Clearance, Clarence!

One of the things I failed to mention before is a little thing called co-morbidities.  These are other little health conditions that exists, often as a result of obesity.  The more you have, the better the candidate you are for weight loss surgery.  Some of my mine include:  high blood pressure, chronic back pain, gallbladder disease (mine was removed in 2006), sleep apnea, polycystic ovary syndrome, etc.

As of March, I've been blessed to be insured again.  That said, I've seen a lot of doctors while playing catch up.

I saw the sleep apnea doctor who immediately prescribed an updated study.  So I spent a night at St. Joseph's and discovered that not only did I need a new machine.  But it was also set to DOUBLE the air pressure setting I had been on for years.  NO WONDER I've been so tired.  My energy level has been improved tremendously since then.  Thank you, Dr. Siler!

My goal is to be able to eliminate the need for the CPAP machine AND the blood pressure and possibly even cholesterol medications.

What is Roux En Y Gastric Bypass?

The surgeon sections off a small piece of the upper stomach, a pouch that has a capacity of about a tablespoon. It can stretch comfortably to hold two ounces of food and that amount of food creates a "full stomach" feel. This is the "restrictive" component of gastric bypass surgery.

The "bypass" part of the operation occurs when surgeon, at a point about 18-24 inches below the beginning of the small intestine, divides the intestine. He then moves the lower piece of the small intestine up to connect with the new stomach pouch.  Bypassing most of the original stomach and two to five feet of the small intestine does not cause significant malabsorption of nutrients from food. However, vitamins and iron are taken into the body through this now bypassed first part of the intestine. Therefore, gastric bypass patients must take multivitamins with iron every day.

After the stomach pouch and the stoma, or opening into the intestine, have been created, the upper part of the small intestine is reconnected to the small intestine that receives the food and is going downstream. Why? So the stomach and pancreatic juices and bile salts that normally travel down this upper intestine can be available for processing the food in the intestine.

Now then...........back to JULY!

So on July 12th I made the trek back to Des Peres.  This time for the dietary consult and the psych eval.  I had to take another day off!  My mom has been managing me by seeing to it that I follow up on these appointments.  I thought she retired?  HA HA.  No matter how old you are, I suppose mom's never retire from being moms?!  Anyhooo.....so like a good daughter, I call mom to let her know I've been a good girl and scheduled my follow up (from the endoscopy on 6-12).  And she says to me, "I may be able to drive my van by then" (it had been in need of a minor repair).  I say to her, "well, mom, this appointment won't require me to have someone else drive me home.".  So she reaches to feel needed by saying, "I thought you might like someone to go with you.".  I say, "Well mom, if you want to go, you can go with me........." (not wanting to exclude her).  And she JUMPS on it and replies, "GOOD, cos I have LOTS of questions!".  Mind you, this is the same woman who in 1995 would slip me brochures for breast reduction slipped in with mail or papers she'd hand me from time to time.  When I eventually relented and had that surgery, she has the audacity to tell the surgeon during pre-op, "take it ALL, I don't want her to have to come back and do this again!!!".  She totally gave my boobs away!  WTH?!  What was she going to tell this doctor???  

I took yet another day off for the half day run of appointments:  dietary consultation, follow up appointment and psychiatric evaluation.....and I DREADED them.  I was most wigged out about the psych eval.  I was sure they were going to tell me I was bat shit crazy!!!

Turns out it was a walk in the park.  I appreciated Dr. French's years of practice alongside bariatric physicians.  He walked me through the surgical procedure and was sure to go over the positives and negatives of it.  I learned that the data is starting to come back with regard to lap band surgeries (like I initially had in 2006).  More than half the patients are ending up having them removed after all....due to various reasons.  And based on some of my mom's questions, I learned that with the bypass I can expect to lose about 75-80% of my "excess weight" (the number of pounds I am over weight) in the first year.  For me, that means I should expect to lose 150-160 lbs by the one year mark.  Can't.Even.Imagine.  Then, he says, it may take the next few months to drop the last 20%.

One of the ugliest things I've heard and he reiterated about the post surgery expectations is a little complication called "dumping syndrome".  I've had the whole lap band throwing up.  And I have IBS so I'm used to having to run to the bathroom at times.  But what I didn't expect to hear is that after surgery, due to the way they have to re-reroute your organs, I may not have control of so called syndrome.  In layman's terms that means I can get diarrhea and it can creep up so fast that I may not have any warning or make it to a bathroom.  So expect "accidents".  This WILL happen if I eat things I'm not supposed to eat, like items high in sugar.  LAWD, give me the willpower to avoid such things so I do not have to suffer the embarrassment of shitting myself in public!!!!  This is one thing that scares the living hell out of me.  Other than that, it sounds very much like some side effects of the lap band minus certain food restrictions.  Unlike the band, I'll be able to eat steak again.  But I'll share all those types of details with you as I get underway. 

One thing that the dietitian and the psych doctor asked about was my support system.  Apparently this is PARAMOUNT to success.  I was sure to tell them I had a huge, loving and supportive family and group of friends.  So I am not at all concerned about this. 

Next up, I saw the dietitian.  She asked me some questions and took the time to get familiar with my lifestyle.  This will help her understand what my personal challenges are and how to guide me from there.  Together we made some short and long term goals.  Mine were:

Short Term:

• Substitute one soda per day with iced tea
• Try to eat breakfast at least 3x per week

Long Term:

• To be able to walk a 5k
• To reach a healthy weight

Dietary Guidelines I was given:

• 3 day pre-operative diet
• diet progression:  clear liquids 1 wk post op, full liquids wk 2 post op, soft foods week 3 post op and solid foods by week 4 post op.  YIKES.  I remember I HATED this part after the lap band!!!
• Lifelong supplements:  Multivitamin with Iron
• Calcium with Vitamin D
• B12
• Protein Supplements

Lifestyle & Behavior Modifications:

• Measure portion sizes 1/2-1 cup
• 3 meals per day
• Take 15-20 min to consume a 1/2 cup but no longer than 30 min
• Chew food to a toothpaste consistency
• Do NOT eat and drink at the same time, stop drinking 30 min before meals and wait till 30 min after a meal to drink again
• Choose foods low in fat and sugar
• Limit caffeine
• Limit alcohol
• Avoid carbonated beverages
• Avoid drinking through a straw
• Avoid gulping and guzzling liquids
• Avoid foods that cause gastric disturbances

Exercise:

• Cardio (walking, biking, swimming)
• Muscular strength (free weights, exercise bands, machines)
• Flexibility (stretching, yoga, pilates)

Follow Ups:

• 1 wk post op
• 1 month post op

For now, the good news is that according to all the testing Dr. Scott did, including the endoscopy, he found no reason to be concerned with proceeding with the surgery.  He found nothing on the Endo.  And my blood work showed no enzymes that indicate a predisposition to blood clotting disorders.  My check list was down to ONE last item.....a surgical clearance from my primary care physician/internist.

Last Friday I met with Dr. Murray who gave me the GREEN light for surgery.  It was nice that he already had copies of the results from all the tests Dr. Scott's office had taken.  Dr. Murray simply wanted to run another Thyroid panel, as my levels were still high.  He was referring to my TSH level, Thyroid Stimulating Hormone.  It is high because it has to work over time to keep my thyroid in check.  I have Hypothyroidism.  So I have to be sure to take my meds all week then run up to have another blood draw on Friday.  That will determine whether or not they need to adjust my current thyroid meds.

Ironically, Dr. Scott's office emailed me just today indicating they wanted another panel taken, as well.  At least they are on the same page.  I can just go once and they will share the results.  Once those are in, the next step is for Dr. Scott's office to submit everything to CIGNA for approval.  By law, the insurance company has 30 days to approve or deny.  My doctor's office says Cigna has been running 2 weeks.  Once approval comes in, surgery can typically be scheduled within 2 weeks.

Aside from the last bit of blood work, I'll be working on the list below of "What should I do to get prepared for surgery?"

• Research everything about the surgery:  Support Groups, Twitter, Daily Strength, Obesityhelp, Bariatric Bad Girls Club, Bariatric TV, etc
• Make Weight Loss Friends to get support from those who have been there, done that.
• Add more exercise to your day
• Lose some weight (cut back on simple carbs, up protein, practice post op lifestyle)
• Drink more water!
• Eliminate Soda and Smoking
• Figure out what made you overweight, what your eating issues are, what your trigger foods are, etc
• Take measurements and pictures
• Journal, blog etc..........

Thanks for following along, for ALL the words of encouragement I've already received and always for your friendship.

I look forward to the day I can blog again telling you that insurance has approved me!!!

Lori

Just the Facts, Jack!

First things first....my profile photo is from April 2008.  It was taken at my leanest weight post gastric banding surgery.  I like the thinness of my face; and I've chosen to use this as motivation to get back to that "place".

Many of you may not know, but in order for insurance to cover a surgery such as Roux En Y Gastric Bypass, there is a long check list of things to do and submit for approval.  The list varies by insurance company.  I have CIGNA.  My list looked something like this:

1. Complete Medical/Diet History Questionnaire
2. Obtain a Medical Clearance from my Internist
3. Obtain a Psychological Evaluation
4. Complete a Dietary Consultation
5. Complete a Surgical Consultation
6. Submit a complete Thyroid Blood Panel
7. Undergo an Endoscopy procedure
8. Complete a 3 month multidisciplinary supervised weight loss program

I had my first appointment with Dr. Scott at My New Self Bariatrics on 5-20-13.  On June 12, 2013, I had my Endoscopy, Doppler test and blood work (see post from 6-12-13).

Before I get to July's events, I wanted to just share a few things that I think are noteworthy.  My goal is to be 100% candid about everything along my journey.  I make no apologies for that.  My intention is to give you a peek as to what goes on in my mind and with my body on a daily basis as a result of my current condition (which I accept responsibility for) and during what I hope will soon be a smooth transformation.  It will also contain lists or reminders to myself of what I do and do not want for my future.  Overall, I hope you find it uplifting.

What made me reach the point of desiring change?  Recently I've noticed a severe lack of mobility (see list below).  I also inherited a step son (now 9) with my 2010 marriage.  And I really long to be more active with he and my husband.  I don't want to spend the last half of my life dying.  I want to spend it LIVING!

How has my weight disabled me physically, you ask?

• My back (which was broken in 1985) bothers me more often and more severely
• I cannot stand on my feet for more than 5 or 10 minutes.  If I shop, I end up hovering over the cart for relief.  If I rinse dishes to load the dishwasher, I have to lean on the sink.
• I have to sit on a bed or sofa and lift my leg up on the side to tie my shoes versus being able to simply bend over or lift my leg.  
• I get shortness of breath and can't even walk a mile anymore.
• My knees are shot, I can't bend or kneel on them to garden, etc.
• I'm flat our exhausted after a shower.  My energy is spent.
• Speaking of shower, suffice it to say range of motion is limited, so some areas are harder to reach than if I were a normal weight.
• I have to ask my husband for assistance at times, for things I wish he never had to do for me.
• My poor bikini line hasn't seen the light of day for countless years.  It's been taken over by my thunder thighs.  Let's face it, they'll probably always exist; but it sure would be nice to be able to see it myself for a change!  All joking aside, the stark reality is that with heat and summer, there can be chaffing of the thighs, heat rashes that develop in areas that have friction, etc.  Sorry, but I promised the good, bad AND the ugly on this blog!
• A day of business travel wipes me OUT.  I suffer back pain and shortness of breath just making my way through the average airport with a laptop bag and a purse on me, much less a garment bag and the shuffle from bag claim to the rental car shuttle.
• I have severe edema or swelling of the feet.  It's horrid and UGLY and embarrassing.  My normal feet are quite pretty, although vein-y, and my ankles proportionate.
• Let's just say it can be limiting when trying to share some intimacy with my husband. (I apologize for the visual but it's important that others who struggle find me relatable)
• It means I ask for an extra seat on the airlines so I don't have to worry about making anyone else uncomfortable next to me.
• I have to use a seat belt extender on airplanes and I have one for my car!

What does this mean to me?

• I avoid sporting events (which my husband and I both love) due to the discomfort of stadium seating.  Even if I was able to pry myself in the seats, I'd be sitting all crooked and would end up in severe back pain by the end of the game.
• I wouldn't dream of taking our son to an amusement park due to the walking involved.  Or even the zoo.  This makes me sad.  Once again it's not fair to my husband or son.
• Obviously, there are countless trends, designs, clothing styles I cannot attempt.  WORSE, however, is not being able to put on a cute pair of summer shoes and rock them.  Something about cankles in strappy sandals just isn't cool nor attractive?!
• I volunteer less than I used to.  When I do, I have to ask for "seated positions".  I miss the days of working the walk/run events and cheering runners on at the finish lines.
• My husband has to do the "heavy lifting" around the house because I simply can't.  Even when I want to.
• I rarely even visit the "man cave" that is our finished basement as it's hard to climb stairs without getting winded.

How does this impact me, emotionally???

• Just this year, I've noticed that I feel worse about myself and my appearance than I ever have.  
• I pass up social invitations to have girls weekends or meet new friends simply because I feel like if I no longer like me how will anyone else?  What must they think of me?  So I end up sticking to a very few close friends, my safety net, my comfort zone.  This particularly bothers me, as I don't recall EVER being like this.  And I've battled weight for almost my entire life time. 
• I don't have the amount of intimacy I would like to have with my spouse.  And I often wonder IF and WHY he even finds me attractive.

The mental clutter is hard to explain.  On one hand I look in the mirror on a given day and I think I look polished and presentable.  Then later I may see a photograph of myself taken that same day and all I see is a round individual that looks like a blob.  It's like there is some sort of distortion.

I worry that when I DO lose weight, I will look in the mirror and it will be opposite.  I'll still see the pre-surgery Lori.  And how will I react to this "new" shell if I've only known THIS Lori all my life?!  

In a lot of ways it's scary.  Ironically, nothing about the physical procedure or recuperation intimidates me.  It's the unknown and all the what ifs that concern me.  I'm anxious to discover a leaner Lori; but will I like her?  Will "she" change who I am on the inside today?  Am I up for the mental exercise?  And do I have what it takes to make this surgery a SUCCESS and maintain it?

For those who choose to follow along the journey, I appreciate your comments, encouragement, suggestions, feedback, etc.

As they say, 'Be kind to everyone you meet, for they may also be struggling"............

Prologue (from a Facebook note dated 6-12-12)

So for those "in the know", I had gastric lap band surgery in 2006.  Once I began getting "adjustments" to my band or "fills" as we like to call them.........I began a THREE YEAR process of regurgitating all of my meals....with little to no weight loss beyond the initial 50 lbs I dropped before the fills.

In January 2010, with the urging and support of my husband (Kevin) and parents, my lap band was completely drained.  In the past 3 yrs I've proceeded to gain all of my original weight back PLUS an additional near 50 lbs.  A year of unemployment and stress didn't help matters.

Now that I'm working and insured.........AND trying to schlep luggage and a heavy laptop through airports semi-regularly, I've decided it's time to revisit the subject of weight loss surgery.  With the encouragement of my husband, parents and extended family and a friend who recently had her band removed and got gastric bypass surgery, I saw a surgeon a few weeks ago for a consult.  We began the process of obtaining all of the items on a "checklist" to gain approval from the insurance company.  

Fortunately, the surgeon is thorough....so he also ordered some outpatient procedures:  and Endoscopy (to take a look at what my stomach is up to (given I still have the band as an implant, although it's empty), a battery of blood work (mostly to check my clotting enzymes since I had a major blood clot in 2009) and a venous Doppler test (to check for any clotting or red flags prior to surgery as that could alter the treatment plan).

The outpatient procedures were scheduled for today.  While I was in that area I was also scheduled to see the dietitian (for an insurance mandated consult) and also have a psychiatric evaluation (also one of the pre approval requirements for insurance).

I was advised that I wouldn't be able to drive myself home; so my mom was gracious enough to go with me.  Since Kevin is new on his job, we really didn't want for him to have to take off.  Given I had like 3 procedures and 2 appointments, I took a day off from work!  Not a good time to take off; but what can ya do???  It's never a good time to take off, least of all year end.

So here's how my long day ended up being even longer............

This morning I woke and showered with no problems, mom arrived early (true to form) and after I got dressed I found myself on a full out safari for my missing orange flip flop.  Not just any flip flop, these are my BORN flip flops, comfy as heck...and summery.  How does ONE flip flop go missing when you're anal enough to ALWAYS keep your shoes in the closet where they belong.  Did one of the cats run off with it?  Did it not make it out of a suitcase from a previous business trip?  Did it not make it out of a hotel after a recent business trip?  I had no friggin idea.  But it was time to wear something else and get the hell out the door.  So that I did.

We arrived at the doctor's office by 10 am, plenty of time for a one hour dietary consult and to get to the hospital by 11:30 for admittance.  We waited in a crowded waiting room then I was finally called back.....only to be told they didn't have time to see me.  I politely reminded her I'd taken the damned day off to take care of all this.  And I also told her that I'd arranged all of this in advance; and it's not like I live nearby.  All I got was a "sorry"....which hardly seemed adequate.  

Mom and I now had 90 minutes to kill in West St. Louis County (which seems like a foreign country to me at times).  We ventured out to find a Hallmark.  Not knowing the area, we drove down Dougherty Ferry to Barrett Station to Barrett Station Parkway to Manchester with NO luck in finding a stinking Hallmark.  We did, however, stumble across a Trader Joe's and decide to check it out for the first time.  That was the fun part of the day......well, until I decided to get a $2 bag of Cheddar Horseradish flavored chips...........my fargin debit card was declined at the check out.  OK, so if having your card declined isn't embarrassing enough, it was a TWO DOLLAR transaction.  I almost went into cardiac arrest right there.  Mom being the mom she is, put my bag with her items and check out while I made tracks to the car.  There I logged onto my bank account from my cell phone to see WTF was going on with my account.

Whaddya know.....the dead beat tenant in my KS home BOUNCED her rent check, which sent our account into the negative.  So here I am 15 minutes from a host of outpatient procedure with a serious spike in blood pressure.  I was ready to say screw the procedures, let's go to KS.  Picture two sassy ass redheads hauling balls across 70......oh yea, I didn't have effin MONEY to go to KS.  So off to the hospital we went.

I'm sitting in admissions dialing like a mad woman to the lawyer who is supposedly handling the short sale of my house in KS.  I get the usual voice mail with no return calls.  This pisses me off even more.

Surprisingly once I was admitted and blood pressure was taken, it was quite normal.  Thank God for small favors.  While they were showing me to a "room"....think ER with curtains as dividers and people on both sides of me....they at least had the phlebotomist come in and take the labs.  I'm a very hard "stick" so I've been told.  But the gal got me the first time.  I was elated.  She filled her 6 tubes in like a minute flat.  I was ready to kiss her cos I'd never been through that process so quickly!  Then I asked her if she got the enzyme test (for the clotting factor), she said it wasn't ordered.  So she asked to see my paperwork again and there it was.  CRAP.  She had to stick me AGAIN.  Fortunately, it was every bit as quick and painless.  One "procedure" down, two to go.

Next they made me get into my robe and began to search for a "good IV vein" which they couldn't find.  So they had to stick me in a very uncomfortable place (inside my wrist) and it hurt like hell the entire time it was in.  At that point, all I wanted was to get the procedure and lose the IV.  Everyone told me the procedure (EGD) goes real fast, so I was counting on it.  The test was scheduled for 12:30 and he does them in like a "batch" mode, one after another after another, assembly line-ish.  Piece of cake, right?

Weeeellllll, we were told at 1 pm that the doctor was running late.  I began to panic as I had a 3 pm pysch eval and still had a venous Doppler after the endoscopy!  There was no way.  I asked the nurse to call over to the office and cancel for me.  But I was still worried that mom hadn't had anything to eat all day.  She gets headaches if she goes too long.  I hadn't been able to eat or drink either (due to doctors orders) but at least they had been giving me fluids.  The nurses at Des Peres Endo Lab were WONDERFUL.  They cancelled my 3 pm Psych Eval for me and notified mom in the waiting room so she wouldn't be wigging out, either.  I mean, WHO do you think I get it from anyway???  I was pissed off that I am now going to have to take MORE time off to address the two things that didn't get done today; but what can you do?  So they gave me warm blankies, turned my lights down and I drifted off to sleep (but NOT before praying!!!).

At 2:30 they informed the patients in the room that the doctor had arrived.  He had 5 patients and I was 4th in line, of course!  I think I got in at 3 pm and was done by 3:20.  They gave me full anesthesia; so I was OUT, I remember nothing.  Initially, they told me I would have conscious sedation.  LUCKY ME, they put us all out completely.  ZERO argument there.  When I woke in recovery, I felt nothing, no sore or scratchy throat.  I thanked the nurse anesthetist and the endo nurses who were all awesome....and they did me the courtesy of ditching the IV.  Woo Hoo.  Next time I have surgery, that will be the worst part given my non cooperative veins!

The doctor informed mom that everything went well, looked good and promising.  He said he saw nothing wrong and we will be able to move forward....with planning on RYGB surgery once approved by insurance.

I got dressed and was whisked off to radiology in a wheelchair.  There I got the 'ol venous Doppler.  It wasn't my first rodeo with this; so I had nothing to fear.  By 4:30 we were FINALLY done...........although we were two appointments short of our original agenda!

Mom drove home in full on St. Louis 270 rush hour traffic and treated me to dinner at El Maguey since we were both starved!  

I'm home now and following doctor's orders to rest and take it easy the next 12 hours.  I have to follow up at the doctor's office next week.  Should be fun telling my boss I need to take another 1/2 day at minimum to take care of that and the other items.  We are not "allowed" to take time off at month/year end, which is typically the last 2 weeks of each month.  June happens to be fiscal year end; so that makes it even more special.

It's now 8:30 pm and I've still not heard back from the lawyer regarding what will be done about the bounced rent check.  I tried like hell to get the nurse anesthetist to come home with me and administer that shiz that knocked me out and made me forget about everything so well.  He laughed and said, "That's why Michael Jackson liked it so much!".  Yes, I can see why, MJ.

I'll try to blog a little about my journey with the whole gastric bypass endeavor just as I did my lap band.  I'm hoping to find much more success with this exercise....given the last one was such a waste!  We'll see.  I know a handful of people who have had real success with it, in addition to the celebrities we hear of (Star Jones, Al Roker, etc).  I just PRAY I can get healthy enough to enjoy the lifestyle I try to have.........keeping up with Fox (my step-son), not getting so winded when hauling ass through an airport, not avoiding sporting events due to narrow seating (or airplanes for that matter), etc.  Mobility is important.

For those who are reading this and saying, "why doesn't she just go on a diet and do it herself rather than take the easy way out"???  Clearly, you've never been more than 100 lbs overweight, so don't attempt to understand how "easy" or "difficult" it is.  Keep your narrow mindedness to yourself and feel free to delete me if you see fit.  To all others, thanks for being my family/friends and encouraging and supporting me through all my successes and failures.  I need you.

Lori

UPDATE:  Said Orange Flip Flop has since been found and rocked on numerous occasions since!