Friday, May 25, 2012

Bariatric Betty 99 days post op; Joy, Pride, and Fitbit!

I went to my 3 month post-op visit this week and got great news!  Since my operation I have lost 40 pounds, which is 46% of my excess weight on the day of surgery. 70 pounds since the beginning of my blog.  The doctor was thrilled and called me a "model patient".  I felt like my teacher just gave me a big gold star, and couldn't stop smiling all day - even when my labs where being drawn.  I also enjoyed wearing my new size 12 shorts that day. 

I got a Fitbit this month, kind of a pedometer on steroids.  It not only tracks steps taken and distance traveled, but flights of stairs climbed, calories burned based on your profile, and has a motivating graphic of a flower that grows taller the more active you have been in the past 3 hours.  I have been LOVING my Fitbit, and the fact that it downloads the info wirelessly to the website, which then communicates my exercise information to (where I log my food) automatically - which really simplifies my activity logging.  I've also found  that it motivates me to push myself farther - so I can reach the 10 flights of stairs, or so I can hit a new "record" for steps taken in a day, etc. 

I clip my Fitbit on every morning, and the morning I had my follow-up appointment was no different.  What was different was that by the time I was at my surgeon's office I realized it wasn't clipped on any longer.  I lost my Fitbit.  I back-tracked my errands that morning and have been unable to find it, so I contacted and asked them if I could purchase another unit but without the charging base (and therefore hopefully cutting down the replacement cost).  To my surprise, after giving them the information about where I purchased it, on what date, and what email address it was registered under, they offered to send me a new one FOR FREE!  Are you kidding me?  I can't say enough about their customer service.  Their product didn't break - this was all on me and they are sending me a new one. 

So I'm sending a shout-out to the folks at Fitbit today, and it's just part of the reason I'm smiling so much this week.

Here's another.  I've lost two pounds in the last two days.  Huh?  Yeah, we all know that our weight fluctuates daily.  So a one day one pound difference is normal, and I tend to lose 1-2 pounds a week right now.  The weird part is, I was already down 1.5 pounds for this week - and now I lost another 2.  So I found myself grinning as I walked around the neighborhood with my dog this morning.  It's important not to become dependent on seeing weight loss on the scale all the time - I have gone for 5 days or so without seeing a drop, and those are the days that I have to remind myself that my body will go at it's own pace but continue to get healthier as long as I follow the program.  I remind myself that I will have plateaus in the future - real ones that last weeks, not days.  But to not do anything different and lose 3.5 pounds this week instead of 1-2... yeah, baby!

After my appointment, I had another class with the nutritionist.  I explained that I was concerned about trying bread and pasta - both because they could be triggers, and because I was worried about dumping.  She encouraged me to try some small low carb options.  I tried making cheese pizza on Flatout Lite Italian and could only eat about 2/3 of it.  It didn't make me sick, but the bread felt like a rock in my pouch - not really painful but uncomfortable.  I have no interest in trying it again any time soon - no trigger there.  Then last night I tried eating half a small pita bread as a cheese sandwich with provolone, lettuce, and avocado.  It tasted great, but I got that same pouch-full-of-setting-cement feeling after a couple bites.  So I know I CAN eat these grains in moderation without dumping, or having them get stuck.  But I don't WANT to.  Avocado, on the other hand, I think I could eat daily (yum!) if only it was a protein source ;) 

I'm really proud of myself and feel certain that I will get to my personal goal (140-150 pounds).  The surgeon expects that I might be around 150 at my 6 month follow-up! 

I'm preparing for the end of the school year.  I will enjoy spending more time with my sons (most of the time, anyway) and not going to work.  However, I will be losing the paychecks and guaranteed extra 5000-7000 steps M-F that I have been getting as a school monitor.  So, I'm preparing to start Couch to 5K training with my boys.  My goal is for all three of us to be able to jog one as a team by the end of the summer.  I've never liked running, and don't have the best knees in the world, but after hearing about the successes of other WLS patients with this program, I'm really excited to try.  That, walking the dog, and swimming will be my exercise staples over break, supplemented by the elliptical on bad weather days.  We are also planning for our upcoming trip to Williamsburg and some weddings of friends. 

Hoping all my readers have one of these can't-stop-smiling days soon.  Happy Friday!

Friday, May 18, 2012

Bariatric Betty Talks Truth, Lies, and Money

I am three months out from surgery, and VERY happy with the results.  In addition to no longer being diabetic, I have lost 36 pounds since surgery, for a total of 66 pounds lost.  I have my 3 month checkup next week, and feel confident that they will be pleased.  They told me that the average person loses 50% of their excess weight by 6 months post-op.  I am 3 months out and have lost 40% of my excess weight (from time of surgery).  Yippee!!!  My energy is super high, my mood is improved, and I have the ability to do things I couldn't have done a few months ago.  I look forward to getting my labs done and making sure I'm doing well with my vitamins - I will be honest and say that I have forgotten to take them a few times (but only a few) and want to make sure my levels are good.

One thing about being three months out from surgery - all of the claims have been submitted, processed, and paid (as much as they will be) by my insurance company.  Watching this (and paying the remainders) has been very interesting.

For those of you who may not have been reading my blog since the beginning, I will suggest you take a look at my first few posts - probably starting with Bariatric Betty Gets Sucker Punched, and the ones immediately following.  To summarize, I will say that the first hospital's bariatric program (Hospital A) gave poor/ false information in their information session and after I was all psyched to begin my journey I found out the costs were more than DOUBLE what I had been told.  I then attended information sessions at Hospital B and Hospital C - eventually choosing Hospital C in part because of it's relative affordability, and partially because I was so impressed with the warmth of it's surgeon and staff, and it's low complication rates. 

The truth is two-fold.  The warmth and skill of Hospital C was genuine and fabulous.  The costs they estimated were not.  Did they knowingly give me false information?  I don't know.  I'm dissappointed that they didn't give me correct information - and given the extraordinary care I have received and continued to receive I prefer to guess that they don't know what really gets billed.  That leads me to think that perhaps I should think less harshly of Hospital A and their mistakes.   Maybe I would have found the same thing at Hospital B if I had gone there.  It really makes you wonder: DO DOCTORS AND STAFF AT HOSPITALS HAVE ANY IDEA WHAT THEIR PATIENTS ARE BILLED?  At least in Northeast Ohio, I would guess the answer is No. 

Hospital C told me that for my surgery (RNY Gastric Bypass, laproscopic) and the typical hospital stay (two nights, three days) I should expect that the total bill of about $22,000 - not including anesthesiology (which for some reason, none of the hospitals bills for - it's all billed seperately by the anesthesiologists).  I was told that the average anesthesiology bill for my surgery would probably be a couple thousand by my patient care coordinator, but since she doesn't work for the anesthesiology groups, that was the best she could do.  They also estimated (based on past experience with my insurance and this surgery) that I would need to pay about $3000 out of pocket all said and done, and took a deposit for that amount during pre-admission testing. 

Ready for reality?  I had 10 bills between preadmission testing and surgery.  Radiologists, labs, the hospital, the surgeon, the anesthesiologist, the doctor who check in on me before I was discharged.  Total bills?  $54,539.30!  Yup. 

Now, once my insurance calculated what was "allowable" under their contracts (this was all in network and pre-certified) the total recalculated amount to be paid was $19,946.26 (big difference).  My insurance paid $17,464.24 and I was responsible for $2482.02.  Of course, I have had to pay for the bills not directly through the hospital out of my pocket and have to wait another month or so to get my refund of the remainder of the deposit - so as of right now I have paid about $3600, but I should be getting over $1100 back (eventually).  And yes - all of these numbers included anesthesiology: it was originally billed at $2800 for the surgery and an additional $100 for post-op pain relief (a bargain) and was negotiated to just under $1300 total under contract). 

So why the discrepancies?  I can only figure that the person I talked to who does the billing to the insurance was looking at the negotiated rates when she gave me the quote of $22,000 (plus anesth.) even though I asked her what the difference was between the billed amount and the contracted costs - she only had one set of figures and gave me the impression it was the billed amount.  I ended up paying less than they anticipated out of pocket for as perfect an experience as I could have hoped for.  It's hard to be mad.  But it does make me ache for everyone who doesn't know how to read Explanation of Benefits (I used to do that as part of my job in my former life), and it did give me some stress during my recovery (like watching the amount billed and then PRAYING that the allowable amount would be signifigantly lower). 

As I watched things "in process" and "approved" and bills come in I knew I would want to blog about this when it was all done.  Why can't hospitals tell us all the costs?  Why can't they bill the contracted amount instead of inflated figures?  Why can't we understand the real cost of healthcare BEFORE it's given?  We need to be educated consumers, and I thought I was.  Still, I was surprised.  I know I was lucky - so many people want this surgery and don't have any insurance (or no coverage for bariatric procedures, specifically).  People in Canada routinely wait 6 months - 2 years for their free procedures - I started this journey only 9 months ago and had excellent teaching and guidance (part of which was mandated by my insurance). 

I don't have a solution for what's wrong with healthcare in America.  I do know it needs to be available to and affordable for everyone, and it is neither.  I know my insurance company (and myself ) will likely save tens of thousands of dollars now that I am not a diabetic.  I am worlds healthier and will live years longer than I would have without the surgery.  I pray that everyone else gets the opportunity to have life changing operations like I did if they need them. 

Wednesday, May 9, 2012

Bariatric Betty Gets Touched

So last night I went swimming with my family.  I went over to do some laps and since all the lanes already had someone swimming, I waited until the guy in my lane was almost down to the other end and then started. We passed each other somewhere in the middle and he bumped into me briefly - pretty common, when you don't realize someone is sharing your lane until the last minute.  Then he reached out and grabbed my leg as I was swimming by.  WTH?  I stopped and stood up and he smiled and said "So, how do you want to do this?"  I was stunned for about 1 second while I processed the situation and then said "uh... well, we can circle swim or split the lane..." and he suggested we split it and we went back to swimming. 

What happened after that was interesting.  I felt overwhelmed.  Really emotional.  I finished swimming a few more laps and then went over to my husband and stayed with him for a while, and tried to put into words what I was feeling.  It was hard to convey. 

See, obese people are not used to being touched.  I mean our kids touch us, our spouses touch us, family members hug us.  And sometimes we get hugged by friends.  *I can see my friends reading this right now and starting to worry "Oh my gosh, did I hug her the last time I saw her?" - please don't worry, you probably did and if not it's NOT a problem, and I love you guys. 

What I mean is that casual acquaintances and strangers don't usually touch us.  Co-workers don't usually touch us.  We also don't usually put ourselves in situations where we are LIKELY to get touched.  Take the situation last night - how often do you run into an obese person swimming laps with you?  That's just about the only situation I can imagine a stranger surprising me by putting his hand on my bare leg right now. 

There are multiple reasons for this decrease in touching.  One is the obese person's choice:  Do we remove ourselves from touching situations because we want to avoid being touched?  Sometimes.  We don't usually feel comfortable drawing attention to our bodies - and touching does that.  It makes us aware of where our body stops at skin, and then the nerves let us know what parts were touched (like a muffin top) and what parts weren't (like our natural waist under the muffin top) and that can be interpreted into a sad realization that someone just touched a particularly fat part of our body. 

Another reason is that people choose NOT to touch us.  This might be because we are sweating - a common situation for the obese.  Who wants to touch someone else's sweat?  Nobody.  We would all rather touch a dry and deodorized loved one than a sweaty stinky one (not that we wouldn't do both).  But when it comes to strangers, sheen of sweat (or a "glistening" as my southern friends would say) can be quite off-putting. 

Yet another reason is that obese people are often ignored by others.  Whether it's because they are being sized up as a potential mate and being found unsuitable, or just not someone that seems "worthy" of social interaction as compared with the normal sized person next to them.  The fact is, we are very aware of every time someone looks at us and then looks away, or leaves extra space between us and them when they sit down, or worse yet - gets that momentary look of repulsion or disgust on their face after seeing us.  Nobody likes to be judged, but it happens to everyone.  It's fun when somebody's face breaks into a smile or a spontaneous "Hi!" but obese people are used to getting the same stares that kids give an amputee before being taught not to stare.  From adults.  It's better than the hurtful comments that some people make. 

Anyway, we don't get touched as much.  So, when this man grabbed me by my leg I was stunned.  It instantly brought up my memories of being grabbed by a man who tried to rape me, even though I simultaneously knew that this situation was completely different.  But it made me think about how I was touched a lot more when I was a healthy-weight teenager around the time I was attacked.  And about how afterwards I sometimes had panic attacks when somebody touched me innocently - taking my hand to look at my class ring, putting their hand on my shoulder from behind... Before the attack I assumed every touch was friendly.  After the attack, my fight-or-flight response was triggered a lot. 

As I got heavier, I was touched less.  And when I was touched, it was by people I knew well.  No panic attacks.  As I have gone to therapy and worked through issues related to my depression and obesity, I have long understood that I felt safer as an obese person - someone less likely to be attacked.  Of course, that "safer" feeling was entirely false - my body was becoming toxic, and I was killing myself slowly.  But I felt safer from "bad guys" - after all, less men would choose to rape a fat woman, right?  Last night I realized that I also removed myself from so many situations that caused panic attacks - being touched unexpectedly. 

Now that I have been losing weight I am putting myself OUT THERE more, and that means getting touched more.   I'm more active and outdoors more.  Meeting more new people.  Getting hugged by kindergartners every weekday as a school monitor.  Making new friends.  A lot of weight loss surgery patients talk about being talked to more, about being "noticed" more often.  Getting more compliments.  I just never realized it included being touched more until last night, and how big of a deal that is until last night.  I look forward to getting used to it.

Thursday, May 3, 2012

Bariatric Betty at 11 weeks post-op, blending in and standing out.

My shorts fit great when I tried them on two weeks ago, now after I wore them an hour they started falling down.  I smiled.  I grabbed my belt and put it on only to find that the holes stopped too soon.  My belt is too big.  Joy!  I grabbed an awl and made a new hole so my shorts will stay up all day, but it made me think about what this means.  Last summer, not only didn't I need a belt to keep up my size 20 pants, this belt was too short for me to even wear.  Now I needed to add a 6th hole to keep up my size 14 shorts.  Whoa. 
There's a little punch to the left of the fifth whole you can see in this picture.  Yay, #6!

It has become entertaining to look myself in the mirror as I go in to take a shower.  Because some days I notice something new.  Today I noticed some new wrinkles/ folds at my hips - wrinkles and folds mean that I've lost enough weight that there is some new extra skin.  It's not attractive, but it beats the skin being stretched taut because of more fat.  One of the biggest things that weight loss surgery patients have to accept is that barring a LOT of plastic surgery, our bodies will never look like we are "typical".  Our skin has stretched to the point that it has lost a lot of elasticity (like we're 80 or 90 years old). 

Our metabolism will never act like we're "typical" - we will always have a slower metabolism and won't be able to burn the same amount of calories that our never-obese friends will when doing normal activities.  A typical woman might maintain her weight at 1500 calories with 10,000 steps a day.  A weight loss surgery (and previously obese) woman would probably gain weight.  So we will need to eat less and exercise more to maintain, let alone lose weight. 

One of the facebook friends I have made has worked incredibly hard to lose 181 pounds, and when someone at the gym where she was taking a spin class found out, she was asked "did you to it the hard way of the easy way?"  Right.  Like there is any EASY was to lose 181 pounds. 

It made me think a lot about the weight I've lost so far.  I lost 30 pounds before surgery, the so-called "hard way" in about 120 days.  I've lost 35 in the 77 days since surgery by 1) greatly restricting my calories (usually about 700 a day) and 2) Being very active - making sure I'm walking an average of 15,000 steps a day or alternatively exercising (elliptical, swimming, etc). After the first few weeks (when I was limited to fluids and thin purees) were over, I started losing about 1-2 pounds a week.  That's about the same rate I was losing pre-op.  Pre-op I was eating about 1,500 calories a day and was less active. 

I've lost 30-35 pounds before with programs like Weight Watchers and Nutrisystem.  What's the difference?  This time I knew I needed something to lose the other 70 pounds after I took the traditional route.  I think that Weight Watchers is a fantastic program for losing some excess weight, I just don't think it usually works for most morbidly obese people who need to lose 100 pounds or more.  So this time I lost the 30 pounds, and then kicked it up several notches with surgery.  The surgery gives me a temporary "shock collar" on my stomach.  Eat the wrong stuff - feel sick.  Eat too much stuff - feel sick.  Eat too fast - feel sick.  It lets me re-train my brain.  Because my stomach can learn to like the old way of eating again - it's up to me to train my brain to not want to.

Is there anything easy about the surgery?  No.  It was painful and meant committing myself to a lifetime of changed eating and activity.  It came after months of education, psychological screening and introspection.  It meant giving up the notion that I would ever be normal.  Let's face it, as a morbidly obese person I had never lived or eaten like a normal person.  As an obese person, I had never lived or eaten as a normal person.  As an overweight person, I had never lived eaten as a normal person.  And as healthy-weight person I will not live or eat as a normal person.  I have done lots of things that "normal" people have done, but differently.  So what do I know about normal?  Not much.  So why was I so desperate to reach it?  Because I wanted to be healthy, and didn't want to be viewed through someone else's judgement of what an obese person is anymore. 

Here's the cool thing - I will never be normal, but I can fake it now.  I can wear nicer clothes from a non-plus-sized section.  I can wear makeup without sweating it off in normal activities.  I can run after my kids.  I can volunteer in their schools and work a job without collapsing from exhaustion.  I can't quite fake eating "normally" yet, but it will come.  I will learn how to eat 15-20 grams of dense lean protein (even if that means packing it in my purse) and then pushing "normal" food around my plate, even eventually taking a bite or two of select things. 

My personality has never been typical - I've always lived life with enthusiasm and passion.  Nobody has ever taken me for a demure, unopinionated gentlewoman.  Working as a monitor in the elementary schools has been eye-opening in many ways.  I see many children who stick out as "different".  I like different, different makes life interesting, and you can be proud to be different.  However, you also need to learn how to conform at times.  Sometimes you can steal the spotlight, but other times you really have to know how to blend in with the choir - because life requires it.  And now I can blend in when I want to/ need to, and be part of the supporting chorus.  To pitch in as an equally able part of a team.  So the judgement backs off a bit, and then when I want to - I can show people things I'm PROUD to be judged on.