Friday, August 29, 2008

It's Official - Got my Surgery Packet

Today I got the packet that tells me how to pay for my surgery and get ready for it. I'm so excited!

I have to be at the hospital at 6:00 am! I think I'm going to die. Sometimes it takes hours to get to San Francisco from my house and sometimes it takes 45 minutes so I'll probably leave the house at 4:00 am. Yikes! (I am most definitely NOT a morning person.)

My packet has an informed consent form that is pages and pages that I have to sign and write paragraphs paraphrasing what it says. It has all the info for pre-registering at the hospital. It has some protein samples and info for ordering more foods from the office. I might order some of their protein soups since I don't have a source for them. I already ordered a bunch of protein packet samples from Vita Lady so I don't need more of those. It has info for ordering vitamins too. I'll probably continue to get mine at the supermarket or GNC though.

I do have to take some milk of magnesia the night before but I don't have to do that horrible bowel prep with the TriLyte that made my colonoscopy such a horrendous experience. That's a relief.

The rest is pretty typical... start exercising, don't gain weight, lose if you can, don't take NSAIDs and other things that thin the blood starting two weeks before the surgery. I'm also supposed to not get a cold as that increases the risk of pneumonia right after surgery. Not sure how I can control that, but I'll do my best.

I can take my blood pressure medicine the morning of though. Of all the things I think about that are in my future, not having to take blood pressure medicine ranks right at the top. For some reason, getting put on blood pressure meds really put me over the edge.

Wednesday, August 27, 2008

Apparently I'm a 'great' exerciser

I had my Cardiac Stress test on Tues. The Cardiologist was VERY impressed with my ability to exercise. I found it amusing because I was on the treadmill for only seven and a half minutes and I was beat and out of breath. I guess there aren't a lot of really fit people taking these tests because anyone reasonably fit would have kicked my butt.

Then the doctor and his technician tried to talk me out of surgery. I wasn't big enough. I could do it with diet and exercise. Blah, blah, blah.

I chose to be amused as it was the first time someone has told me that and I've been waiting and waiting for it! I am now officially a LightWeight*

*a lightweight is someone who is getting WLS with a BMI around 40-ish or lower. In the WLS we are actually considered lightweights even though in the real world, we are big time FATTIES!

I've got another date!

They changed my date. Now it's 9/24. That's only two days later and I think it will work better for me anyway. So I'm okay with it.

But very impatient!

A message for the new me

My daughter, Mini-Mac, gave me the following card for my birthday this year:

It's Your Day to Shine

Your birthday's here and you're in charge - A brand new year of living large ...

Twelve new months to write your story, Live your dreams in all your glory ...

Inspire the world, be wild and free -- be all that you were born to be!


Except for the part about living LARGE, I thought it was a very appropriate card to give to someone about to have weight loss surgery.

Monday, August 25, 2008

Another set back

I just went to transfer my yearly bonus into our money market account so it wouldn't disappear into the abyss of school shopping and credit card payments and would still be available when I need to write checks to the surgeon, the hospital and the anesthesiologist. This is when I discovered that my company took out more than 50% in various deductions.

This includes some for SSI -- which I am going to top out on before year end anyway so taking it out of the bonus was just mean -- and also my normal contribution into my 401k, which I never planned on happening and now I'm at risk of putting in more than that allowed yearly limit. They also took out the federal taxes at the normal rate instead of the reduced rate they used to use for bonuses. Which is going to increase my tax refund well passed an reasonable amount.

Not to mention, now I have about $5000 less on hand than I expected right when I need a huge wad of cash to pay for my surgery.

On the one hand, it feels petty to complain about a bonus -- not everyone gets these and I did get a nice one. But on the other, this is going to cause me all sorts of troubles in the future including pissy letters from the IRS when I have a massive refund for the third year in a row and having to fill out forms to deal with the overpayment on the 401k, not to mention the cash flow issues with my surgery.

I don't understand why getting this surgery has to be so difficult. Every time I turn around something is going wrong.

Wednesday, August 20, 2008

I've got a date!!!

Okay, so I have a date. It's not 100% because they have to see if the OR is available that day as it's not a normal surgery day. But it's something!

Sept 22, 2008 to be exact.

I'm excited and scared all at once.

Tuesday, August 19, 2008

Does Barium have calories?

I had my Upper GI today. What a weird test!

First you "drink" something they call fizzies. But they are more like pop rocks than a liquid and they would not go down. I had to wash them down with a little water. At this point, you want to burp. But you are not allowed to burp.

Then, you turn this way and that way as they take pictures. In the middle, they had me "take a mouthful" of this really thick barium solution. But don't swallow until I say Swallow. Okay, mouthful, wait, wait, swallow, don't breathe, okay, breathe. Now turn this way and start over.

Except as soon as that stuff is in your mouth, your stomach starts protesting. It's like it knows somehow that barium is not fun for tummies. So you're trying not to gag on the barium in your mouth and when they say "Swallow," your stomach starts trying to wretch even before the barium hits it.

I managed to do everything they said and didn't throw up or anything. I did burp though. Twice. Oops.

After you turn this way and that way and swallow the thick stuff a few times, they lower the wall you are leaning against until it's a table. Then you have to turn back and forth some more. They even do a sort of shaky thing with your hips to get the solution to all the right places. Kinky!

In the middle of that, they have you swallow some thinner barium through a straw while laying on your stomach. It's a non-stop sip, sip, sip and the stomach doesn't seem to mind it as much, so it wasn't too hard to get through.

They also pushed a plastic thing into my stomach when I was standing up and put some sort of paddle under me when I was laying down and also some kind of balloon between me and the paddle.

Then it was all over and I went for my next test... which got cancelled because you aren't supposed to eat or drink before it and barium counts even though it apparently has no nutritional value.

So now I'm at work with instructions to drink a lot. I feel kind of queasy. Not to mention gassy. But it wasn't nearly as bad as I thought it would be, nor nearly as bad as the colonoscopy I'm scheduled for later in the week is going to be.

Wednesday, August 13, 2008

Leaks and Complications and Stuff

At my surgical consult, I asked Dr. Awesome about leak tests and how complications are handled.

He said they don't do leak tests for sleeves any more!

The reason is that they have never found one in the OR. Yet people were getting them later on. They speculated that the leak test itself was actually causing the leaks by putting too much pressure on the staple line.

So they've stopped and, since then, haven't had a leak in over a year.

They do a leak test before you leave if you have any of a number of symptoms, but otherwise not.

As for other complications:

If I have one that requires resurgery, Dr. Awesome isn't going to charge me. The $8995 all-inclusive fee includes that sort of thing. But the hospital and anesthesiologist will charge me. It's $2000 a day for any extra days and $4000 a day if I end up in the ICU. Yikes!

The good news is that for most his patients, insurance picks up the tab for any compliations. I think he said that happens 90% of the time, but don't quote me.

As long as I'm not in the 10%! Better yet would be not having any complications at all.

I almost have a date!

So I've scheduled my pre-op testing. Mostly anyway. Dr. Whiny "forgot" to give me a referral for the EKG and my medical group won't give me the test without one even though I have a prescription for it from Dr. Awesome and my insurance doesn't require a PCP referral. But they do them as a walk-in so I can get my PCP to give the referral when she gets back from vacation and do it that same day.

My last test is the physical and lab work on Sept 8th. I could have scheduled for Sept. 4th, but I would have had to miss a meeting at work I didn't want to miss. I may change my mind later.

I've put down my deposit and paid for my surgical consult. I picked my "package" which is 16,890 in total -- 410 bucks less than I was expecting because of not having to pay for the nutritional evaluation and psych consult. Since I only had $25 in co-pays for those, I've made out. It's not much, but I'll take it.

So now I'm waiting. Waiting for my tests to happen. Waiting for a call back from the office to schedule my surgery. I hate waiting!

Sunday, August 10, 2008

My Surgical Consult

I finally had a surgical consult! I can't believe it's taken this long. I decided to look into Weight Loss Surgery (WLS) back in February. I was taking my time because I knew I couldn't take off from work until this year's QuickBooks was done. But, still, it's been a wild and very long ride. I've been cancelled two times, for example.

But third time's a charm, it seems, and this time it really happened. And then I got so busy that I didn't get anything written down and I can't remember everything I was going to say! I'll try to reconstruct.

The consult started late. Apparently this is a theme with Dr. Awesome. I had been somewhat prepared for this and called ahead to see if he was running behind. They said he was by about 15 and I tried very hard to be 15 min. late but I could only manage about five. I just can't be intentionally late, I guess. I brought some stuff to read, but next time I'll bring something to eat (since it was lunch time).

I ended up at the San Jose satellite office and, I have to say, I don't like it. It's part of a plastic surgeon's office and I think cosmetic surgery is stupid. (Not reconstructive surgery -- that's awesome.) I can't believe people pay good money so they can look like The Joker. Plus there were brochures with pictures of beautiful women saying things like "parentheses don't belong on your face" as if there was something wrong with them; every room has a scale, even the bathrooms; and the decor was designed to make you think you were at a fancy spa and not a doctor's office. It was creepy.

Then I went into Dr. Awesome's office and we talked. He wanted to know what questions I had and I had a ton. We talked about my worry that they wouldn't be able to do the surgery laparoscopically due to my rib cage. He told me that there was no reason I couldn't have had my gallbladder out without being slit down the front. (Reading between the lines: my gallbladder surgeon was an idiot.) I went through my rationale for picking the sleeve and he agreed with my reasoning for picking this particular surgery.

Some points:
-I should expect to lose at least 80% of my excess weight. (But we didn't talk about a goal weight.)
-I'll need to be on Lovenox for a few weeks after the surgery -- I just love shooting myself up (Not) -- due to my history of pulmonary embolism.
-Hunger tends to come back around 14-18 months but it's never like it is now
-Most people need to get to goal by 12 months because the longer you go, the more you start pushing the rules and the harder it gets.
-Less than 5% of sleeve patients can't get enough B12 from food.
-I'll probably still have excessive facial hair even if after I lose weight (Expected, but still disappointing.)
-I might have a hiatal hernia and, if so, he'll fix it during the surgery, but either way my recent horrible heartburn should be better with the surgery.
-I don't need to do an autologous donation so I guess I'll give at the blood drive at work next week and not worry about it.

Then he asked me questions about my medical history. At the end, he handed over four pages of stuff. They have everything set up so that the doctor checks off little boxes on the form based on what you tell them and it turns into a prescription for your PCP. There is also a master checklist. I thought that was so cool! I love systems and organization so having something like this that makes it less likely to forget a pre-op requirement and organizes it all makes me smile.

I was sure that LapSF and Dr. Awesome would be well suited to my own approach to health care and, so far, that hunch is panning out.

Here are all the tests I have to get:
-Psychologist Referral -- but they'll accept the one I already had done, which I expected
-Registered Dietician Consultation -- but they'll accept the one I already had done, which I didn't expect
-Nine different blood tests (within two weeks of the surgery)
-Pre-op History and Physical including a PAP and Mammogram done with in a year (which I have already done)
-EKG
-Upper GI
-Cardiac Stress Test

I also received a 35-page Post-op guide that has all the info I need about pain management, eating, exercising, etc. for after the surgery and a 30 page Pre-op guide that is more about why have the surgery and which surgery to have. Dr. Awesome said it would probably be more interesting to my family such as my husband since it was clear I had researched pretty thoroughly before I got there. I lent it to my mom when she was up for the wedding and I think it helped her feel a little better about deciding to get the sleeve (vs. the Lap Band).

Then I left. Then I came back because I forgot to pay. Oops. I got to use my FSA debit card though so that's good. I was a bit worried about cash flow since I have to pay for the surgery up front and I was planning to use a combination of my annual bonus and my FSA account.

I called up my PCP as soon as I got back to start scheduling all those tests and got some bad news. She's on vacation until the end of August!! So I went to see a different doctor within the practice -- the one Mr. Mac sees -- and he was kind of resistant to the whole thing. I don't think he liked some other doctor telling him what to do. Dr. Boyer (my doc) will be fine with it, but I can't wait that long. I'll probably have her do the lab work and Physical when she gets back since they need to wait until just before surgery and I got Dr. Whiny to give me a referral for the other tests in spite of himself.

I just realized I haven't got a blog name for Dr. Boyer. I'll have to think on that. I guess I could call her Dr. PCP but she deserves a better name than that to reflect how great she is.

The Cat is out of the Bag

I think I mentioned that my sister found my blog. (Hi MacSis!) I put a link on my main blog site where I put more stuff about the family and random rants on random subjects, so it's not like I didn't want my family to come here. In fact, that's why I put it there -- so family and friends could find out about my plans without me having to tell everyone. I was trying to be low key. While blogging. Ya right.

Anyway, in spite of wanting it to happen, I was nervous about going to my niece's wedding on Friday. I figured everyone would have been talking about me and taking sides on whether it was a good idea. (Hey, I would in their place.)

But it wasn't so bad. The wedding was the focus and I didn't know most of the people so I doubt they were talking about me. The next morning MacSis and MacMom and I went to brunch at the hotel and talked about stuff.

During that time I had a revelation. If you had asked me a year ago if I was ever going to get weight loss surgery, I would have probably said something like "are you out of your mind?! That stuff is dangerous! Plus I'm not that fat. WLS is for *really* fat people. I bet I don't even qualify." To get from there to where I am now has been a very long process with lots of soul searching and research.

Therefore, I can't really get too pissed off when someone who hasn't really thought about WLS at all isn't exactly in the same place that I am about it. I went on a journey and I have to bring my friends and family along on the same journey if I want them to keep up and be supportive. I mean beside the general "I love you and I'll be there for you" kind of support. Specific support requires specifics.

So, in an effort to bring everyone along and to calm any lingering fears that people who care about me have, I will offer up the following:

-My surgeon (the awesome Dr. Awesome) has done around 4000-5000 bariatric procedures. He's been doing sleeves so long that when other guys were just starting to do them, he had already done about 500. In all that time, he hasn't anyone die on him. Not every bariatric surgeon can say that.

-The hospital I will be having the surgery at - California Pacific Medical Center -- is an award-wining hospital and a bariatric Center of Excellence. They were rated one of the top 41 hospitals in the US by some organization called LeapFrog. There is another study showing that hospitals that do a lot of bariatric surgeries -- at least 125 a year -- are significantly safer to have surgery at than ones that do 25 or less a year. (My surgeon alone does more than that and they have a bunch more bariatric surgeons operating out of CPMC.) There is also a study that shows that hopsitals with a 5-star rating on the Health Grades report had a 65% smaller risk of hospital complications than at a 1-star hospital and 41% lower chance that a 3-star hospital. CPMC has a 5-star rating.

-The Vertical Sleeve Gastrectomy has overall complication rates in line with the Lap Band. It is not a bypass type of surgery and there is no malabsorption. It is also considered by LapSF to be the best surgery for patients over 50 because it has this low complication rate while still having weight loss similar to bypass.

That's all for now... because of the wedding (which was very nice), I haven't had time to write about my surgical consult. That's going to be a long one, so I'll get to it in a bit.

Monday, August 4, 2008

Good lord, I'm fat!

I am a person who thinks of myself as thin, even when I'm not. I look in the mirror and I minimize my weight and concentrate on the awesome stuff -- look at those knockers! or what a great haircut!

Now, it's not that I don't know I'm fat. I am reminded that I’m fat at least once every day. It's more that I've managed to convince myself that I'm not that fat. I have convinced myself that I haven't crossed any invisible line and gone over to the side of "I maybe be overweight, but I'll never get that fat." Even though I have.

Every once in a while something happens to jolt me out of my pleasant fantasy though. Usually it's a photograph. I see how big I am and it's like someone sucker punched me. Of course, the camera does put on 20 lb. right? So maybe I really don’t look that bad. See how it easy it is to talk myself back to my own reality?

Well last night I had one of those moments. Only it wasn't something I could talk myself out of. You see, I took my measurements. And the tape measure doesn't lie. I am fat. Very, very fat. Much bigger than I thought I was.

And here I was thinking I should have taken them twenty pounds ago because now it won't be a true picture of my weight loss journey and blah, blah, blah. Now I'm thinking, thank goodness I didn't take them back then because then they'd be EVEN BIGGER. I’m not sure I could take that, to be honest.

Anyway, here are the damages:

Chest 43"
Bust 48"
Waist 41"
Hips 51"
Stomach 53"
Thigh 25" - right; 24" left
Calf 16 - right; 16.5" left
Arm 15 right; 14" left

Also, based on my wrist measurements, I have a large frame. But my wrist used to be at least an inch smaller so I am disinclined to believe that. Maybe it's part of my "I'm not big" delusions, but I've heard before that the wrist method isn't accurate for the morbidly obese and I used to come out right on the cutoff between small and medium back when I was merely overweight.

I decided not to put my measurements in the stat box on the right because there are too many of them, but I may post updates from time to time for people who think that's interesting. Hopefully next time it might not be so much of a shock.

Friday, August 1, 2008

Have you lost weight?

Weight loss surgery (WLS) patients are encouraged (and sometimes required) to lose weight prior to surgery. So I've been drinking more water, eating my protein first, and trying to eat smaller portions and not rush through my meals. As a results, I've lost almost 20 lb. Now, I can see it. I've noticed it in my face. My clothes are fitting loser too. But when I ask my family if they can notice, they look at me like I'm nuts.

This is why I was walking on air at work the other day when someone passed me in the hall and asked me if I'd lost some weight!

See... I'm not crazy. You really can see it!

I'm hoping I can lose another 5 before my surgery for a total of 25. The smaller I am, the less risky the surgery will be and I'm all about minimizing risk.