my boss also asked me to start letting them know each time the doctor left the office.  They were trying to gather information that would be used to counsel him, and I thought that was great.  Unfortunately, I put myself in the position of reporting on someone over whom I had NO AUTHORITY.  Here's a clue, if something like that happens to you, say no.  After it became apparent to him that I was "narcing"on his unscheduled absences he confronted me, in his office, with the door closed.  He didn't even know about the copied charts and potential fraud charges.  As he yelled at me, and implied that he was going to do something awful if this continued, my PTSD kicked in.

I finally went to a shrink.  I was diagnosed with PTSD and depression.  I started gaining more weight.  At my husband's urging I found another job. We had been trying to get pregnant for a year and finally did but I had a miscarriage.  That was horrible, but my husband was wonderfully supportive.  When we got pregnant again, I carried the baby to full term and only gained 1 pound!  It seemed a lot easier to eat healthier serving sizes when the baby was depending on me (and having it squish my stomach probably helped too).  A few years later and I had my second son, again only gaining 11 pounds.  Both boys were big (almost 9 and 10 pounds, 23 inches each) but no gestational diabetes or anything.  My weight after both pregnancies was lower than it was before I got pregnant.

When my youngest son was 18 months I could tell something was wrong.  We started getting evaluations for his regressing and delayed speech.  Eventually he was diagnosed with Apraxia - a motor planning disorder that affected his speech, eating, gross motor, and fine motor.  We spent the next 6 years with aggressive speech therapy, 3 years of PT, 2 years of OT and special needs pre-school.  By the time he was in elementary school the school district decided that he no longer qualified for school services, but he was still getting them privately.  I was his cheerleader, his taxi driver, his advocate, and his grizzly mama.  I did not take care of myself.  I ate too much, and I ate unhealthy - which contrary to popular thought is perfectly easy to do even when you're vegetarian. 

During that time I tried to lose weight with nutrisystem.  Then with weight watchers.  Then we began trying to sell our home so we could move back to Cleveland to be closer to all our family and my stress level contributed to me eating more.  I was hospitalized with the onset of diabetes.  I started religiously following the diabetes diet plans and got my blood sugar under control, but now I've been obese for over 10 years. 

Some choices were made for me.  I made more choices myself.  Being heavier used to make me feel safer in some ways, but now I know that it will kill me.  There is nothing safe about being obese.  In Cleveland I feel closer to family, loved by my husband and sons, and ready to take control of my health. 

Saturday, September 24, 2011

Bariatric Betty's 90 days begins!

I had my first appointment with Drew, a P.A. who has worked with many patients who are planning for bariatric surgery.  He seems to be very knowledgable about everything that I need to do to prepare - both for myself and the insurance company's certification process. 

1) I need to see him 3 more times in the next 90 days or so.
2) I need to keep a food and exercise diary - he suggested and it seems to be pretty user friendly.  Best of all, I can invite my support team to be my "friends" and then they can see how I'm doing each day.
3) I need to see a nutritionist 3 times in the next 90 days to become better educated about how to eat healthy now and after surgery.
4) I need to see a psychologist three times in the next 90 days to help him evaluate me as a candidate for the surgery and help prepare me emotionally for my life post-surgery.
5) I need to work with an exercise physiologist/ trainer who can document my progress with her over the next 90 days, meeting with her at least three times.

At the end of that, he will assemble a packet of everyone's consults and reports plus printouts of my food and exercise diary and send it to Hospital C which will add their parts and send it to my insurance company for pre-certification approval.  Then they can schedule my surgery! 

I'm thinking about sharing this blog with the support team, but I'll probably wait until I know them better :)

I have my first nutrionist and psych appointments in 6 days.  My first surgical consult is in 3 weeks.  My husband is getting me a membership to the gym at his work - Drew knows a trainer there who he said is great at documenting everything we need.  Step by step...

On a positive note, even though I've only lost a couple of pounds, I have been getting complements from people who say that I'm looking like I've lost weight.  It's mostly just improved muscle tone, but I still enjoy the complements!

Friday, September 23, 2011

Bariatric Betty gets the call, just in time.

First, a warning, there is a rant coming...
A lot of things happened this week, starting this weekend.  I took the family to a local apple orchard where we got to pick our own apples.  It was a beautiful sunny day, my waistline is smaller than it's been in a year thanks to my increased exercising and decreased after dinner snacks, and I felt great.  Most of the best apples were high up on the tree, so after sending my older son to climb up a couple of times, I left him on one tree and climbed another next to it.  My younger son was with me and I climbed up about three or four feet and started picking.  When I came down I was pretty pleased with myself until I saw my older son stomping towards me. 

It turned out he had overheard a family laughing at me, saying "I bet that branch is going to break with that fat lady on it".  He was trying hard to restrain himself from going and starting a fight.  My younger son looked like he wanted to cry.  The family had moved on, and I steered us into another part of the orchard.  It's not the first time my weight has been made fun of, but that hurt my kids.  Try explaining that some insecure people are going to always find something to make fun of other people about - and that it's not worth getting mad over.  Not a fun discussion.  I tried to make light of it by saying "at least next year there will be less of me for people to make fun of..."

Here's the truth.  I feel horrible.  My kids had to hear people laughing at me.  And it is those cruel people who are responsible for their pain.  But I have to take responsibility for being a target.  I know that I'm working on losing weight.  I know I don't deserve to be made fun of.  But I also know that there are ways that you attract the wrong sort of attention and if I had already lost the weight, they probably wouldn't have sad anything this weekend.  Of course, they might have made comments about my chest, or my clothes or anything else, but something about being overweight paints a neon target sign on people.  Don't they think I would be thin if it was easy?  I know that most thin people don't understand the difficulty of losing a signifigant amount of weight (and keeping it off) when you're obese.  That over 85% of us either don't succeed in the first place, or gain it back.  And some people think that having a gastric bypass is "the easy way" to lose weight.  They don't understand that I'll still be on a restricted diet for the REST OF MY LIFE.  That I will never be able to eat as many calories as a naturally thin person.  My body will not stay a healthy weight if I eat like they do. 

I read a quote from an actress recently that talked about how she easily lost weight for a role recently.  She said "you just have to want it enough, eat less, and exercise more".  She went from being skinny to being underweight for the role.  Does she realize that she gained the weight she lost back, too?  For her, that was healthy, but I'm sure she was relieved to stop feeling hungry.  I'm happy for people who can eat the proper amount of food and feel satisfied and stay a healthy weight.  But my brain doesn't work like theirs, my metabolism doesn't work like theirs, and I'm always tired because I'm carrying around 100 extra pounds.  It's not easy.  Don't people like that understand that we wouldn't subject ourselves to lifelong dieting and surgery if there was any other way that we had found to make it work???

So when I spoke to Diane, my Patient Advocate at Hospital C for the rest of my life, on Tuesday it couldn't have come at a better time.  She recommended that I see a P.A. (physician's assistant) at a health services center nearby because he does a fabulous job documenting medically supervised weight loss for the insurance company, I called and made an appointment.  I meet him later today.

I also returned the elliptical I bought at Walmart for $200.  It was wobbly and having problems with the LCD screen and starting to make louder thumping noises when I used it, so I got a full refund.  Luckily, I found a used Nordic Track elliptical for $150 through craigslist, and bought it.  So now I have a better elliptical that was more affordable and I am back on it daily!  90 days from now, I should be able to get pre-certified approval for the surgery from my insurance company.  I'm on track, and not looking back.

Sunday, September 18, 2011

Bariatric Betty and her BMI battle

Well, now that I know that I want to have my surgery at hospital C, I'm just waiting for the phone call from my assigned Personal Patient Advocate to start scheduling everything...

Meanwhile, I have been working on healthy changes at home.  It started out with a search for an elliptical at a bunch of garage sales.  That didn't pan out, but something else happened.  A neighbor offered me his Total Body Gym and treadmill for FREE.  I'm not a huge treadmill fan, and I think I'm lifting enough weight for the moment ;P but keeping my family, my future self, and the price in mind - I accepted.  Now I need to find some big strong guys who can help get it out of his basement into ours... (the current owner had a back injury/ surgery that prevents him from using, let alone moving them).  Then, after missing a great reconditioned elliptical at a Sears outlet by 1 hour, I decided to try out a bottom of the line basic model sold at Walmart for under $200.  My review - it works, as in it goes in an elliptical path and makes me sweat.  The console doesn't do great readouts (some of the numbers blink in and out of readability) but I can see how long I've been on it, and the resistance seems to work.  Given what I paid for it, I think that's pretty good.  I'm going to work on tightening the bolts to get rid of a thunking sound I hear every revolution.

So I've also cut down on snacking after dinner.  I used to have popcorn, or light fro-yo, or something after dinner.  Between our kids having their community sports gearing up and a concerted effort to distract myself most nights I'm not having dessert/ post dinner snacks.  I'm still walking at least a mile a day and now doing about 15 minutes a day on the elliptical (which sometimes says I have burned 144 calories doing it), and I have actually lost a few pounds in the last two weeks.  Now, my only concern is a strange one.  What if I lose enough weight that I'm no longer elligible for the surgery?

My BMI is 41, but in three more pounds lost it will be 40.  Currently I qualify for surgery by having a BMI over 40.  I will still qualify for surgery with a BMI 35-40 because of my co-morbidity of type II diabetes.  To drop under 35, I would need to lose 33 pounds from now.  Unlikely, but possibile.  Because I will be on a medically supervised diet for 90 days after my initial surgical consult, I should be continuing to lose weight.  I doubt I can lose 33 more pounds in that time period.  If I could, I wouldn't be considering this weight loss surgery.  The last time I lost 33 pounds it took me 5 months on a very restrictive nutrisystem diet.  So why am I worried?  I guess logically I'm not.  But it does seem strange that for some reason I wouldn't want to lose TOO much weight. 

The other part is that when I lose that much weight I haven't been successful at keeping it off.  I feel hungry all the time, and start thinking things like "why can everybody eat a piece of bread except me and I'm still obese?"  That's what I'm hoping will be taken care of by the surgery.  That I'll have a tool that lets me feel full - REALLY full, after eating just a small amount of bread, protein, vegetable, etc.  Then I won't want more.  A friend told me about a friend of theirs who had the surgery and for two years was religious about what they ate. After two years, he came into the breakroom and saw the every-present donuts and said "You know, I want a donut!"  So he cut a quarter of a donut off and ate it, smiled and said "OK, I'm full".  That's my dream.  Two years after surgery to be at a healthy weight, be able to have a couple bites of a dessert and say "OK, I'm done." 

Waiting for that phone call....

Thursday, September 15, 2011

Bariatric Betty sees the light!

Hospital C's info session was Tuesday.  That's the small catholic hospital that I decided to look at just because of the sticker shock from Hospitals A and B, as well as finding out that they have an excellent reputation for bariatric surgery. 

I am happy to say that I was blown away by Hospital C's presentation!  First, while I had heard that Hospital C was really the first hospital in the area to specialize in bariatric surgery, I had no idea how many they've done.  The surgeon who did the presentation at Hospital A talked about having done hundreds.  This surgeon talked about having done over 3,000!!!  He's going on 3,500.  Their complication rate is exceptionally low.  Their cost for the surgery is at least $16,000 LESS than the other hospitals.  And here was something that nearly made me cry.  They provide a 30-day "insurance" policy for complications from surgery.

What does that mean?  Well, if I had the surgery at Hospital A or B, and then had complications (infection, leaking, excessive bleeding requiring a transfusion, blood clots, etc), then I would be responsible for paying for all of the necessary treatment OUT OF POCKET, because I would already have used my maximum lifetime bariatric surgery benefit, and all complications would be tied to the surgery.  Now they all had lower rates of complications than the national averages, but it's hard not to worry about being the 1 in 100 who had something happen.  Add to that the worry of how much the bills could be (tens of thousands of dollars more) and you get a sense of a little invisible elephant that was sitting on my shoulders.  

At Hospital C, if you have an complications from surgery in the 30 days after the operation, you will be treated AT NO COST.  You won't be billed, your insurance won't be billed.  I hadn't even realized the stress I was feeling about the potential for those bills until it was taken away.  I felt like I had just won the lottery. 

What else impressed me?  The warmth and social aspect of the practice.  They talked about lifetime relationships between the patients and staff.  Having contact information for someone you can call if you have a question 10 years after surgery.  Having not only monthly support groups, but having guest speakers come in.  Having an online chat and website where patients can ask questions and support each other.  Having their annual holiday and summer get togethers with patients and families.  And then there was Graduation.

When you are at least one year post surgery and have been meeting your own goals, you are invited to attend the Graduation party along with your family.  Held in a beautiful hotel it's a evening where all the "graduates" are recognized for their hard work and success, and then everyone parties with a DJ and has fun.  The surgeon invited us all to attend this year's graduation just to be inspired.  Graduation is a an important step, but does not mean you have left the program - it just means that you have done what they told you to do and have begun your new life as a healthier happier person. 

One of the funnier moments of the evening was a question from an attendee who was worried because a friend of her's had experienced a drop in her sex drive after the surgery, and wanted to know if it was common.  In her words "because that is something that I've GOTTA know!"  After sharing a lot of good natured chuckles with the audience, we were reassured that he usually hears the opposite. 

I can't wait to get going.  My personal patient advocate will be calling me in the next week to start scheduling everything, and then my journey will finally start. 

Thursday, September 8, 2011

Bariatric Betty and Hospital B

Another week, another information session.  This time it was hospital B, the world-reknown hospital's bariatric center.  Most of the information was similar to what I heard at Hospital A's info session, but the resources given to us were very different.  We got a bound collection of information about the surgeries, possible risks, side effects, outcomes, pre-surgical instructions and diets, post surgical instructions and recipies and diets - basically a really good This-is-what-will-happen resource.  In addition, I got a card from them in the mail saying that I was considered a low risk patient, and only needed to provide them with recent labs, ekg and chest x-ray.  No sleep study required (like it was at hospital A), no stress test (implied that it was required at hospital A), etc.  I also got clued in on something to look for.  Bariatric Centers of Excellence is a national certification indicating high volume, good outcome, low complication rates.  Hospital B is proud to announce that they are one of only two hospitals in the area to be certified.  Hospital A is NOT the other one.  Surprisingly that honor goes to the small catholic hospital C.

Speaking of Hospital C, I also got an amazingly different quote for the cost of the surgery there.  They said that the average cost of the surgeon, facility, and everything except the anesthesia is $24,000!  That's right, at least $16,000 less than the other hospitals. 

That combined with the Bariatric Center of Excellence certification and everything else lead me to decide to cancel my appointment with the surgeon at Hospital A.  I'm considering contacting their patient advocate, PR department, and possibly someone else to make sure that they give accurate information to people who come to their information session from now on.  I spoke to one of their program coordinators yesterday and she still couldn't provide me with how much the average charge would be for the surgeon or anesthesiology.  She also came right out and said that they would only charge a self pay patient $20,000 instead of $40,000 for everything other than the surgeon and anesthesiology.  So if I had done my surgery there, I would have been paying approximately $11,000 and my insurance would have paid $15,000 out of the $40,000 and they would have gotten $7,000 more than with a self pay patient.  I understand the difficulty of self pay patients - we've had to pay out of pocket for speech therapy and other services for my son with special needs before, but why should an insured patient have to pay  $7000 more for the same service?  I was also told that their patients that work at Hospital A end up paying $17,000.  I would imagine that they would get the best deal possible, so I don't have a problem with the $3000 discrepancy between that and the self pay $20,000, but that means just because I have different insurance, they will get $9000 more paid out of my pocket than an employee. 

I contacted my insurance and they are trying to find the allowable amount for the surgery at hospital C, and I scheduled to attend an info session for hospital C next week.  Hospital A is history.  Hospital B and C are still in the running.  Who knew this would be so hard?

Tuesday, September 6, 2011

Bariatric Betty Bounces Back

So, after finding out that the operation would be at least twice what I was quoted in the information session I was upset.  Really upset.  I cried, swore, and felt exposed and raw.  Here I had gotten my courage up to do this life changing operation and it felt like I was the victim of a bait and switch attempt.  However, I am no victim.  I decided to call my insurance company and tell them what I was told - maybe they could explain it (they couldn't) and then I decided it was time to do some comparison shopping.  I have two other hospital systems as in-network on my insurance plan.  The well-respected teaching hospital let me down, but there was the world-reknown hospital and the smaller Catholic hospital to go check out.  Next up, world-reknown!

I checked out their bariatric center website online and it looked about what I've come to expect - although they offer a fourth surgery as well, where the stomach is folded in on itself and stitched shut.  I suspect that wouldn't reset the hormones to signal the pancreas to reverse diabetes, but I'll find out at the information session.  Yup, another information session.  But this time, I called the financial counselors before going to the info session.  Bariatric Betty has picked up a few things...

So, after having a hard time reaching the financial counselors via phone, I used their email and got a response almost immediately.  Hospital B said the average total cost of a gastric bypass is $40,000.  Ouch again.  But, this estimate included pre-surgery studies (sleep and ekg, labs, etc), the facility charges, plus the surgeon and the anesthesiologist!  I detailed all that out in my email requesting the info.  So hopefully, the pre-surgical expense part of that will be outside my $15,000 cap.  It feels a lot better knowing a total figure.  Here's the downside, and why it's important to talk to your insurance:

Hospital A estimates the cost to be $40,000, plus surgeon, plus anesthesiology (two unknowns they wouldn't estimate).  My insurance contracts with them at a 66% reimbursement allowable, which means that the hospital will accept $26,400 as payment in full.  Subtract the $15,000 cap and I would owe about $11,400 plus the surgeon and anesthesia. 

Hospital B estimates the total cost to be $40,000 (including the surgeon and anesthesia).  My insurance contracts with them at an 80% reimbursable allowable, which means that they will only accept $32,000 as payment in full.  Subtract $15,000 cap and I am left paying up to $17,000.  At least that estimate includes everything. 

I contacted Hospital A's bariatric center coordinator to tell her I was considering going elsewhere for my surgery and how upset I was about the discrepancy in the costs between their financial person and the information session.  She seemed genuinely surprised and concerned at the discrepancy as well and promised to get to the bottom of it.  She asked me for a few days to figure out what's going on before I make my decision, which I agreed to because it will take me longer than that anyway.  She said they will get back to me with the total amount I would pay for everything after talking to my insurance and the finance people. 

Meanwhile, I've got the information session for Hospital B tomorrow night.  The fun continues...

Sunday, September 4, 2011

Bariatric Betty gets sucker-punched

So a week after I went to the info session I was excited and cautiously starting to tell close friends and family.  Most were very supportive, others meant to be supportive but were frustrating i.e.:  "Are you going to be seeing a psychologist to address your real issues?"  Thanks.  Yes, I already see a therapist and will be consulting with a psychologist throughout this whole situation.  And how are YOUR issues being addressed?  OK, I didn't say the last part but I thought it. 

Then I got a call back from the bariatric center's financial counselor who dropped the bomb.  The cost of the surgery is $40,000.  What?  What happened to 20-30 K?  Nope, it's $40,000.  And that doesn't include the surgeon or anesthesiology.  So it could be 50 or 60K.  WTF?  I felt betrayed, duped, and ticked. 

Bariatric Betty and the Information Session

In August 2011 I signed up to attend a free Bariatric Center information session at a nationally respected local teaching hospital.  My husband came with me so he could learn more about the procedures and what my lifestyle would require post surgery. 

First impression: Wow, I think I might be in the best shape of all the people here.  At a BMI of 41, I was not expecting that.  Several are having labored breathing just walking to the conference hall.  Everyone is very welcoming and warm.  The center's coordinator starts things off and then hands the mike to the director (one of two surgeons for the center).  She's also very gentle and supportive- congratulating us all for having come to the session and knowing that we've all been through a lot to decide this is necessary to consider.  She details the three types of surgery they perform (gastric bypass, lap-band, and gastric sleeve) and their risks and average outcomes.  I quickly decide that I will be considering the gastric bypass when she says that they recommend it for type II diabetics, and that clinical trials show it "cures" most type II diabetics by making their pancreas start producing more insulin again, even before any weight is lost. 

The pre-surgical prep is extensive.  At least three months of medically supervised dieting checking in monthly at the center.  Meetings with the surgeon, nutritionist, psychologists, sleep studies, ekgs, labwork, x-rays.  I'm a bit surprised by the sleep study, as I rarely wake up during the night unless one of my kids is calling for me.  I ask if it's necessary, and they respond that over 85% of the patients they refer are diagnosed with sleep apnea.  Being a sound stomach sleeper and thinking of the mask and wires, I have reservations, especially thinking that this will be one more night/ morning that my hubby will have to handle the kids on his own.  He later tells me not to worry about it. 

Another person from the bariatric center talks to us about the financial process, and everybody hangs on her every word.  The surgeries range "from $20,000 to $30,000" and are "more expensive at the main location, less expensive here" (in the suburban center).  Ouch.  Still, I've already spoken to my insurance company and they say that they have a $15,000 lifetime cap, but at least it is a benefit.  Some insurance companies still don't cover it.  Having a BMI over 40, I qualify.  Having a co-morbidity of diabetes mean I would qualify  even if my BMI was 35-40.  This is good news, because with the pre-surgical diet, I might go down to 40. 

After surgery I will be in the hospital for 2-3 nights.  Initially I'll be on clear liquids, then full liquids, then soft foods.  By 6-8 weeks however, they need you to be eating regular food.  Since my stomach will now be the size of an egg, I will eat VERY LITTLE and feel full.  That's great, because I'm a volume eater.  I'll choose to eat 6 cups of popcorn than 16 pieces of skittles because I need to feel the fullness to be satisfied.  I will also have to learn not to drink while eating - I simply won't have room for the nutrients I need and liquid.  Also, the liquid could wash some of the food out of my stomach prematurely.  I'll need to sip water frequently through the day to stay hydrated.  Your food needs to be chewed 30 times before swallowing because it won't be in your stomach as long to be digested.  I try this later at home and find it's kind of gross feeling liquified food swishing around in your mouth, but I'll get used to it.  Here's one I didn't know about ahead of time.  No more soda-pop.  Really, not even diet?  I'm a lifetime diet pop drinker, and a caffeine addict in the morning (but I don't like coffee or tea).  Apparently carbonation is VERY uncomfortable in your new small stomach and they chuckle saying "everybody tries drinking it ONCE, but then swear never again".  Bummer.  Add weaning myself off caffeine to the pre-surgical list.  People who have the traditional gastric bypass are also prone to "dumping syndrome".  That means that most of us will be unable to eat sweet creamy temptations like ice cream or fudge without experiencing cramping, discomfort and diarrhea.  Yuck.  However, I agree with the surgeon - this is a positive behavior reinforcer.  I shouldn't be eating that stuff anyway in my new stomach.  It reminds me of the medicine that alcoholics can take to make them sick if they have alcohol. 

I will need to exercise regularly and I'm actually looking forward to that.  I already walk 1-2 miles a day with my dog (usually the one to be honest), but if I have more energy then I can do more exercise.  Swimming laps used to be so relaxing, but now after 6 laps I'm too tired.  To be able to have the energy to bike when the kids ask me...  and being a good role model for my kids means a lot.  They've inherited the low tone chunky body type, but that doesn't mean they have to become obese like me. 

The average patient loses 60 - 80% of their excess weight after 12 months, and at 5 years, 85% have kept it off.  LOVE THAT.  While curing my diabetes is my first goal, I would love to be a healthier weight, have more energy, fit into non-plus size clothes.  When I was a teenager I dieted (and eventually starved myself) until I got to 112 pounds.  Unfortunately, my naturally endowed bust didn't shrink at all, and I felt I ended up looking a stripper with breast implants. Even though I wore a size 8 in pants, I wore a 14-16 top. I stopped starving myself and kept eating healthy for a couple years and settled into a weight between 125-135.  That felt ideal.  At this point, I would be really happy to get down to 160.  When I was 26 I was swimming with a master's club twice a week and was a strong 160. 

My husband's impression:  This is more about the work you do after the surgery than the surgery.  Yup.  He thinks it sound like something I could really do well at, and so do I.
I'll have monthly support meetings and checkups at 1, 3, and 6 weeks, 3 months, 6 months, and 12 months.  I'm excited!

*A word about dieting.  Other than the crazy cut-out-everything-with-sugar-and-fat I did as a teenager, I have dieted with weight watchers and nutrisystem.  Nutrisystem helped me lose over 30 pounds (15% of my body weight) which felt great, but as a vegetarian after 6 months of eating the same food EVERY DAY and not losing any more weight it just didn't seem worth it.  Weight Watchers was better for me in many ways, but I lost 23 pounds after 9 months, and was exercising a lot just to earn points so I could eat enough food to feel full.  Sounds good, but unless you plan on biking 6 miles a day for the rest of your life, it isn't sustainable.  When winter hit and biking was out, I had to cut my points/ food back and still wasn't losing any more weight.  So the idea of feeling hungry, eating a restrictive diet and STILL being morbidly obese just didn't feel worth it either.  The idea of not being hungry, not being diabetic, and not being obese but with a very restrictive diet seems TOTALLY worth it.