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.