Bariatric Betty's 3 week check up - doing great, BUT...

So yesterday (actually day 19) I had my three week check-up with my surgeon's office.  They were very pleased with my weight, the amount of fluid I'm getting in, the amount of protein I'm getting in, and my walking.  According to their scales I've lost 15 lbs since surgery, which was 17% of my excess weight.  They said that the average lost at one month post op is 16% of excess weight, so I'm already ahead at less than 3 weeks.  She also mentioned that they would anticipate that I will have lost 50% of my excess weight at 6 months post-op.  That would mean I would lose 30 more pounds in the next 5 months - sounds great to me.  So that's the good news.

They were concerned about a couple of things.  First - I haven't been taking long enough to eat.  I found that out myself the night before when I ate my black bean soup in about 10 minutes and was in pain for about the next hour and a half.  That was the FIRST TIME I had even had any discomfort from my pouch.  I was almost happy that it happened, because I was starting to wonder when I would get some pouch "feedback".  So I had already resolved to take a lot more time eating.  I've been getting a lot of volume in my pouch for being 3 weeks out.  I was getting almost a cup in most meals, and they said that eating that quickly means that 1) I probably have been having my puree too thin so it's exiting the pouch too quickly and 2) I'm a quick healer and not very swollen at this point.  They said that I will be able to eat less as my food gets more solid.

Second, I was asking about being allowed to exercise more.  I wanted to start some lightweight free weight training for my arms/ shoulders, and maybe gentle walking on the elliptical.  As my fat is decreasing my arms are starting to get flabby, and I miss the endorphin rush I get working out.  Plus, I keep on reading and hearing others being warned not to waste their window of opportunity/ honeymoon period.  I want to make the most of mine.  This appointment burst a few bubbles.  I was told very bluntly that I'm not consuming enough calories yet to build any muscle, and that if I start working out now, it's possible I could destroy my existing muscle tissue, and then it wouldn't come back.  Whoa.  When I asked about the elliptical I was told "No, because even that will use your abdominal muscles more, and if the stitches in your abdominal muscles don't heal well then you could have permanent weakness in spots."  Oh.  So I said "OK, so just keep walking, you know walking my dog..." and she almost choked.  "You're walking your dog?!?"  I tried to explain that I've come up with strategies if he starts to pull (like standing on the leash) so I don't stabilize with my abs, but that he usually doesn't pull, he just walks at my side.  But, she was still worried.  I tried to explain that my dog HAS to go out at least once during the time that my kids and husband are away during the day, and that I have made sure that I take all the precautions I can.  So I'm not arguing about weight training or using my elliptical - I totally get it.  And I'm going to be very careful walking my dog, but I have to walk everyday and so does he. 

So one of the funnier moments of the visit was with the surgeon's assistant who was talking about how I'll be on regular food before I see them again.  So she says, "Breakfast, talk to me about cereal and milk..." and looked at me.  Huh?  I think I can only say I had a confused deer-in-headlights look.  "C'mon, what do you think about cereal and milk for breakfast?"  Ummmmm.  I don't.  I don't think of cereal and milk for breakfast.  I've been a diabetic for the previous year and a half.  Too many carbs, too low protein, etc.  "No, no.  Think about your rules, would milk and cereal make a good breakfast?  No.  Protein is way too low, right, but it is also a lot of LIQUID calories.  You aren't supposed to have liquid calories.  And it will wash the cereal right out of your pouch - it's like drinking with a meal!"  Oh.  OK.  Right.  But I had a whole nutrition class with one of their nutritionists after the appointment and she felt really confident that I understand the rules.  It was just being asked like that, my brain froze and went "Whaaaaaaaaahhhhhht?"

I had the nutrition class with Orlando, a fellow RNY patient that I met in the hospital.  He's doing really well, too.  I have to say, the support of fellow patients as well as the amazing staff at the hospital means so much.  I talked to them about me attending my local support group vs. the one at the hospital because they're on the same night each month.  The surgeon's office said that was fine - yippee!  And pretty soon I get to start having TVP (texturized vegetable protein) - a staple in most vegetarians' diet. 

Yesterday I also got the formal invite to my best friend's wedding reception in May.  And promptly got anxious about it.  A dinner reception - eating in front of non-family members.  What if my pouch throws a fit and I vomit?  Will there be anything I can eat?  OMG, I've never been anxious like this, but I calmed down and started working through it like a challenge.  OK, I'll ask my friend exactly what is on the menu, then I can see what I might be able to eat.  If there is anything appropriate for me to eat, I can try making it at home a few times before the surgery so that I can see if my pouch will tolerate it.  And I will pack a source of protein that I can eat - maybe cheese cubes, I'll be on normal food by then.  That way I can have a ready protein I can eat out of my purse before I try a bite of anything else.  OK, that will work. 

So I have a bunch of social things coming up.  My son turns 9 this month, and is making his first communion next month.  Then my friend's wedding reception in May, and a family vacation in June.  I need to have clothes that will fit for all these occasions.  The birthday is fine - at a bowling alley, I can get away with loose jeans and shirts.  The first communion will need something dressy, and I will be too small for anything I currently own.  Ditto on the wedding.  And I will need summer clothes for vacation...  Luckily, there is a local community garage sale in about 10 days where they usually have really nice clothing.  I will be all over that sale.  Once my weight stabilizes I will save up and buy some new nice clothes for myself - but it doesn't make sense to waste money on clothes I may only wear a couple times while I'm shrinking. 

I hinted to my family that maybe in 6-9 months they could nominate me for "What Not to Wear" so I could get professional advice on how to dress my new body, as well as a gift card to pay for it.  The response?  "Ummm, they would need you to be in New York for like a week, right?  We'll just save money up for you to shop here."  It is nice to needed. And the poor guys did just do without me for three days and they still don't have me back in full form yet.   Maybe What Not To Wear will decide to make a stop in Cleveland someday :)  I can't complain - not with all the blessings in my life.  My family, my friends, and my pouch.

Bariatric Betty 5 days before Surgery

So, here it comes.  The big day is less than a week away, and I'm tying up lose ends.  I've labeled where lots of things are kept in the house for the benefit of my family and my mom who will be coming over to help for 5 days.  I've done extra grocery shopping, made lists of food suggestions that the kids like, written down how they like things prepared.  I've written just-in-case notes to my husband, kids, and sent emails to the kids' teachers letting them know what is happening just in case they see behavior changes in the kids because of anxiety or anything.  I'm continuing to go over the plans for the day before surgery (now called "Poop Day" by my boys), surgery, discharge, and when I first get home with everyone.  I've bought all of the suggested post-op supplies and meds the bariatric center suggested and set up my little "liquid protein station" complete with shakes, whey powders, blender, and a sieve.  I've bought some books I'm looking forward to reading on my kindle.  I've set up some post-op playdates for the kids. 

All of that stuff is logical and healthy.  Now here's the other side - I've been enjoying my farewells to carbs. In the last week I've had a small serving of ice cream and a medium size fro-yo.  I've been choosing my meals to include some of my favorites that I won't eat the same again (or modified for a long time) - pasta, pizza, calzones, eggplant paremesean, and big salads (OK, that's a healthy one, but still).  I haven't been binging or going outside my calorie allowances, but my total carbs per day have definitely gone up.  My blood sugar is still fine.  But it's still part of giving up loving to eat to become healthy - the mind change that I have to make that the scapel doesn't touch.  I've asked my son to let me make chocolate chip cookies for his birthday in March instead of the cake balls he wanted - because I hate chocolate chip cookes, and love cake balls, and don't want to be faced with temptation too early.

I think that in all my previous diets there was this feeling that "after I make goal I can eat like a normal person again" and a big difference here is that I am choosing that I will never be normal, and I'm OK with that.  That it's worth it.  That this change will be permanent.  That I will NEVER get an ice cream cone again.  Not because I couldn't, but because I will choose to follow the RULES, and the RULES say no liquid calories.  Will I ever indulge in a taste of something?  Yes, but not for the first or maybe even second year and then it will be something solid so it gives me statiety.  I've heard from the vets and know that the more you let carbs in, the harder it is.  So I'm going to think like I did when I was feeding my kids their first solid foods.  Start with vegetables not fruits. Focus on protein.  It's easier to like fruits, so hold off on them until later.  I want to re-program my taste buds during my honeymoon period.  I would LOVE it if I no longer wanted chewy bread and pizza crusts, or sweet/ salty carbs.  So I will stay away from them.  Protein and fluids, protein and fluids....

I wonder what things I might enjoy post-op when I can eat normal food that I don't like now.  Could I learn to like squash or cooked cauliflower?  Kale?  Tomato soup?  I wonder what size I will be in 6 months.  In a year.  I pray that I will no longer be diabetic by the time I am discharged.

We're planning an extended family trip to Williamsburg, VA in a few months, and I gingerly explained to my parents that I won't be comfortable eating with some of their friends who live nearby at that point.  They totally heard me and said they understand that my dietary restrictions will be tough and that I will still be working through what stays down and what won't (which could change on any given day).  They also made sure that the place we're staying at is a condo with a full kitchen, so I don't have to depend on food from a restaurant.  I have to say, my parents are being really supportive.  My mom has totally taken my request for positive-only comments to heart, and has become my biggest cheerleader (well, maybe second to my husband). 

I've also been getting a lot of support online from my WLS surgery friends - which means so much.  My traditional friends have been taking me out, writing me emails of encouragment, and offering to help with the kids - which is all VERY much appreciated.  But my WLS friends know where I am because they've been there, and they know where I'm going.  They are able to handle my panicky questions, like "If I dump after surgery from having too much carbs, I'll have pretty much have the same symptoms as when I become hypoglycemic as a diabetic - but I won't go into a coma and die, like I could now, RIGHT?"  They know my personal brand of crazy, because they've have it to.  It's still there, just in remission.

Everyone has a different story, a different outcome.  All I know is that whatever my best possible outcome is will only happen if I do the best following my surgeon's guidelines.  I trust my surgeon, and I trust God.  How I use this tool, this gift, is up to me.

The Decision, and The Call

OK, so if you're a Weight Loss Surgery person, you know what "The Call" is and can skip the next paragraph.  If not, here you go.

I got two days of The Call.  The first one was yesterday, 1/30/2012, about 6 months after I went to my first information session about baritric surgery.  It was my patient care coordinator, Diane, from hospital C calling to tell me that my insurance company had finally pre-approved my surgery!  This is the call I've been waiting for - I finished my 90 days of multidisciplinary supervised dieting a month ago, and needed them to review all the documentation and say "Yes, she's compliant and fulfilled our requirements for pre-approval".  The second part happened today, 1/31/2012 about 15 minutes ago.  Sabrina, the scheduler called and said that they actually have an opening in the surgical schedule for Feb. 16th! 

So now that I have a surgery date, I'll call Feb. 16th my new Valentine's Day.  The one where I and my whole family say "You are worth this, we love you and want you to live a long healthy life".  I'll be honest, when I got the call about the insurance company approving me I broke down and cried.  In my car in the parking lot of the grocery store.  Several times.  It took me until my fourth phone call to family to stop crying each time I told them.  So the scheduler was supposed to call me in the next couple days, but they needed to make sure I understood that I would need to pay the $350 program fee and the $3000 deposit (because my insurance caps it's bariatric benefits below the cost of the operation) when I come in for pre-admission testing.  OK, I've been preparing for that.

I was so overwhelmed, I almost got in a car accident on the way home.  By the time it was dinner, I think I felt like a kid at the end of Christmas day.  Dazed, so happy to have gotten just what I wanted, but exhausted from the emotions of it all.

The scheduler called today, and I'm going in for blood work, EKG and counseling with the inpatient care doctor and nutritionist all day on Thursday.  Deal!  Can I pay the program fee and deposit in just two days?  If they take credit cards, I can!  (The answer was yes). 

So now things are clipping right along, and I'm going to be working like crazy to get everything prepared.  Coverage for the kids (my husband and mom will be helping), grocery shopping for them ahead of time - grocery shopping for my liquid diet post-op (noting NOT to overbuy - especially on things like broth, thank you guys for your blogs), and cleaning the house so my mom doesn't put EVERYTHING away where I can't find it when she comes to help.  Pre-op pictures - check.  The list is a living, evolving thing.  Suggestions are welcome!

I'm so excited!  And everyone I know is so excited for me.  I am blessed. 

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. 

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 myfitnesspal.com 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!

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!

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 :)

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. 

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 myfitnesspal.com 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!

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....

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. 

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?

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.