Sunday, September 28, 2008

My scars

I thought people might be interested in seeing my scars. This is 5 days out and they are already pretty well healed.



The one for the liver retractor is on top of the remains of my gallbladder scar which runs from just under my breasts to right around my belly button.

Still at an acceptable weight - 1994

This picture was taken about five years after my wedding picture, when MacBoy was about 2.5 years old.



As you can see, I've started to gain the weight back but I'm no where near where I was when I started (207 pounds). I'm about 165 pounds here, so only 30 pounds heavier than my lowest.

At my tiniest since college - 1989

Here's a picture of Mr. Mac and I at our wedding.



I lost another 10 pounds on Nutri/systems after it was taken. This is about what I expect to look like at goal.

Mr. Mac looks so young and he is still skinny in this shot.

Return of the purple shirt



Here's another picture of me in the purple shirt. If you look closely you can see that it's slightly bigger on me, but again it's not a dramatic difference. It just feels dramatic, I guess.

Before & After - Pre-surgery pix

Mr. Mac took these the night before the surgery. You can kind of see that I've lost weight compared to my first set of "befores" but it's not as obvious as I'd been hoping.



Yes, I'm still listing to the side.

Weight Loss Surgery Requires discipline

According to this Jane Brody article Weight Loss surgery requires discipline.

To which I say "no duh". Getting WLS has been the hardest thing I've ever done and I've only gotten to the point of just having had it. I still have to lose all my weight and create a post-op life for myself.

I really don't understand the whole "easy way out" and "cheating" mentality that people have about weight loss surgery.

Speaking of "cheating", MacBoy had a birthday party today. I am on a liquid diet at this point because my staple line isn't healed enough to eat solid food. So I sat in the middle of the party and watched 15 people eat stuff I couldn't eat. Not wouldn't eat or chose not to eat, but couldn't eat or I'd die. If I had been on a diet, I could have "cheated" and had a mini Hershey bar. And I would have too.

This is one of the reasons that WLS is harder, in some ways, than dieting.

Once I've had it for a couple of years, I'll tell you if it's easier in the long run, but I'm guessing the only thing "easier" about it is that it works. Of course, that's a really big win for me, but it's not like the surgery does all the work and that's what I think people don't get.

Friday, September 26, 2008

I'm a post-op!

Hey, I’m home from the hospital! And what a long, strange trip it’s been. In fact, I’m pretty sure I dreamed most of it since a lot of what I’m about to report will seem unbelievable – I don’t even believe it. But I’ll let you be the judge.

We went up to San Francisco on Tues. evening because going up from our house during morning rush hour is iffy at best. Sometimes it takes 45 min. and sometimes it takes three-four hours. Having to be there by 6:00 am would mean leaving at 4:00 am that day to be sure to get there in time and even then, we might be late.

My husband drove us up and Mini-Mac, the youngest, went with us. MacBoy is a teenager — in other words, weird — and had been nursing a cold and fighting coming with us even before that so we left him home. I knew he was worried about me, but more worried about crying in front of me or some other behavior that would seem absolutely horrible to a teenaged boy, so I didn’t push him to come up even though I knew all the things he was dreading – like seeing his mom in pain – weren't really going to happen. Plus I didn’t feel like getting sick from him.

The Cathedral Hill Hotel is very pretty. Our room was enormous. I couldn’t believe how nice it was for a downtown SF hotel under $100 a night. (Thought that is the special hospital rate. I think normal people pay more.) When we got checked in, I took my Milk of Magnesia and that meant I couldn't go over to the hospital to visit Ainjul from the ObesityHelp.com "sleeve" board as I had originally planned. I needed to stick close to the bathroom, if you know what I mean.

I think it was okay because her surgery got put off until 5:00 pm so at 8:30pm there was no way she’d be up for visitors. I know I wasn’t really up for them until about ten hours after my surgery.

I had some really weird dreams that night. Mostly about being late and everything going wrong. I got up in the middle of the night and realized that, when we flipped the switch to turn off the lights over the bed, it had turned off the clock radio! (Luckily I never trust the hotel alarm clocks and had also set an alarm on my iPhone.) I ended up giving up on sleep around 4:50 am and decided to take a shower. This is when I discovered that there was no hot water. Just freezing and lukewarm. I went for lukewarm.

So I guess Cathedral Hill is a more typical of $100 a night SF hotel room than I'd originally thought. It’s still a nice place though.

There is a shuttle from the hotel to the hospital, but the first one left about 45 min. after we were supposed to be there. So, based on the info that the hospital is six blocks from the hotel, we walked. And discovered it was more like 15-20 walking blocks and uphill almost the whole way! My daughter whined the whole time until the ground leveled out and she could use her Heelies, but I practically ran the whole way because I so excited.

We checked in and paid. Good thing my surgery was Wed., because Thurs. my bank failed. (Seriously, it’s WaMu. Failed and sold to J.P. Morgan.) They took me to different rooms and had me sign things and change into a hospital gown — which barely fit around me. This was bad because the Milk of Magnesia had really kicked in by then, so I made lots and lots of trips to the bathroom clutching my gown around my buttocks. I was surprised because I was expecting a bariatric-sized gown that would swim on me.

Between the day of clears and the MoM, I had dropped another three pounds – assuming that their scale and mine were calibrated the same.

Mr. Mac and Mini-Mac got to come with me for part of the prep, but then had to go to the lobby when I hit the “holding pen”/recovery area. I forgot to leave my glasses with my clothes so Mr. Mac took them. Being without my glasses is very disoriented to me so this increased the feeling of unreality.

While I was waiting in my little holding cell, I listened in to other patients. (I’m so nosy!) The guy next door was in for something completely unrelated, but when he listed all this previous operations, he had had a gastric bypass! Isn’t that weird how you can go for years without hearing about something but then suddenly it’s everywhere?

Most of the people talking to patients were anesthesiologists and didn’t impress me that much. I was starting to get worried – because the anesthesiologist is the one who keeps you alive. But mine came in and I really liked him. He gave me a lot of confidence.

He had a resident with him and he was explaining stuff to her and raving about my airways – both in the holding room and also, later, in the OR. Apparently my neck is an anesthesiologist’s dream. Who knew? I’ll have to tell my mom because she’s always telling me I have a pretty neck and mom’s appreciated stuff like that.

They walked me to the OR (to prevent blood clots) and I got on the table and they prepped me. At one point they said, “let’s call Dr. Awesome and make sure he’s here and not in traffic.” I was surprised he wasn’t already there. In fact, I never saw Dr. Awesome the entire time, which I thought was strange. But I did go out like a light soon after so he could have been there the entire time and I wouldn’t have known.

When I woke up in recovery, I had some pain, but not too bad. They had me hooked up to that machine where you give yourself a shot of painkiller whenever you felt like it. Here’s another weird thing – the LED panel said it was morphine. It’s not supposed to be morphine, right? But between the no glasses and feeling like I was dreaming, maybe I just misread it.

I took full advantage of whatever it was and, as a result, the next 24 hours had a very dream-like quality. But Mr. Mac says that everything I said that happened when he was there was true, so maybe I didn’t dream it all. On the other hand, if it turns out that I was dreaming the entire time, that’s totally believable too.

In the recovery room, I had to pee but I couldn’t use the bedpan. (Nothing came out.) I swear they let me walk to the bathroom because no one else was there. That seems questionable, doesn’t it? But later on they wheeled more people in and then I was stuck with the bedpan. So maybe I just had a rule-breaker looking after me.

My next memory was being in my room. It was a very tiny room. I had trouble getting my IV wheelie thing to move around with me because it kept getting caught on things. Plus it plugged into the wall. So if I went far away, I had to unplug it and it would go on battery power. Again, that doesn’t make sense and it part of why I think I dreamed the whole thing.

Anyway, the room felt a bit like a private room that had an extra bed shoved into it. Mr. Mac and Mini-Mac were there with me. Mini-Mac had read her card and really appreciated it so I’m glad she wrote it. She bought me a round stone that said courage on it in English and Chinese from the gift shop.

But I didn’t visit with them much as I kept falling asleep. Around 3:00 pm, they went home. I was unhappy to see them go, but couldn't blame them. I'm sure they were bored out of their skulls.

I walked the halls a lot, but pretty much never saw other patients there, just medical personnel. Again, that seemed strange and contributed to the dream-like quality of my experience. I expected a ton of bariatric people, but it’s an enormous hospital and we seemed to be scattered on different floors. During this time, my roommate was sleeping. At one point, Ainjul came by to visit me on her way out the door. She said she was on the fifth floor. (I was on the fourth.) Maybe I was on a non-surgery floor so all the patients weren’t supposed to be walking?

Then my roommate woke up and that’s when everything got very, very Fellini. She was making a lot of noise. Moaning and rocking back and forth and babbling incoherently and picking at herself. Her hands never stopped moving. It was distracting, but I thought the nurses were very mean to her in response and that put me on her side, whereas normally I’d be upset with the moaning.

They said she had to stop because she was disturbing the other patients, which she was, but how is yelling at a sick person who is clearly out her mind going to get her to stop? It reminded me of when I had my gallbladder out and the nurse in the recovery room was saying I was disturbing everyone with my crying and I was saying “but I can’t freaking BREATHE” until I made them give me more morphine and could breathe and calmed down. So this treatment of “Jessie” (I think that was her name) really pissed me off and I decided to adopt her.

I got some ice chips at some point and then later my first meal of clears. It had a Popsicle, some broth, some tea and some sort of Healthwise protein drink (with a little bottle of Arrowhead water to mix it up with) and jello. After I’d worked on it for a time, the nurses kept trying to take it away. But I wanted to eat/drink it all because of the protein. At one point when I wasn’t looking, they took everything but the protein drink and a pitcher of water. I was annoyed. I never even got to try the broth.

I also had trouble with the drinking. I was taking tiny, tiny sips but they still hurt. So it would be sip, okay, sip, pain, sip, pain, sip BRACK! (That last part was the belch-a big, loud one). I finally decided to use the straw from my water glass and that helped a lot. But it took forever to finish a drink and I don’t see how I’m going to get my protein in at this rate.

I also kept falling asleep while drinking and ended up spilling tea all over myself. The staff said they weren’t sure a bariatric-sized robe was available, but I told them the regular ones fit well enough. Besides, I had a robe with me to keep myself from giving the rest of the world a show.

I did eventually finish the Healthwise drink, which has a whopping 15 grams of protein. Yeah me! I would have been happier if I’d had the jello too, though.

Then I concentrated on my roommate who was still quite upset. Over the course of the evening, I pieced together her story — obviously the medical staff couldn’t tell me much because of HIPAA and she couldn’t tell me much either because she was out of it — but she was an elderly patient from a nearby nursing home and had dementia. (Though, I’m not sure if someone told me that or that was my homegrown diagnosis.) She wasn’t in for that, but I never figured out what she was in for.

Honestly, I think she was just old and everything was giving out and she didn’t much want to live either. She was on a catheter and also she never got up from her bed the entire time I was there.

She couldn’t really make herself understood to the staff either, but at some point, I got used to her special language (the Mother Skills never die and old people and toddlers have a lot in common) and could piece together what she wanted much of the time.

Mostly, it seemed to me that she was lonely because all of her friends and family her age were dead (she kept asking for various people by name and sometimes I could make out that they were an uncle or sister or something who had died and she missed them) and also, she didn't like losing her mind. I guess she still had enough of it to know what she was missing.

Several times she said something that made it seem like she wanted to die. I told the staff – because suicidal thoughts are not good – but they didn't seem to care. Of course, I was high as a kite on painkillers and kept losing my glasses, so maybe I only thought I had told them. Or maybe they didn’t take me seriously.

This is the same staff that delivered my spirometer but never really showed me how to use it. I was unimpressed with them. Note to afternoon staff on the fourth floor at CPMC: you suck.

The evening staff was much better. They showed me how to use the spirometer and were nicer to "Jessie". (I don’t think that was her name – it’s just what I ended up calling her.) They actually brought the earplugs for me that the afternoon staff said they'd get and didn’t. They said between the earplugs and my headphones listening to music, I should be okay, as that has worked for the gal in that room the night before. But I couldn't get the earplugs to work at all and it bothered me to just block “Jessie” out.

In the end, I spent a lot of time perched on the end of her bed rubbing her back and soothing her. She liked it when I held her hands too. This kept her quiet so the staff wouldn’t get on her case and it occupied me and kept her from picking at her bandages. It kept me off the Internet though so that's why I haven't checked in with anyone or answered any messages.

During this time, I kept waiting for Dr. Awesome to show up as I had questions for him. I’d hear he as “in the building” and did catch sight of him a few times, but he never came to see me. So I asked about it and the nurses said he wouldn’t necessarily come see me if there was no issues (again this seems iffy to me—maybe I just dreamed it?) so I put in a special request and around midnight he did pop in and answer my questions. Too bad I didn't take notes because my recollection of our conversation was hazy at best.

One thing I did figure out – that horrible pain I’ve been having in my middle left back off and on for years that felt often felt like a muscle tear and, at one point, I thought was related to my allergies? It was the hiatal hernia! Dr. Awesome said all my back pain at this time was because he repaired it. He apologized for it, but I was so happy to have my heartburn disappear and to not have that localized pain that I didn’t care.

Most people tell their bariatric surgeon that he saved their lives because of the weight they lose. Dr. Awesome improved my quality of life dramatically in one day just by fixing the hiatal hernia. He's my hero!

Around 2:00 am, the night nurse (Henry?) came in and gave me a shot of something called Tramadol. It was AWESOME. No pain and I felt like I could paint my house. However, I was now wide-awake. This was good though because "Jessie" was not in good shape. In fact, I ended up crawling into bed with her. Again, this makes no sense to me that the hospital staff would let me do this. Think of the liability! But I'm pretty sure I did, in fact, do it because at one point her doctor came in and pointedly asked me if I was a family member.

I scuttled back to my bed and let him draw the curtains between us so he could poke at her and ask her questions she couldn’t answer. Then as soon as he left, I scuttled back.

I did question the staff at various points about what was wrong with Jessie because I was afraid I would accidentally hurt her by sleeping with her like that. They were tight-lipped, but never did anything to stop me. I think they were so grateful that I was keeping her quiet that they didn’t want to rock the boat.

At one point, I told them it wasn't fair to Jessie not to be in a private room – that all these strange people coming and going were upsetting her. They agreed, but said every hospital bed was in use (reinforcing my idea that my room was supposed to be a single). Plus, later the rational part of me realized that old folks who’ve been left to die in nursing homes don’t get private rooms.

Then, the morning staff came back and at this point I was really wiped out from not having slept since the anesthesia wore off. So even though I was in better shape than the day before, I was more out of it.

I actually remembered some of them from the day before, which made the whole thing seem like less of a dream. They were also nice so my goal at this point was to get checked out by 11:00 am (like the sign in the room said to) before the dreaded afternoon staff came back. I felt bad abandoning Jessie, but not bad enough to stay another day.

Breakfast came and was a repeat of the day before except my Healthwise drink was orange and not red. Because of what happened with dinner, I made sure to try everything on the tray at least once.

I got a visit from Amy, the LapSF nutritionist soon after. We exchanged paperwork (medical leave forms) and then I wanted to go some stuff in the book to make sure I understood it. She was happy I was working on the protein drink and said it looked like from my breakfast tray that I was going pretty well. I forgot to tell her about the pain when I drink though.

Either she or Dr. Awesome said I shouldn’t take my blood pressure medicine any more, but that I should monitor it. Also, since the Potassium Chloride is only being taken because the HCTZ is, no more of that either. Yeah, I’m so happy! Except I can’t find that in my release notes so now I’m wondering if I made that up too.

At that point, all I had to do was get a sponge bath from my day nurse and then I could go home. But Mr. Mac hadn’t shown up yet! I was sort of annoyed, but when he did show up – with Mini-Mac, who I thought was supposed to go to school – he said traffic was horrible just as we had feared it would be if we came up on Wed. There was an accident on the bridge among other things and it took two hours to get there instead of the one it should have taken.

They got me all packed, I had my sponge bath, and then I said good-bye to “Jessie” and went home. I did make sure to get one more shot of pain killer from the blue box before they disconnected me. Also, because I still felt kind of loopy, I had them take me down to the curb in a wheelchair so I wouldn’t fall over and be sprawled all over the payment

As soon as I left the hospital, and got out in the sun, I had a massive case of dry mouth. Of course my chapstick was in my robe pocket. But, I realized, so was my iPhone! I made Mr. Mac open up my suitcase and make sure the phone really was there before I left. (The chapstick was no where to be found though and later appeared in Mr. Mac’s pocket.) Then we were off!

I kept falling asleep on the way home and at one point thought we were almost home when we were still on the Bay Bridge.

At some point, I found out that Mr. Mac hadn’t called the people on my list. My angel, Janet, called him, and he called my mom. But not my sister or my friend Michelle. So I called Michelle. At least I think I did. That might have been a dream too.

When we got home, Mr. Mac set up a station for me in the bedroom and MacBoy came in and gave me a big hug. I could tell he’d been worried about me. He hadn’t read his card though so he went off to do that and then I didn’t see him again until I went looking for him. Teenaged boys are so weird. They live most of their lives holed up in their rooms playing video games and texting their friends.

While sitting in bed catching up on Dancing with the Stars, I got a massive case of the itchies. It was my incisions. The glue on them was flaking all over. So I scratched at them and picked at it until I was sorry. I couldn’t stop though. Eventually I had Mr. Mac cover them with first aide cream and band-aids so I couldn’t scratch them any more.

Then, I decided to weigh myself to see how much water weight I’d gained in being hooked up to IVs. Remember that 191 figure they told me in the holding area? Well I was 10 pounds heavier when I got home. Ouch!

I had Mr. Mac make me another protein drink for “dinner”. Between that and breakfast, I had 50 g of protein so that’s good. But I’m supposed to have more so I tried an Isopure ready-made drink later on. I didn’t get very far with it though.

I also got a fever. You are supposed to call if it’s over 100.5. Of course mine was at 100.5 exactly. But it went down and was only 99.3 at bedtime. I took off the band-aids at that time because they were making my scabs moist.

This morning I was down to 196 pounds so I assume that water weight is going to fall right off. I’ve sure been peeing enough. I still have slight pain when I drink but nothing I can’t handle. Some slight itchiness too, mostly on the top of my breasts. I have no idea why it’s in that particular area.

My incisions look great too. Dr. Awesome used the top of my gallbladder incisions for the liver retractor and now it’s in better shape than it was to start with. The ones around my waistline do hurt occasionally especially if I stretch to get something off a top shelf. So mostly I make Mr. Mac do all my reaching.

The really great thing is that my stomach feels entirely normal. I was worried about that the most. With some of these operations, you end up with stomas and other weirdness that makes it hard to judge normal and can limit what you can eat.

My main problem at this point is that it takes forever to finish a protein drink. I’m still working on the Isopure from last night. Also, I can’t suck hard enough on my spirometer. Related to that, when I tried to go to bed last night, I couldn’t lie down and had to use too pillows to prop me up.

So today my goals are to get in at least 50 g of protein – as least as much as yesterday – and to walk around the neighborhood and also to blow on the spirometer until I can get up to the 1500 mark every time. I don’t want to get pneumonia.

Mr. Mac is home to help me and the kids have no school because it’s Native American day. It feels like Saturday, but it’s nice.

I’m sure I’ll think of something I left out later on, but for now, that’s my sleeve story.

Tuesday, September 23, 2008

Calm before the knife

I woke up this morning with a sense of calm certainty, which over the course of the day has turned into excitement. After all my angst and drama, it's nice to be back to normal.

Clear fluids all day.

It started out good -- I wasn't even hungry most of the day. But then around 2:00 pm it all caught up to me. I was STARVING and also my heartburn was horrible because I stupidly only drank clears that were citrusy. Crystal Light Lemonade. Lemon sugar free jello. Orange Citrus sugar free popsicle. So then I tried to have some other jello and some other popsicles with fruiter flavors. It didn't really help. I cant wait to get this hiatal hernia repaired.

We're at the hotel now. Our room is fantastic. For $90 a night, we have an enormous room and everything is pretty, clean and quiet. This is not what I'm used to staying in downtown San Francisco! I'm watching the Biggest Loser. It seemed appropriate. Strange show though.

Anyway, I've taken my Milk of Magnesia and I'm just waiting for the big event so I can go to bed. That stuff is pretty nasty, by the way. I thought it wouldn't be a big deal because I only had to take three tablespoons and -- compared to the gallon of Trilyte for my colonoscopy last month -- that should be nothing, right? I swear, I was could barely choke it down.

Now I'm supposed to write my cards to my kids and husband, but I can't seem to get motivated. It seemed like such a good idea at the time.

Tomorrow's the big day and I can't wait.

Sunday, September 21, 2008

2 am. Can't sleep

I've been having trouble sleeping. It got really bad tonight. So here I am on the computer.

When I go to sleep and wake up I have the same thoughts "Have you lost your mind? How can you pay someone to cut off your stomach?" But during the day I'm excited, picturing my future and how I'll be able to do all these things that are hard now and not have to take so much medicine.

It's a scary kind of exciting though because the future is unknown. I could have complications and insurance might not cover them. I could be one of the people whose hunger comes back fast or who can't keep down a lot of different kinds of foods. I could lose a lot of weight, but develop some completely unrelated health problem and die prematurely anyway. Plus, even if everything goes about as perfect as it could possibly go, it's not like I'll never have any problems ever again.

On the other hand, I could go back to skating and actually get an ice dance partner this time. Or take up ballroom dancing and win lots of trophies. I could become a fashion diva and enjoy clothes shopping for the first time in my life. Or maybe I'll go in a completely different direction that I never would have thought of living my life as I was.

Someone asked me if I am going to write a letter to my loved ones just in case something happens. Apparently "everyone" does this. I guess I'm not everyone, because it never occurred to me. I know nothing is going to happen to me. That's not what I'm afraid of.

But then I think: what if it does and my kids are left confused and resentful.

So I think I will write them a letter. Not to be given to them if something happens, but to give to them no matter what. After all, it's never a bad idea to tell your family you love them and as specific as possible.

Tuesday, September 16, 2008

100 Calorie Packs: Marketing junk food as diet food

A recent trend in the snack food industry is to package food into "100 calorie packs". When I first saw these "packs" on the shelves, I gravitated toward them because the packaging made them seem like diet food. But when I got closer and saw that they were mostly the same snacks that I avoid like the plague when in their normal packaging, I was bemused.

"How can chips and crackers and cookies be healthy?" I asked myself. Sure, some of these packs use baked chips instead of fried. But they are still mostly carbs and they still usually have 30 % or more of their calories from fat and negligible amounts of protein.

I can hear the Yes, buts now ...

Yes, but they are only 100 calories, you are probably thinking.

It certainly seems logical that you will eat less if you limit yourself to a 100 calorie pack of Teddy Grahams than if you grab some from full box of Teddy Grahams. But apparently we are not logical creatures. (Shocking, I know.) In fact, scientists are now studying this new snack food phenomena. (I guess I wasn't the only one who was bemused.)

Their conclusion? Smaller packages encourage you to consume more.

I admit I was quite surprised to read this. I bet the snack companies aren't though. Sneaky devils.

Another "Before" photo

I found this picture on the web the other day and was HORRIFIED.



I think this really shows off how BIG I had become more so than the shots Mr. Mac did as my official Befores. I'm not exactly sure why this picture horrified me more than my full body shots, but it did. I'm guessing it's because I'm wider in this shot. Or at least it seems that way.

I still have that shirt. Maybe I'll wear it and take another picture to see if you can see how much weight I've lost already.

Now they all know

Okay, I sent out an "Early OOO" notice as is the custom with my group at work telling people that I'd be on medical leave starting next week and someone came up and asked me if I wouldn't mind telling them what it was for.

So I did.

But everyone was in that morning and there is no privacy in a cube farm so I am going to assume everyone knows now.

I await developments.

Monday, September 15, 2008

Medical Leave confuses me

I'm having so much trouble figuring out my medical leave stuff. My company has all these other companies that do a lot of the work for them and that includes some national company to "manage" our leaves. I think sometimes it just puts obstacles in the way instead of helps us.

So I called the 800# and they sent me a packet. But in the packet it says I have to get the forms for CA SDI myself. Then on one of the forms I have to fill in how much CA SDI is paying me. How will I know that until I get the check? (The CA SDI site is confusing too -- I already tried to get forms from there with no luck.)

I'm so confused!

The cover letter says nothing helpful. either. It's so vague. I remember a lot more handholding from HR when I had my maternity leave. I guess all our cost cutting is having it's effect.

Oh well, at least one of my sleeve friends is in HR. In fact, she used to work for my company! I'll show her my forms at the support meeting on Wed. and maybe she can help me.

Saturday, September 13, 2008

I am a dieting success. No, really.

Did you hear about the study where at two years, 95% of the people had regained the weight they lost. This was just from the group that actually lost weight. About 42% of the people in the study dropped out because they couldn't lose the weight.

So if you define success the same way they did: as "losing all your weight and not regaining it all in two years", I've done that. That makes me a dieting success, right?

There is another study that says that 98% of the participants had regained their weight at five years. So 2% did not. I went on a diet once and did not regained all my lost weight by five years. (It took me about six or seven to do that.) So I guess I'm a success according to that measure too.

Another measure said that 20% of people were able to lose 10% of their excess weight and keep it off for a year. Heck, by that measure, I've been a dieting success at least four times!

Wait: how can you be a success if you regain all your lost weight and then some more than once in your life?

Common sense says you can't. These measures of dieting "success" are ridiculous, both because they define success in too short a time period and because they set the bar so low.

The bariatric surgery industry's definition of success is slightly more reasonable. They define it as keeping 50% of your excess weight off for at least five years. By that definition somewhere between 70 and 90% of bariatric patients are a success.

One study of excess weight loss of Roux-en-Y Gastric Bypass (RNY) vs. Adjustable Gastric Banding (commonly referred to as Lap Band) had each of them trending towards 50% at about fourteen years out. I think for people who have to lose more than 100 pounds, being able to keep at least half of it off more than a decade later, is a success. It may not be what they hoped and dreamed for, but it's an astonishing accomplishment given the alternatives. It also provides a reasonable amount of good health.

There are no 14 year studies weight loss with a vertical sleeve gastrectomy, but early results are promising and this surgery (and the related Duodenal Switch) address of a lot of the issues that cause 50% long-term EWL with these other two surgeries. There are longer term studies for the Duodenal Switch and excess weight loss is better than with Roux-en-Y in both the short and long-term. The jury is out on whether the sleeve can do as well long-term without the malabsorption component, but, at least for a certain percentage of the population, it seems reasonable to think it can.

But let's say all I can hope for long term is 50% excess weight loss. I know I'll be less than happy if I only get down to 150-160 pounds -- about 50% of my excess weight -- in the beginning. But if I get down to 110-120 pounds and then gradually, over a period of 10-20 years, creep up to 144-155, I'm not so sure I'd be wildly unhappy, to be honest. After all, I've been in that range before and my blood pressure was fine, I could still shop in a normal clothing store, and I was reasonably active. Plus, hey, 20 more years of life gets me into my 70s. Something I wasn't too sure I'd see a few years ago when I was at my heaviest and everything started to slow way down and the health problems started to pile up.

But it's less than ideal and so that's not really my definition of success. My definition of success is to be like all my "tiny old lady" relatives and friends. The ones who are lucky to weight 100 pounds soaking wet and live to be at least in their 80s and die with their boots on. That's my idea of how to live and that's what I'm shooting for. Maybe not the less than 100 pounds part. But 110 or 120 pounds would definitely put me in their ballpark and I think I can do that. I've already got the "short" part down pat.

Thursday, September 11, 2008

Pre-op requirements done?

I think I'm done with my pre-op requirements. I think. I have no more scheduled tests and I'm pre-registered at the hospital.

I do have to arrange to pay the hospital and I have to fill out forms to take off from work. Unfortunately, I think I won't be able to be on disability until I'm out the 8th day. Which is also the last day before I come back.

I thought it would kick in as soon as I went into the hospital or on the 6th or 7th day. That's what happened other times I was in the hospital. Something must have changed.

With my lousy three sick days, I'm going to be cutting into my vacation time pretty quick. If I wasn't afraid of complications keeping me out longer, I'd just take 3 sick days and ask for the rest in comp time, which I feel like I've totally earned given how many overtime hours I've worked for this project.

I could also just "work" from home if I thought I was up to it for that second week. I guess I'm going to have to be talking to my boss about this.

Wednesday, September 10, 2008

I'm a Large?

That's right, I'm a size Large on top! How did that happen?!

My mom had promised to send me her fat clothes, lots of 12s and 14s. I figured that would be perfect to tide me over from my 20s until I got down to the 8s and 10s. In the end, she decided to just send the XL, L and size 16s at least for now. So I'm trying them on and all the XL and most of the L tops FIT! Heck I even managed to squeeze into one of the pair of pants. I couldn't breath or anything, but, hey, they went up all the way.

None of the skirts fit though. I think about 10 of the 25 pound I lost so far has come off my face and the other 15 pounds came off my chest with pretty much nothing coming off the bottom. A lot of the large shirts that don't fit actually fit fine around the shoulder area. It's just that they gap a bit around the bra and then don't button at all from there on down. The ones that fit are stretchier and don't button up.

There was also a gorgeous winter coat that fits now. Even when it's too big, I'm going to keep it. It would be perfect for wearing to the rink as a skating judge.

So now I have lots of pretty clothes from normal stores to wear to work... on top anyway. I'll still have to be in my about-to-fall-off-my-ass jeans for a bit longer. But not too much longer. I'm hoping the barely fit pants will fit for my friends wedding about a week and a half after my surgery. There's a gorgeous top that goes with them that fits now and I'd love to wear that and not my old stand-by lavender fat dress that I've worn to every party I've been to for the past three years.

All of this inspired me to go look at some of the stuff at the other end of my closet -- the clothes that haven't fit for years but have sentimental value or they are the special purpose clothes and I was hoping the next time that special occasion came around again, I'd by some miracle be in that size. Most of them fit too. Two were two big. However, once I figured out they fit, I promptly threw most of them out. I realized they were too beat up or too sloppy looking for me to actually wear them. I have no idea why I hung on to them!

The other thing I discovered is that I have no skirt or shorts hangers. Because I never wear skirts or shorts. I have a big pile of them on top of my dresser waiting for me to go buy some hangers. I've been trying to buy some skirts for years and they always came down to my ankles or fit funny. I can't wait for skirts to be a choice again.

Or really anything but JEANS. I've been wearing nothing but jeans for years now. They are going to fall over and die at work when I start showing up in dress pants, jackets, skirts and dresses.

My bones aren't melting!

I got my lab results back already. I only did them this morning so I was actually shocked to find the email when I got home from work today.

My calcium is back up to normal levels (9.2) and my PTH is 20. I don't know what my vitamin D is because the morons at the lab didn't do it even though it was clearly listed on my orders. They didn't do the magnesium test either. I'm going to have to go back, I think.

This is such a relief to me. I am not a big milk drinker and, until recently, wasn't doing much with cheese or yogurt either. Then on top of that, osteoporosis runs in my family. So when I saw the L next to my calcium results this Spring, I FREAKED!

My PCP said it's probably my HCTZ that was doing that and to stop taking it until I got my labs. Which I did. Plus she called today to say all my results are now at Dr. C's. YEAH! I didn't expect that part to go smoothly.

Tuesday, September 9, 2008

I <3 my PCP

Yesterday I had my pre-op physical. It reminded me how much I love my PCP.

First, she was completely apologetic about missing my low calcium levels on my last labs as soon as she walked in the door. She thinks this is happening because of taking HCTZ and told me to stop taking it until I get my pre-op labs because if it's still low they might postpone the surgery.

Of course, now I have another thing to be worried about, but there isn't much I can do about it now. I didn't take my blood pressure medicine this morning and I didn't take my Prilosec either (there is a school of thought that PPIs also inhibit the absorption of calcium). Hopefully between that and all the calcium supplementing I've been doing since I noticed the low calcium for myself, everything will be okay when it counts.

I also told her that you shouldn't take more than 500mg of calcium at a time because you won't absorb it all and, instead of getting all pissy that one of her patients knew something she didn't, she was happy to learn something new. I can only imagine how Dr. Whiny would have reacted to the same conversation.

Then, she asked me how I was feeling about it all. When I said I was nervous it wouldn't work, she said very emphatically not to be because "it works!" Somehow, coming from her, it carries more weight than when a post-op or a baratric surgeon says it. I guess it's because I see her as a neutral party in all this.

She also complemented me on being so prepared and says their bariatric surgeon thinks that's a key to success. (My medical group has a bariatric department but they only do gastric bypass.)

After the physical, I got my EKG right there in the room and she gave me a bunch of reports to fax to Dr. Awesome. Now all I have to do is have my labs done on Wednesday and have my pre-registration phone call with the hospital on Thurs. and I'll be done with the pre-op requirements. Well, beside paying for everything, of course.

Saturday, September 6, 2008

Freaking out

Now that my surgery is getting near, I've been freaking out a bit. Unfortunately it's not a rational freak-out so it's hard to know how to combat it. I'm not afraid of dying. I'm not really that afraid of a complication, though they are a possibility.

It's hard to put my finger on it, but I think that it's a combination of things.

First, I can't predict the future so I can't know 100% that this is the right decision for me until I have it done -- at which point, it's too late. The nice thing about a lap band is that you can always just get it taken out. But once they cut off that part of the stomach, it's gone, baby, gone.

This is why I've been trying to "walk the walk" beforehand -- to get an idea of how it will all work and if I can live with it. But of course, it's different now. Now it's a choice. For example, I still drink with my meals in restaurants. Because I can and not doing so is a PITA. Post-op, I won't have a choice. Drink with meals and I'll probably vomit.

It all gets back to the fact that the future is unknown. Maybe later I'll drop dead of a heart attack at age 57 but right now I'm alive and (reasonably) healthy. Yes, I'm on medicine for my blood pressure and I can't tie my shoes without sitting down, but let's not count that. Let's go with the illusion of health.

Then, I see myself, the "healthy" one and I see people on the WLS boards who were also the "healty" ones prior to surgery and now they have health problem after health problem and are actually sick from the surgery. What if that is me?

Yes, they've all had a bypass or duodenal switch, which involves intestinal rerouting and malabsorption. Or they've had a lap band and it slipped or eroded. Yes, partial gastrectomies have been around since the 70s and we know there aren't long-term complications to speak of. But the irrational part of me hears this and thinks: what if there is some weird complication that only comes up from the vertical gastrectomy that the partial gastrectomies didn't uncover?

Because the irrational part of me is really emo, apparently.

Second, I really don't want to be a person who needs weight loss surgery. THERE. I said it. I want to be someone who can lose weight "naturally" (as if there is something "natural" about going on a diet).

It really changes my self-image to realize I can't. And all the stats about how 98% (or 95% or 90% or 99% or whatever stat you go with) of the people in the world can't do it doesn't make me feel better. I guess deeper down, at a gut level, I've bought into the idea that fat people are that way because they aren't good enough. It's kind of pathetic, really. But there you go. I want to believe I'm special and better than those other people even though I'm not.

It's probably harder because, once again, I am dieting successfully. I'm under 200 lb. which means I've pull myself back from the abyss. I feel better. I also find myself getting hungry at the drop of a hat and lately it's been harder to stick to the protein first thing. Which means if I were to cancel the surgery and continue to do it on my own, I'd be in big trouble very shortly.

See, I can see this happening. I can see why diets don't work in my own life. I can see it happening right now as I'm on one. But the irrational part of me still whispers "this time you'll do it" and "this time it will work." It's like a siren's call. The rational part of my brain sees the rocks beyond the sirens but the irrational part just hears the pretty song.

The rest is just panic. I think.

I'm going to pay someone the big bucks to cut off my stomach and anything can go wrong. I could have a bad reaction to the anesthesia. I could get a blood clot. I could get a leak and not realize it in time. I don't HAVE to do this -- it's elective surgery -- and so part of me says "Don't do it."

Of course the rational part of me can't have Sept. 24th coming here soon enough. Since I am making no effort to get off the surgery train and I'm not the top to scream "STOP" as they wheel me into the OR, I think the rational part is going to win. But if anything goes wrong and I have even one little regret, the irrational part of me is going to be singing "I told you so" for the rest of my life.

Wednesday, September 3, 2008

Onederland!

I can't believe I forgot to mention this.... at my official weigh in yesterday I was under 200 pounds! Yeah for me!

Now I've been under 200 before so I'm not as excited as people who haven't seen it in decades, but it was still one of my goals. I've now made two of my goals... getting a date and getting under 200.

Wait, I've also started exercising again. So three goals.

My next goals are to get in 10,000 steps a day on my pedometer.

Longer term goals are to be in a Size 10 and take up ballroom dancing (and maybe compete on the Pro-Am circuit).

Tuesday, September 2, 2008

Too much to do

Yikes! I managed to fax my informed consent document to my surgeon's office today and I registered for the hospital so I thought I was sitting pretty. Then I got home and saw I had another packet from the hospital with even more forms. Some of them are repeats of what my surgeon sent me but there is also a Durable Health Power of Attorney to read and fill out. More forms - oh joy!

I'm also getting a call from the hospital on Thursday to go over some medical history questions. Plus I have to do some money stuff to get everything in the right account in order to pay for the surgery. I forgot to do that this weekend and forgot to call today with the credit card info. (We're going to use our Debit Card so we don't have to deal with getting a cashier's check. Isn't modern technology wonderful?)

Plus I still need to make a reservation for a hotel room the night before. Someone suggested that if I was stressed about getting to San Francisco by 6am, that I should just go up the night before. Great idea! So we are.

MacBoy doesn't want to go to the hospital for my surgery. I told MacBoy he was going and that was it. Maybe I should let him go to school instead. It just seems weird to not have him there. What if something goes wrong? I'd want to see him. But nothing is going to go wrong, so why force him to hang out in a boring waiting room for hours? But shouldn't I have my family with me? I feel sort of unnatural if I don't care if he doesn't come. Decisions, decisions.

Mini-Mac does want to come to the hospital, but she also wants to talk about my surgery incessantly. She's driving me a bit crazy with all the questions, most of which are unanswerable. I think she's going to drive me crazy in the hospital too and drive Mr. Mac crazy in the waiting room. She wants to spend the night, which I'm sure is not allowed even if I would allow it. I wouldn't mind if she and MacBoy went home at some point and Mr. Mac stayed but I think that's probably not practical.

Plus I haven't asked Mr Mac, but I'm pretty sure if he could have his way entirely with no consequences, that he wouldn't stay all night. He hates hospitals. And surgery. Now if I tell him I need him, he'll stay because he's wonderful that way. But I won't need him. Not to mention, there is a good chance I'll want him to take Mini-Mac away before I kill her.

Why I am worrying about this right now? I still have tests and appointments and tons of other stuff to do before it matters. Probably because I worry about everything.