- Name: Not Penny's Boat
- Username: Glamtastic
- Location: 5K From Everywhere, MN, USA
- Member Since: 12/21/2007
- BMI: 37.5
- Post Op
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2-year sleep apnea check-up on April 7, 2008 9:37 pm
Nearly two years, I had my apnea diagnosed as I was being worked up for surgery. Here's a copy of a recent post I made to a thread asking about what to expect during a sleep study. I'll be doing my first re-titration this week - but thankfully this time my pulmonologist is on-the-ball, and I'll be taking home an Auto-pap with a microchip rather than having to go into the lab. I'll post my results when I get them, but my post pretty much gives the gist of things to this point:
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You would need this done no matter what type of surgery you were having. It's primarily to rule out any difficulties they may have with respiratory concerns and anesthesia - and beyond that, it's to check if some of your other co-morbids may be related to the apnea itself.
Weight isn't the primary cause of apnea in "all" people, but it can exacerbate the symptoms.
I had undiagnosed apnea for more than a decade, it runs in my family. High blood pressure, never feeling like I got enough sleep, having to get up at night to pee, snoring - those are all possible apnea-caused symptoms.
I was diagnosed prior to surgery with severe obstructive apnea. I was put on Bi-Pap with pressures of 22/15 (Bi-Pap simply means that the pressure changes for inhalation and exhalation). I figured I would probably need a machine, but I had no clue my apnea was that severe. Ventilators start at a pressure of 28 - that's how severe I was. It was this realization that my apnea was THAT bad that tipped the scales, so to speak, in my decision to get surgery. My pulmonologist was frank with me - getting the weight off will definitely improve the apnea, but it may not eliminate it 100%, because it could simply be the anatomy of my sinuses/throat causing it.
Flash forward 19 months post-op, 180+ lbs gone, I had my check-up with the pulmonologist last week and will be doing a home titration study this week because I've "graduated" from my original pressures. The doc was pleasantly surprised at the progress I've made - he estimates I may be down to 18/12 - with the goal being a single pressure of 15 on C-pap (just inhalation). We'll see when my study's complete. I still have about 60 lbs of weight loss to go to be 'maxed out'. If I can reach a pressure of 15, we'll be out of the woods - I will graduate to a simple C-pap, or just a dental device at night. Much easier to live with.
As far as the sleep study goes - it really isn't that big of a deal, you don't "feel" any different, the wires stay out of the way. For me, it was having the glow of the machines and knowing there were cameras trained on me that kept me up. I had to do a second study, only that time they gave me an Ambien so it was easier to fall asleep, and that's where I got my titration numbers.
My advice:
- Check with your referring doc ahead of time if you think you'll have trouble getting to sleep - they can at least have a standing order for Ambien or something similar available to you if you do find you're having trouble falling asleep - if you wait til the day of, it might not be possible
- Ask to try out the different masks prior to starting to study - there is a nose mask and a full face mask, they also have nasal 'pillows' - but those aren't typically used for titration studies, they're more for comfort over the long haul. And don't be afraid to ask to switch if they fit you with one during the study and it's not comfortable. Each person has a different comfort level. They started me with a nose mask, but a full mask is what I needed, because my eventual pressures were so strong.
They will likely split the night into two parts - first few hours, they'll monitor you just as you normally sleep - no masks or anything. If they find you're having obstructive episodes, they'll rouse you to fit you with a mask and then watch you from there. Some people find they don't have any apnea, so they just sleep through the night and go home.
They may also take a quick blood gas (lab draw) prior to bedtime and then when you wake up - it's just to measure the C02 level in your blood - an indicator of how well your lungs are working when you're awake vs. when you're asleep.
If you truly have apnea - this study can be a godsend, because the machine really DID help me sleep better. I don't regret having gone through the studies at all, and I'm anxious to see my new numbers when I'm done with my study this week.
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18-month post-op milestone on March 10, 2008 12:39 am
I don't officially reach it on the calendar for another week, but I had my check-up last week, and I was surprised at how "uneventful" it was. And how interesting it was to be sitting in the same office with other folks who were showing up for their pre-op seminars, reflecting on how far I've come since I was (sort-of) in their shoes.
Parking at this particular office is tricky - it's part of a university and hospital campus which presents its own concerns, but the 35W bridge collapse closed of some of the access to it, so I took a bus, a train, then a bus to get there, and walked over to the clinic on a day when it was -15 wind chill. And it didn't occur to me until I sat down in the chair after checking in that I wasn't doing some things:
1) Wasn't out of breath
2) My heart wasn't pounding
3) My feet weren't hurting
4) Wasn't reaching for my inhaler
What I WAS doing:
1) Crossing my legs
2) There was enough room for me and another person in my one bari-sized chair
3) thinking about the rest of my day vs. how I was going to plan my walking to make my connections to get back home
4) thanking my lucky stars that I had another good lab draw and no symptoms to report - my visit would be short
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Things that are "new" since my last check-up in July '07:
1. No longer have high blood pressure - it actually runs a bit on the low side sometimes, it's been resolved for more than 6 months now, so I can cross it off my current medical hx
2. I've shrunk - waist circumference and clothing sizes are a testament to that - I'm down 3 sizes since my last check-up
3. Rate of weight loss has slowed a bit, but is still dropping consistently - per their charts I'm within 80 pounds of "chart" goal - about 65 to my own personal comfort goal (point at which I may need to start looking at plastics to make any further major strides)
Other things: I put my exercise/training off for a few weeks due to a death in the family in January and February - managed to maintain on the scale during that time. Didn't exercise, but knowing that, paid better attention to my food intake, and frankly, didn't have the desire to eat through the grief. Last week I began my spring 5K training and realized that, even despite being "off" for 6 weeks - I've built up such a base that 4.0 m.p.h. on the treadmill is no longer a "jogging" pace - I can walk that pace now. 5.0. m.p.h. is now my "challenge" pace. That was a bit of a shock - I was expecting to have to go back to square one there, but apparently making exercise a habit improves your tolerance, and the effect lasts a while.
The other thing that continued to happen during the hiatus is that I continued losing inches, even if I just maintained on the scale. People who saw me before Christmas are seeing me again now for the first time in weeks and are telling me I look like I've been "doing something." My clothes continued to get baggy.
I imagine it's the "adjustment" effect - the time off gave my bod a chance to catch up to the changes that had been taking place.
Original clothing size pre-op:
Pants/bottoms: 6x (could not wear 30/32W's from Fashion Bug)
Tops: 4X-5X depending on the style/cut (whether it was butt length or not)
Clothes sizes before Christmas '07:
Pants/Bottoms: 20/22
Tops: 18/20
What I can wear now:
Pants/Bottoms: 20 (18's in certain cuts/styles)
Tops: 16 - 18 depending on the style/fabric
XL t-shirts are fine, 1X -shirts give me room, and 2X t-shirts are becoming PJ tops
(OMG - just realized as I typed this that I'm approaching the point where my top size and my bottom size are getting close to being the same number - wow :) Is it possible that my butt is now approaching normal proporions????)
And best of all - I spent the day today in a skirt and my thighs didn't rub together/chafe/catch fire like matchbox! :) It's been a long-long time since I've had to "worry" about that - another thing to celebrate being "gone" :)
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The Myth of Restriction and Rules = "suffering" on February 21, 2008 7:53 pm
Certain folks seem to get their jollies comparing the eating rules and habits of different surgeries as though all things being "equal" - the people who eat less are thereby suffering and the people who eat more are somehow eating "normally."
Here's my take on this false premise.
1) It's not suffering if it simply takes less volume to hit your "sweet spot" of fullness after a meal. Not NEEDING to eat two servings of mac and cheese to "feel" like you've had what you've wanted of it is actually very liberating for most people, and what some folks who haven't had the more restrictive surgery will NEVER fully understand about it, yet they deem themselves somehow qualified to comment on it.
2) People's definitions of "normal" eating tends to be warped - especially the formerly obese trying to tell others that eating more than 1 cup (chewed consistency) at a time is somehow "normal." Normal for whom? For the 60% of Americans who are technically overweight and obese? Normal for an American and normal for a French person are two completely different concepts, for example. A French person who begins to eat like a normal American will put on weight. I've seen it first-hand.
The body (unaltered) doesn't need more than a cup of balanced nutrition at a meal. A normal weight human being isn't eating "normally" when they eat more than 2,000 calories' worth of food consistently in a day. Having a surgery that requires a person to take in more than that simply to maintain status quo is actually causing that person to eat ABnormally by default - despite whatever they may be convincing themselves of to the contrary. There's absolutely nothing wrong with that if that's what their surgery choice requires - the problem is when they try to sell their version of "normal" as though it's the standard bearer, when it typically isn't.
3) The same people who criticize other people's "rules" find themselves ironically posting menus and portions that aren't grossly different, yet still trying to convince themselves that the "others" aren't enjoying their food choices. It starts looking a little schizophrenic after a while to see the same mantras repeated in one post, only to find the same people posting menus of the same type they just got through crticizing. I've heard RnYers and DSers alike describe their bottom-line day as "I eat what I want, just not as much, and until I'm satisfied." Both groups take food home in to-go boxes. Both groups enjoy treats and holidays and good-tasting food. I know of no one from any of the forums who follows a set-in-stone, paint-by-number menu of bland and boring. The only people who have anything to complain about are those still healing from surgery, both sides, who are looking to move on and expand their choices.
I'm one of many RnYers who isn't limited in my choices. I can have my carbs and eat them too. But ask me if I "want" or "crave" those things or if I feel deprived when I choose to go for things that are healthier and more filling.....It's not "suffering" to pass by the doughnuts and leave them alone when I can have CHEESE! :) and be full on its yumminess and get in some good protein at the same time. I can still have the doughnut if I truly wanted it, with no irrational fear of weight gain, because I wouldn't need the whole box. The difference is that I enjoy the cheese/protein so much more. Food doesn't have the psychological grip it once did because my satiety point isn't still set at "bottomless pit" like it was prior to surgery.
4) I was not a person for whom the possibility of dumping syndrome factored into my choice. And as it happens, it wouldn't have mattered, as I'm in the category of being a non-dumper.
But there's a misconception out there that continues to be perpetuated by non-RnY folks that just because a person seeks the risk of dumping, it must mean that they intentionally SEEK to suffer. That they'd WANT to be ill. I know of no one who's ever considered the possibility of dumping syndrome being something they wanted simply for dumping syndrome's sake. It's like knowing that sitting in the sun without sunblock can cause a sunburn, so you put on a certain SPF and still enjoy the sunshine. People who forget to pack it will likely have a bad reaction. Some can still go out in the sun for a little bit at a time and not have to worry about it.
Seeking help in behavior mod in this way isn't a weakness. Anyone trying to convince people otherwise is off their rocker.
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It boils down to mind games. There are some folks who want to feel like they're mavericks for choosing a surgery that isn't as well-known and yet works for them. It helps the serotonin to think that other people are out there "suffering" and whining about not having made the same choice. But the boards are full of people of all stripes who have never in their lives been more CONTENT and HAPPY :) yes - HAPPY! :) with the rules for their procedure. People who have just as easily dropped their weight and co-morbids.
If normal means feeling like you 'have' to give in to every craving, have food still remain your lord and master (psychologically speaking) - then I think there are many people who would say that a certain group of people can "keep" their version of normal.
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Misconceptions about the misinformation people... on February 17, 2008 9:23 pm
It's a common theme in certain debates to discuss whether people who choose one surgery over another are informed "enough" about their choices or simply about what WLS "is."
One thing that occured to me in thinking back on my "long term" view of WLS was that I was once part of the "it's not for me" camp. Too many risks, too illogical to re-arrange organs that were functioning fine in and of themselves - the usual things most outsiders still latch onto. Was impressed with some people's losses, but knew that they had obviously made a choice that would endanger their health down the road, right? That changed the minute I actually stopped listening to those claims and did my own homework.
The point is that for many of us - we arrived at the decision to have WLS after wading through that "outer" layer of misinformation about WLS in general. That's no small feat. And to say that people who've waded through that "initial" layer are somehow not informed "enough" if they then don't choose one procedure over another is extremely short sighted - more a function of the naysayer's personality than of reality. Almost like saying "Everyone would buy my new gadget X if they only knew about it." There is no such "gadget" or "surgery" X - human beings are always going to want and need different choices. The battle is won when you get people to peek into the convention hall to simply "look" at the different booths.
The people we should be concerned about are the folks who are suffering, still struggling with the so-called "healthy" way of doing things, and yet believing the Oprahs of the world; not taking that step to simply find out what WLS is - still telling themselves, after decades of dieting failures, that this "one more time" will do it, and holding off another year, two years, five years, until they find themselves back even further than square one. Once they get past that initial "door" - the decision is no longer an "if" - and the "misinformation mambo" isn't nearly as critical - that dance is going to be different for everyone who shows up to the party.
WLS isn't for everyone - certain procedures have advantages for certain conditions over others. But the real irony is that people on OH are arguing amongst themselves, when the REAL battle is with the people who aren't even asking questions yet. The folks who aren't reading OH.
Just my take on things.
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OT and a bit of a PSA: C-diff on January 25, 2008 8:11 pm
Here's the wiki describing what it actually "is" - Clostridium Difficile http://en.wikipedia.org/wiki/Clostridium_difficileTwo reasons why I'm posting: One: My grandmother developed it last fall after gallbladder surgery and it's now looking as though she's going to lose the battle - it never really went away. The symptoms got better about a month ago, but she got some general lung crud happening and went back on antibiotics and "boom" - it came back. Only this time it's kicking her butt - she was scheduled to have her colon removed this morning as a last-resort effort to get rid of it, but never made it into the o.r. - she went septic during prep and we're waiting to hear what the next step is going to be from here (she lives on opposite end of the country from us). So - it's something we kind of knew was on the horizon, and I just needed to vent a bit. Two: you have to be careful with antibiotics and intestinal flora. Antibiotics can't be avoided, and C-diff might actually be preferable to the alternative if you don't treat whatever condition it might be - but be sure you know what type of antibiotic you're being given, what the dosage is, and monitor your bowel health closely, whether you're recovering from surgery or treating an everyday kind of condition. C-diff isn't easy to get rid of even for otherwise healthy people of a younger age. Not meant to scare anyone - it's more an exception than a rule that someone taking serious antibiotics would develop c-diff - but it's a consequence that many people don't know about or don't think about, and it can very quickly make life miserable. Literally months of constant diahrrea and the toll that takes on the body. **end of PSA** My family's at peace with what may be happening with grandma - she has a strong, comforting faith in God, which in turn comforts us to know she's not afraid. Just needed to take a minute to gather my own thoughts and offer the experience up to others for whatever it might be worth.
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My Story My Weight Story:
Obese since age 7, due in large part to lifestyle - I was a brainiac kid in inner-city Memphis adjusting from private school to public school where I was the oddball. Both parents worked full time, weren't fond of cooking, so we ate out a lot and were left to our own devices for play, entertainment. We had Atari and a Texas Instruments computer that kept us enraptured. I still managed to go out and roller skate, play tennis out in the street with neighbor kids, but I "lived" in my head and the better I did in school, the more positive attention I got from adults, the more negative attention I got from the kids around me, which started the cycle of feeding emotions with food.
Was part of a university weight loss program for kids at age 8 where we were taught green light, yellow light, and red light food choices. When i did well at the scale, the reward was to go to a "healthy" fast-food restaurant that had a salad bar and frozen yogurt. The program did nothing to stop the cycle of weight gain.
Age 12, mid 1980's and I join Weight Watchers for the first time. Their program was about "exchanges" - you eat a certain number of proteins, fats, etc, each day and had bonus calories - they even wanted you to eat liver once a week. It was the first real "diet" I remember having to "work" at - but I felt motivated to do well. But there was no support for the mental changes people needed to keep on track, and I was only 12, and I was the only one in the house who was technically obese at the time, so you can imagine that worked like a charm!
Flash forward through a couple more attempts at weight watchers and exercise as I got through high school - even was part of the track team my senior year. I managed to keep myself under 300, but still never out of the obese range.
College and the freedom of making my own choices about everything just saw those behaviors that had been kept in check "somewhat" before explode into binge eating. This was the point where I got above 400. A relationship ending had caused me to get on a health kick - I went extreme low-fat, did aerobics and strength training, and got to my "best" adult weight of 240 - felt terrific, but was still not at my best weight - and ironically I was in clothes sizes larger than what I wear as a post-op in the 250's, 260's - more serious strength training played a role in that.
But - life changes, relationships come and go, and I went back to the "feed" cycle. Finished two years of grad school, got my first "desk job" after having worked as a language prof in France and back home at my alma mater. And worked my way back up to 400+ at 29 years old. Only this time around my luck at having been "healthy" despite being big had run out. I went to my PCP to ask why my feet were swollen beyond recognition all the time, and the discussion went back to weight loss. She showed me my chart for the past 3 years, and the numbers just kept steadily creeping up. We had already ruled out PCOS the year before, I talked to her about my 8th or 9th or umpteenth re-joining of weight watchers that same year. I had even at one time had two gym memberships - one at Bally's where I had a personal trainer, and one at a YMCA close to work where I would swim laps on my lunch break. Could never seem to get below 350 this time, so I quit trying, and figured I was ok, as long as I was mobile and healthy. But the blood pressure numbers and the wheezing I was doing just walking from car to store, car to desk at work was proof that I was in some serious denial. Family and friends were guarded in telling me, but they were scared for me. My doc during that visit asked if I had considered WLS - and I told her I honestly didn't have an opinion at that point because I hadn't looked into what it "was" to know if it was for "me" or not. So she referred me to a seminar, and I went just to get more information, and the rest is history.
I wasn't sold on the idea of surgery until a month or so after I had my insurance approval letter. I had done my research to know which procedure would be my ideal, but I still struggled with the "if it's mostly in my head, why bother?" doubts that most of us go through. I went through the work up process figuring I had the right to choose not go through with it at any time, and getting the testing done would only be helpful - giving me a better ballpark idea of where my health is at. And it's the results of the testing - the sleep apnea in particular - that cemented my decision. I was titrated for Bi-Pap with pressures of 22/15. To give an idea of how powerful those numbers are - a pressure of 28 is where people start going on ventilation rather than simple pap devices. The apnea isn't likely caused by my obesity, but the obesity wasn't helping the situation, either. Realizing that I was in danger of becoming immobile and potentially trached, battling GERD and stricture ALREADY as a non-op, was my "rock bottom" moment. At 29, I knew I had it "in" me to live a better life than that.
And my decision saved my life. I literally did a 180-degree turn-around after surgery. My outlook has changed, my outer "look" has changed, I'm a "doer" and still a thinker - but my bod isn't content to sit for hours at a time. I ponder the universe while I jog and bike. The only lingering physical effects that are with me is the apnea, which has improved, but hasn't been eliminated. And I'll never be "cured" of my asthma, but I no longer take daily corticosteroids to control constant wheezing. I can climb flights of stairs without going into an attack. I have the "happy" side effects that many of us have - tail bone pain from the fat disappearing, those types of things - but that's much easier to live with than not being able to breathe!
Non-weight things:
I'm trained as a linguistics prof - French is my passion, ESL is my second passion. My research interests are neurolinguistics and educational psych. My current day job is in health care - administrative end, so I have a background there as well, but linguistics is where it's at for me.
Feel free to ask me about: bike commuting, Earl or the Office, the benefits of strength training for SMO persons, 5K distance race training and triathlon, MN, TN, SC, or France, Catholicism after being raised Protestant, Weight Watchers for post-ops, getting family on board for support
Feel free to take a hike if: you're a person who can't accept that there's more than one effective way to approach a single outcome or task
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