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.

Saturday, September 3, 2011

Bariatric Betty's Big Adventure

Over forty, Type 2 diabetic, BMI 41.  Doesn't sound like a description of me, but it seems to be the most important information everyone is asking me now.  I would have said spunky, supportive, lively and creative mom.  But since I was diagnosed with diabetes over a year ago, it has played a huge part in my life.  When I was diagnosed my Hemaglobin A1C was 13.4 - that's a three month measurement of your blood sugar, and normal is 7.0 or lower.  I was a pretty sick girl.  I listened, learned, read, and came up with my plan to get my blood sugar under control.  And now 14 months later my HgA1C is 6.8!  Great, right?  My doctors sure think so, and I've worked hard to get it there, but it's not enough.  My weight has gone up (common with the diabetic medication I'm taking) and that makes my blood sugar highs and lows more erratic.  So while I'm good at keeping them from getting too high, I occasionally "bottom out".  Most of the time that means I get very tired, sweaty, and irritable.  If it's a bad one I also get shaky, confused, and feel all over awful.   The lighter version happens once or twice a week.  Usually after a lot of physical activity or about 2 hours after I get majorly stressed.  Stress elevates blood sugar all on it's own - and the first thing diabetics learn is that the higher yours goes up, the further it's going to go down. 

So after being overweight most of my life, I'm considering bariatric surgery.  Because apparently you can reverse Type II diabetes almost instantly when you get a gastric bypass, which I desperately want to do - and it will help me lose weight.  And I'm going to blog about it, because I didn't see a lot of books or blogs out there about people going through this process.  Maybe it will just keep me sane during what seems to be a crazy process.  Or maybe somebody else will read this someday and it will help them in some way.