I started my research in July, 2005.  It wasn't until then that I found out that health insurance covered this surgery; I always thought it was considered cosmetic.  I'm 37 years old with a bmi over 77. 

8/20/05 - First time I've ever spoken out loud about the subject voluntarily - with my sister-in-law.  She was very excited for me, that I even am 'pondering'

10/5/05- Today my sister-in-law took me to her aunt, who is an anestesiologist, who happens to have worked with a bariatric surgeon for the past 15 years.  She told me everything she knows and has seen.  Gave me a lot to think about.  I have so many fears. 

11/18/05-Had a first consult with Dr Wasser in Willingboro.  Instead of a consult, I was treated as though I was being booked for surgery that day; the office staff scared me off with their lack of professionalism, courtesy and knowledge.  I didn't get a good feeling from the staff or the doctor.  Part of me thought it was just me looking for any excuse to bail on the whole thing, then part of me thought, well, trust your instincts/first impressions mean a lot.  Turns out, as we left, my sister-in-law had the same reservations, and her first words to me were "you're not having surgery here."  I was like, NO I AM NOT!

2/1/06-My sister-in-law encouraged me not to give up; so I spoke my family doc about having surgery, who was very encouraging.  I asked if she had any patients who had it done, and she's had a few, and 2 of them had gone to Dr. Matt Kirkland.  The name was very familiar to me because when I was looking at my health insurance book, his name came up a few times.  He's at Pennsylvania Hospital, affiliated with University of Penn, so my sister-in-law is very happy, because I'll be at one of the best hospitals. 

2/23/06- Tonight I attended a mandatory 2-hour Info. Session at Pennsylvania Hospital.  It was an auditorium, filled with people just like me.  I was so nervous driving there, not sure why, but maybe because this was all getting too real for me.  But once I was there, I started to feel a little more at ease.  They first have you sign in, then they give you this big fancy binder, full of everything you would ever need to know about surgery.  This blew me away, in comparison to the photo copies and lack of information I received from the first Dr. I saw in Jersey.  What a professional organization; the manual they give you is top notch, compared to the poor photocopied pages I rec'd in NJ-that were also very discouraging and derogatory about overweight people! 

3/23/06- Surgical consultation appt. with Dr. Kirkland’s office – me and Traci (weight:  492).  Well, I was really really scared this morning.  Didn’t know what to expect.  There was 3 other patients there, too.  We all sat in the wating area, and Dr. Kirkland comes out, in scrubs.  He was handsome, reminded me of McDreamy on Grey’s Anatomy!  I was also immediately more comfortable, after seeing him, because he’s much older than I expected. I had seen his picture on the internet, and he must have been fresh out of med. School in that picture, and I was nervous about him being so young, so new!  So, I guess I would say he’s in his 40’s, not sure.  But I immediately felt comfort.  It was weird.  He talked for about a half hour or so.  Telling us all about the surgery.  There was a question and answer part.  This one black woman, on state insurance, who clearly did not do her homework on the surgery – she was asking stupid questions, things she would have known had she read anything about the surgery.  And when Dr. Kirkland would say something, she would be like, “no way”… she was so annoying.  It was obvious she was there because she was on state funded health insurance and they pay, so she figured, why not, she clearly was not serous about it, or she would have done her homework.  Anyway, Traci had some questions for him, but I cant even remember them all.  One answer was that Pennsyvlania Hospital does a lot more weight loss surgeries than University of Penn.  That the mortality rate with Dr. Kirkland was under 1%.  And his rate of leaks after surgery was about the same.  Dr. Kirkalnd was on the board of Bariatric Surgeons or something.  I also remember reading he was voted one of Philadelphia Magazines Top Docs several years in a row!!  After Dr. Kirkland was done speaking, we then were called to an exam room, one by one.  Cindy, Dr. Kirkland’s nurse, took me back to get weighed.  Then brought me and Traci to a room.  She spoke to us briefly, no medical exam (strange).  She told me that she wants me to go see the Vascular Surgeon for an ultrasound of my legs to see if I have any blood clots.  If I do have one, then I’d have to have a vena cava filter inserted through my groin area, this would prevent blood clots after surgery.  If I have this done, it’s done the day before the weight loss surgery (RNY).  This was a major setback emotionally, for me.  Cindy talked about all the requirements in order to get the insurance to approve you, that I had to do before I could even get a surgery date.  I have to go see a lung doctor (pulmonologist), they may send you for a sleep study to see if I have sleep apnea.  Then I have to go see a cardiologist, for clearance.  I should get an ultrasound of my gall bladder, to make sure I don’t already have gall stones.  People that lose a dramatic amound of weight, fast, tend to develop them after surgery, so if you have them already, they will remove your gall bladder during surgery.  She did tell me all my family doctor had to do was write a letter stating that she approves me for surgery, and that is all my insurance would require!  Another insurance requirement is a psychiatric evaluation. You have to go meet with a psychiatrist, I guess to see if you are mentally ready for this, or have other disorders or eating disorders.  After we met with Cindy, Jim the nutritionist, met with us.  I cant even remember what he talked about!  We did find out that, we have a 2-hour nutition class with him a few weeks before surgery, to learn how we eat after surgery.  He also said the $200 cost for this, is lifetime, in other words, I can see him any time I want after surgery (no charge).  And if I make my follow up appointments with Dr Kirkland on Tuesdays, then I will always see Jim at those appointments as well.  Today went better than I expected, I left, very very comfortable tiwth this doctor and his practice, and told Traci this was the place.  She agreed, but still said let’s just check out Univeristy of Penn.  I am very upset inside, about the Vascular Surgeon appointment.  I was not prepared to hear anything about this.  I’m really scared now.

April 7th, 2006 – had my psychiatric evaluation today – I’m not crazy!!!

April 12, 2006 – went all by myself today to 2 big appointments, Traci couldn’t make it and I was freaking out:  Dr. Casey (pulmonologist) appt. (set appt. for sleep study); Vascular Surgeon appt. for ultrasound of legs

May 2nd, 2006 – received insurance approval for surgery!

May 25, 2006 – told Vicky (my best friend) about my plans.  It was such a big relief to get that off my chest.  She was very excited for me.

May 30, 2006 – first support group meeting at Pennsylvania Hospital (me and Vicky).  This was 2 hours and it was so informative.  We heard from the nutritionist and the program coordinator.  They go around the room and do like a roll call, and the post-ops tell how much weight they've lost, etc.  It was really encouraging to see and hear from the post-ops.

6/7/06 – Booked my surgery date - Monday, Oct. 16th, 2006!!!

June 10, 2006 – told my 20 yr. old niece, Angela.  She was scared for me, but I talked with her for a few hours, showed her all the research I've been doing the past year, funny, I had to put her at ease!

June 26, 2006 – Support group meeting – Vicky and Traci came with me

July 14, 2006 – gall bladder ultrasound - I really am praying for gallstones, so they can remove the gallbladder at the same time of wls.  I'm so concerned with all I'm hearing about how many people who have a lot of weight to lose, and they lose it so fast, they develop gallstones soon after surgery, only to have to go back in for surgery.  I don't want to have to go back in!  If your gall bladder looks bad at time of surgery, dr. will just take it out. 

July 15, 2006 – sleep study at Pennsylvania hospital – this was the absolute worst night EVER.  They hook you up to all these wires – coming out of your head, your chest, your shoulders, your stomach/heart, and your legs – and then expect you to sleep comfortably?  I tossed and turned literally all night long.  Plus, I am just getting over a cold, so my nose was stuffy all night.  By 6am, when the lady came in to wake me up, which I was already awake, just counting down the minutes until I could take this crap off, I was overly-exhausted.  I threw my clothes on, didn’t even brush my hair, and left.  When I got home, I had a little breakfast, then went and laid down.  I was so exhausted, I was sick inside.  That feeling you get when you are so tired, where you feel physically ill.  It took me the rest of the weekend to recover.

July 17, 2006 – informed work of medical leave.  This was really hard, because I did not want to deal with work knowing anything.  I just told my boss I will be out beginning in October for medical leave, having surgery, and it is not something I choose to discuss right now.  I can't deal with those people in my office knowing.  I am just not ready for that yet. 

July 24, 2006 – today Dr. Casey, the sleep study dr., called me back with my results of the sleep study.  He said I have a very, very mild case of sleep apnea.  He wants me to go back for another study, this time, wearing a CPAP, so they can get my readings, to set me up with my own CPAP.  To me, this is bad news; one, because I do not want to go through that night of sleeping hell at the hospital again, and two, because I really do not want to wear that mask every night. 

August 7, 2006 – cardiologist Dr. Lori Frank/routine appt. with Dr. Pellecchia – today did not go as well as planned.  I had what they call an ‘abnormal EKG.  So they put me on a heart monitor to wear for the next 3 days, to get a better reading of my heart.  They also have me scheduled for an Adenosine Nuclear Stress Test.  I have to go at the end of the month to do this, and it’s a 2-day test.  I’m really scared, can’t stop crying about it.  I am also pms-ing, so that is making matters worse.  I’m so scared, where I really want to tell mommy, I don’t want to have to go to the stress test alone, but I don’t think I want to upset mommy with that either.  Traci said she’d take me, which is great, but she’ll have the kids, so she’s only going to be able to drive me. 

I went to see Dr. Pellecchia after this appt., very upset about what happened at the cardiologist.  She told me that it did not mean anything significant.  She said that all it meant that my heart skipped a milli-second of a beat; which can be normal, for me.  The EKG is a reading of my heart for only 1 minute.  This is all starting to get to be too much to handle, way more than I ever expected.  Dr. Pellecchia did tell me that my gall bladder scan came back perfect – excellent condition.  This is the one test I WANTED to be bad, because I am so afraid of developing gall stones after I lose weight and having an attack, I am so afraid of having to go back into surgery again. 

*somewhere along the line, got a call from Cindy at Dr. Kirkland’s office – she said Dr. K is no longer doing surgery on Monday’s, so they rescheduled my date for Wednesday, October 18th.

August 21, 2006 - the heart dr. just called me  - she said nothing alarming with the results – she saw some slow heart beats, mainly while I’m sleeping… said it may be an affect of the sleep apnea and nothing too concerning… makes me feel a little better, but I still have to go for the nuclear stress test which is what I’m really scared about

August 25, 2006 -  I had the 1st part of the nuclear stress test today, at Hahnemann. I was so nervous inside, like I was crying inside. I started out in the waiting area, waiting for them to call my name. I see this good looking bald male nurse/tech – with a goatee, and I prayed he was not going to be my nurse.... I really wanted to die when he called my name! Out the door with humiliation! He told me he had to get me weighed!!!! - I WANTED TO PUT A GUN TO MY HEAD!!! He was really nice, and turns out, his twin sister had gastric bypass a few years ago; I was so embarrassed, initially, to be around the medical staff but it seems as though more and more, there are people everywhere who've been through it or know someone who is, and these people you're embarrassed to be around, turn out to be really nice and not look down on you... Next they put the IV in my arm. Laid me on a table, and hooked me up to all the heart monitor wires. They prepped me for what to expect while the Adenosine was injected into the IV. They said the affects would only last 5 minutes, but to be sure and speak up if anything felt funny. So, they start. And at first, I just felt a strong warm sensation in my chest, about a minute later, I felt it going down my legs.... Then it got warmer and warmer and a weird feeling inside, I can’t even explain. I felt sweat dripping down my forehead, as the nurse Michelle even said “how you doin’, I can see your face is red, so I know its working.” It started to feel like something was sitting on my chest; I was so scared I was having a heart attack and spoke up the whole 5 minutes – saying how warm it felt and that it felt tingly and heavy, they just kept saying, you’re doing good, and counting down the minutes of time left. When they said I was done, I was so relieved. I just kept saying, you’re sure I’m not having a heart attack? After that, they told me to go down to the cafeteria and get something to eat. And come back in an hour for x-rays. I felt so nauseous and wiped out. It turns out the receptionist at the cardiology desk had gastric bypass a year ago – she showed me her drivers license picture from last year – she really has lost a lot of weight. She told me a lot of positive things. We talked until it was time for me to go back for x-rays. They strapped me on this small board that was ½ the size of my butt, another embarrassing moment, I was so scared I was going to fall off! Anyhow, the x-ray machine moves over you for about 20 minutes and takes pictures. Then I was done. I was so emotionally drained afterwards. On Monday, I have to go back for more pictures. Now I wait... for the results, and pray that they are all clear. I asked the doc/techs if they could see anything wrong, they said they couldnt from the dye test, that the pictures tell that

August 28, 2006 - Part 2 Nuclear Stress Test - It's all over!  They injected a 'tracer' through an IV, felt no side affects.  They sent me down to the cafeteria and told me to eat - eating somehow pushes the tracer through your system.  An hour later, went back up to take more xrays on that skinny table!  There was a different tech there today that wasn't there Friday, so I asked her if my symptoms/reaction on Friday was normal, or a sign that there could be a heart blockage.  She said it was normal and that if they saw anything, they would have had me wait to talk to a doctor.  So, I feel a little bit better.  Can't wait to get the results from the doctor.

August 28, 2006 - Part 2 Nuclear Stress Test - It's all over! First I woke up this morning with that old familiar pain in my lower back – SCIATICA!  I know that pain all too well, so I spent the day trying to pretend it wasn’t there.  Maybe I slept funny; I didn’t sleep well at all lastnight; I was up every few hours; I think it’s my nerves?  I don’t know.  Anyway, Traci and the kids picked me up at 8am and dropped me off out front; went up and they were ready for me - they injected a 'tracer' through an IV, felt no side affects. They sent me down to the cafeteria and told me to eat - eating somehow pushes the tracer through your system. An hour later, went back up to take more xrays on that skinny table! Boy, my back was hurting.  There was a different tech there today that wasn't there Friday, so I asked her if my symptoms/reaction on Friday was normal, or a sign that there could be a heart blockage. She said it was normal and that if they saw anything, they would have had me wait to talk to a doctor. So, I feel a little bit better. Can't wait to get the results from the doctor. 

Sept. 1, 2006 – Nothing new to report – still waiting on results from the stress test! I called the doctors office every day this week – she wasn’t in, and they kept telling me the report isn’t back yet.  Called again today, and someone actually looked into my file, because they saw my follow-up appt. isn’t until Sept. 25th, and I said the doctor wasn’t going to make me wait that long to get the results.  But the results still aren’t back – so now I have to wait until next week!!!  Same thing with Dr. Casey’s office – the sleep study results – he never called me back!  But I have an appt. w/him next Tuesday – so we’ll see what kind of machinery they are going to have me sleeping with!!!  Back is feeling a lot better today – Dr. Pellecchia put me on Prednisone and Flexiril – something kept me up all night having to pee!!! But the good news is, I’m feeling better! Back pain is the last thing I needed to deal with right now! 

Sept. 18, 2006 - I picked up my Cpap machine today- my settings are 6.  I don't know how I'm going to be able to sleep with this thing, I am a stomach sleeper, this is going to be hard.

Sept. 19, 2006  - My cardiologist called today and told me she was writing my letter of approval for surgery!  My stress test results finally came back and there is no heart damage!  I am so relieved.  This is it.... that was my last clearance to obtain.... surgery is really going to happen now... I am freaking out inside!  I still have to tell my family!

Also, I managed to sleep with the cpap/mask for just under 2 hours lastnight, my first night.  Then I ripped it off.  I feel claustrophobic at times and then it was so hard to sleep on my stomach and get a good position for my face in the pillow with that mask on!

Sept. 21, 2006 - Tonight I told my parents.  It was very emotional, but they were both very happy and "proud" of me - my dad told me he supports me, then started crying! 
Well, the cat is out of the bag.  Fear has officially kicked into high gear.  Next week, I plan on telling the remaining members of the family.

Oct. 12, 2006 – had last appt. with Dr. Kirkland today.  First met with Cindy his nurse.  She spent about 40 minutes with us just going over things to expect while in the hospital and afterwards.  She told me they have already reserved a spot for me in ICU.  I’m concerned only because maybe they are concerned about my heart?  She said it’s due to my size and my apnea.  I do feel good knowing that I’ll be there – I’ll get better care, and a private room, can’t beat that.  She said she wanted to tell me before hand, because she didn’t want me to wake up in ICU and freak out, because I’ll think something went wrong; it’s also good for my family to know ahead of time, so they aren’t panic stricken, thinking something went wrong also.  Dr. Kirkland came in at the end.  I just feel so comfortable with him – not nervous, which is a good thing, to be comfortable with the man who is cutting me open!  He explained that he’ll do a liver biopsy while he is in there; that obese people tend to have fatty liver disease, which can lead to cancer or cirrhosis.  Great – one more thing to worry about – and throughout my year and a half of research, this was the first time I have heard anything about this subject.  As I was signing consent forms, my hand was shaking.  I told him I felt like I was signing my life away.  He also explained to me the reasons for NOT taking out a healthy gall bladder – that it does have its cons.  This, after I expressed my desire for wanting to have it removed.  His reasons of course made sense.  He said he’d still give it a squeeze during surgery and if it had stones, he’d take it.  He is very reassuring and very confident.  This was it.  This finalizes everything – I’m really going to have surgery next week.  I just can not believe this. 

Oct. 14, 2006 – Tonight I went out to dinner with Joey, Traci, Rudy, Cathy and Andrea to Outback.  I honestly had no appetite although I hadn’t eaten much all day, so I should have been hungry.  I still ate, but I just didn’t have the appetite for it. It was a nice night and fun, just what I needed.  Just wanted to be around the people who mean most to me and who care about me and vice versa.  Just wanted to be myself and not be ‘the one who is having surgery’ in a few days.  Have had a sore throat for 2 days now – worried that I’m getting sick and fear they will postpone my surgery if I am.  I keep taking my temperature.  Called Dr. Pellecchia, she said there’s a sore throat kind of bug going around – but unless I spike a fever, she doesn’t want to give me antibiotics. 

October 17, 2006 - Night before surgery.  I tried to remain a 'rock' with my family.  I cried uncontrollably when my brother came to say goodnite/goodbye and wish me luck.  I had a grilled cheese for dinner.  Hadn't eaten much all day at work.  Saying goodbye at work was really hard - started crying and couldn't stop.  I don't think it was really about the people - I think it was just because I knew what this meant.  Around midnight, I started to get hungry, ofcourse!  So I had a stella dora cinnamon cookie!  Didn't sleep much this night. 

October 18, 2006 - Surgery day.  Woke up at 7am, took a shower and was all ready to go by 8am.  Stayed by myself in my house until 9, when my sister-in-law arrived.  I didnt want to go see my family or I'd cry.  My hospital call time was 9:15am. I arrived with my entourage at exactly that time. Checked in, and waited,,,, and waited… (special thanks to Linda Sands for checking in on me!!) around 1pm, my beeper went off, and I jumped up so fast as if I were excited (at this point, I just wanted it to be over already), and they headed us up to the 4th floor. There I got changed into my lovely hospital gown, and booties, gave a urine sample, got a shot of heparin in my stomach, they took my temperature and my blood pressure, and I waited, not too long, just about 15 minutes. This is when my family could come in 1 at a time. I cried uncontrollably. After about 10 minutes of that, I calmed down, and before I knew it, my entire entourage was in that waiting area with me, and had me laughing a bit. Then a nurse came for me. Me and my family went in the elevator together, me and the nurse got off at the 8th floor and the family went up to the 9th. I said “Bye” rather quickly and didn’t look at them as I left. We walked to a surgical prep area, where I was greeted by 2 anestesiologists, who had me lay on a table. The proceeded to have me open wide and do ‘aaah’ several times and played with my neck and chin for a bit. Saying nothing the whole time. I looked to the tech on the right and said “don’t even tell me you are going to have to do this to me awake” and he said, yes, we do. They had to intubate me while awake – they said I had a difficult airway. I panicked, freaked, cried… you name it… and got no bedside manner whatsoever from the 2 anestesiologists. They had me inhale this stuff that puffed like smoke for 20 minutes; it numbed my throat and inside of my mouth. Then they squirted stuff around the inside of my mouth, like novacaine or something, that made me gag. Next they started wheeling me down the halls to the operating room. I kept my eyes closed because I was scared but then I opened them to see what it looked like – looked nothing like Grey’s Anatomy. Next they put all of these pillows up on the operating table, then I had to assist them in moving onto that table – I kept saying, I’m not going to make it up there, but somehow I did. Last thing I remember is being propped on a bunch of pillows, with my neck hanging over them, and gagging…. Next thing I remember is waking up in recovery and them trying to get me to assist them in moving me onto a bed. Woke up in my room with them saying ‘your family will be here shortly’ and looked up and there they were. Cant remember much about the first night; only what the family says. They say I kept saying I needed drugs all night long, so they upped my morphine and gave me a shot of something every 6 hours. I do remember them telling me I needed to sit up on the edge of my bed. It wasn’t so bad, but as I stood up, it just felt like gravity was pulling everything down. My mom and my aunt were able to sleep over with me, because I had an empty bed that night. Dr. Kirkland came in the next morning for 2 seconds, and he pointed to the green bracelet on my right hand that said “difficult airway” and said that it took 35 minutes for anesthesia to get me ready beacus of that, but that surgery went fine, no complications. He said because of the difficult airway, he may want to keep me an extra day to keep an eye on me. That day after surgery, I was also out of bed at 9am, getting washed by myself in a chair. Sat in that chair all morning; then around noon, took a walk around the whole floor, and then back in the chair until about 4pm. Felt pretty good. Friday, I was tired, and only got out of bed to go to the bathroom, which I didn’t even want to do. Was tired and sore, and didn’t even want to go home. They discharged me about 4pm, but I didn’t leave until 7:30pm. First night at home I took a percocet, but it didn’t help me sleep. Sleeping was a nightmare. Went from my parents bed, to their recliner, to my couch… back and forth. Awful. Same thing for the first 3 nights – I couldn’t take it anymore. Finally made it to my bed, got on my side, propped with some pillows, and before I knew it, I was partially on my belly, with a pillow stuffed under it, and got some sleep! I called the Dr.’s office the next morning to make sure I wasn’t damaging anything inside if I do sleep on my belly. She said my body will tell me what it can and can’t do and I wont hurt anything inside. So sleeping has been better! I haven’t had a percocet since my first night home. The week went by good. I was doing more and more on my own, even able to get in/out of bed and on/off the couch without assistance. Even showering and “WIPING” on my own by Monday! Well, showering I was able to do on my own from the beginning. Took brief walks during the day. Not much pain, just discomfort. Tolerated liquids very well. Was scared to move to full liquids – but got there with no problems. I just am very, very bored with this stage and have no desire to consume anything. No hunger whatsoever, but boy, do I want a cracker in the worst way!

10/27/06 -Fast forward to 1 week home, this past Friday night, where it was about dinnertime, I got up to go to the bathroom; and I looked down at my belly, and seen a trickle of fluid running down. So I wiped it up. Only to notice it kept running, like a faucet. It was semi clear with red/yellow fluid. I was freaking out. Called the surgeon. Dr. on call said he would like to make sure one of the internal incisions didn’t open and suggested I go to the ER. Crying like a baby the whole time, we waited in the ER for 2 hours, as the fluid amount increased dramatically, when I moved, even more came out. Got into an exam room after 9pm, and the ER doc commented on how great I looked after just having surgery a week ago. She said she didn’t think it was anything serious, and very common, that it could be a collection of fluid that builds up that just needs to be drained. We waited for Dr Fitzpatrick to come down, he is on Dr Kirkland’s team. So it turns out that I have a seroma – it’s a collection of fluid/blood that builds up after surgery beneath the skin, and is supposedly very common, not caused by anything I did. Drawback – they had to cut me open without numbing me first!!!!!!!!!!!!! They ‘said’ that the numbing part would hurt more than what they had to do…. If you can even believe that! So once they stuck scissors inside and cut me open again, to drain it, all this gross stuff kept coming out. They kept pressing my stomach to push it out. After doing that for a while, they stuck packing inside the incision under the skin, and left a small piece hanging out. Then they put lots of gauze on and taped me up; I have to pull the packing out tomorrow, and keep it covered; told me it could take days for it to finally stop draining. But they don’t stitch me up again because they said it will heal from the inside-out, once all the fluid is gone. They said I don’t show signs of infection, but if symptoms occur, I will probably end up back in the hospital. He said normally he’d assign a visiting nurse, but being that it was Friday night, and the weekend, that’s not possible. Since I have a follow up appt. with Dr Kirkland next Tuesday anyhow, he could determine then if I still need a nurse. He said I would most likely still be draining by then. Very sore, very tired, very drained, we were home by midnight. I still didn’t take a percocet. I think because I take so many vitamins and pills daily, the thought of taking another, is not appetizing!