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Results:
-I've lost a total of 71.6 lbs
     -16 lbs on Optifast & 10 lbs in the last month
-My BMI is 31.93. I can't wait to be overweight!
-I've lost a total of 37.5 inches
     -7 inches from my waist
     -7.5 inches from my bust
     -5 inches from my chest
     -8 inches from my hips
     -2 inches from my upper arm
     -.5 inches from my elbow
     -2.5 inches from my thigh
     -1 inch from my calf
     -1.5 inches from my knee
     -2 inches from my neck
     -.5 inches from my ankle
-I've lost 65% of my excess weight
-In July, I consumed on average 771 calories/day
     -23.5% came from fat (goal = 30%)
     -32% came from carbs (goal = 30%)
     -44.5% came from protein (goal = 40%)
-I drank on average 65.7 oz water/day (goal = 64 oz/day)

Observations:
-I've gone from a size 24 to a size 12-14
-My hair loss has finally decreased & I'm hoping to be back to normal soon
-I'm getting compliments every day
-I'm slowly getting used to shopping in regular stores.
-I still have to have the darned gallbladder out! I get twinges every day!

During this time:
-I'm continuing to go to the Barrie Support Group
-I'm starting a York Region Support Group on Sunday September 14th with Pixie Dusting & MDWife
-I continue to track everything I eat
-I'm still exercising
     -I do pilates & strength training weekly
     -I walk on the treadmill several times/week
     -I walk the dog daily
>I had my 4-month update with the Dietician Denise Poirier 7/23/08:
     >Denise is moving to a new office 7/24/08
     >I met the new Dietician, Sue
     >After weighing me, Denise observed that my weight loss has decreased since my 4 week update. Hmmm. Isn't that as expected?
     >She provided no encouragement at all. She could be more supportive.
     >Denise asked what I'm eating & if I'm having any problems. I'm not.
     >She ordered bloodwork, for which I had fasted. 
     >I still have not received the results so I'll have to call her for them.
     >I spent a total of about 10 minutes with her.
-I continue to get B-12 injections from my PCP

Results:
>Lost 16 lbs on Optifast & an additional 45.6 lbs since surgery for a total of 61.6 lbs.
>My BMI is 33.8 vs 45.5. I'm almost overweight!
>I've lost 56% of my excess weight
>I've lost a total of 30.5 inches:
     >6.5" from my waist
     >6" from my bust
     >4" from my chest
     >6" from my hips
     >2" from my upper arm
     >.5" from my thigh
     >1" from my calf
     >1" from my knee
     >3" from my neck
     >.5" from my ankle
>I've gone from a size 24 to 14-16
>In June, I consumed an average of 727.3 calories/day
     >24.3% calories from fat vs goal of 30%
     >29.1% calories from carbs vs goal of 30%
     >46.6% calories from protein vs goal of 40%

Observations:
>My face looks significantly slimmer
     >I've found my collar bones and my dimples. I've lost my double chin
>I have more energy during the day
>I'm developing new, healthier eating habits
>People are noticing my weight loss every day
>I continue to feel so much better about myself
>I've found many new friends through OH
>I'm having trouble building a work wardrobe! A good problem.
>I'm still losing my hair. I've cut it shorter to allow the new growth to catch up.
>I have to have my gallbladder out.
>I'm continuing to go to the Barrie Support Group
>I've created an excel spreadsheet to properly track what I eat. Gone is my little notebook
>I've introduced exercise into my weekly routine. I continue to walk the dog, but I'm also walking on the treadmill, doing Pilates weekly & strength-training weekly
>My weight loss is still pretty consistent & I'm happy

During this time:
>I had my ultrasound for my gall bladder on 7/3/08
>I had my monthly appointment with my PCP on 7/14/08:
     >She gave me my B-12 shot
     >She gave me the results of the ultrasound. I have a gallstone 
     >She made a copy of the results for Dr. Starr
>I had my 4-month follow up with Dr. Starr on 7/15/08:
     >He was happy with my weight loss
     >He reviewed my ultrasound results & felt I would need to have my gallbladder removed
          >He agreed to wait until my next appointment with him in 3 months before scheduling surgery
          >If I have another attack, I'm to go to HRRH ER & have him paged
          >He'll likely schedule the surgery right away if I have another attack
          >He explained how the surgery is performed
               >4 incisions done laparascopically 99.6% of time
               >He should be able to use 1-2 of my WLS incisions
               >20 minute procedure
               >1 week required for recovery

Results:
>I've lost 16 lbs on Optifast & an additional 36.4lbs for a total of 52.4 lbs.
>My BMI is 34.6 vs 45.5
>I've lost 47.6 of my excess body weight.
>I've lost a total of 25 inches:
     >4.5" from my waist
     >5" from my bust
     >3" from my chest
     >6" from my hips
     >2" from my upper arm
     >1" from my thigh
     >.5" from my calf
     >1" from my knee
     >1.5" from my neck
     >.5" from my ankle
>In the month of May, I ate an average of 624.6 calories/day
     >22.2% of calories from fat vs goal of 30%
     >30.2% of calories from carbs vs goal of 30%
     >47.6% of calories from protein vs goal of 40%

Observations:
>I'm buying a lot of slimming underwear/spanx to smooth my rolls
>More & more people are noticing my weight loss
>I have no clothes for work. I'm having to pin & binder-clip my pants so they don't fall off
>My hair is starting to fall out
>I've just started to be able to eat salads! I'm sooo excited
>I have more & more enjoyable eating experiences every day
>I still have no appetite, but I'm starting to have cravings for fries & gravy & buttered popcorn. Holding firm so far.
>I'm continuing to go to the Barrie Support Group
>I'm continuing to track everything I eat & I've established goals for fat, carb & protein consumption (see results above)
>I'm doing extensive gardening & can't believe the amount of energy I have. I could not have done this 1 year ago.
>Ida, Sharon & I are going to try to get a York Region Support Group off the ground in September.
>My weight loss is still pretty consistent & I'm happy with my results

During this period:
>I had an appointment with my PCP:
     >Received B-12 shot.
     >She ordered an ultrasound to see if I did have a gallbladder attack.
>I had a 3-month follow-up appointment w Dr. Starr:
     >He felt my weight loss was good
     >I have not thrown up since I last met with him
     >My energy is good although I have to sleep more
     >He emphasized the importance of excercise in my success
     >He agreed that my attack sounded like a gallbladder attack.
          >He's happy to remove my gallbladder if required
          >He wants to see the results of my ultrasound

Results:
>I've lost 16 lbs on Optifast & an additional 27.4 lbs since surgery for a total of 43.4 lbs.
>My BMI is 37.3 vs 45.5
>I've entered Onderland!
>I've lost 39.5% of my excess weight
>I've lost a total of 18 inches:
     >3" from my waist
     >4.5" from my bust
     >2" from my chest
     >4" from my hips
     >2" from my upper arm
     >1" from my thigh
     >.5" from my calf
     >1" from my knee
     >.5" from my neck
     >.5" from my ankle
>I'm wearing a size 16-18 vs a size 24
>In the month of April, I consumed an average of 505.6 calories/day
     >21.8% calories from Fat
     >26.9% calories from carbs
     >51.3% calories from protein

Observations:
>I'm loving OH & I'm addicted to it!
>I had what appears to be a gallbladder attack on 5/6/08, which is a common result from rapid weight loss
>I went to a family reunion to celebrate my grandmother's 100th birthday & a few people noticed my weight loss.
>I still have no appetite
>Each mean still seems to be a bit of a challenge, although every day I'm able to eat a greater variety of food.
>I've rejoined the gym at work & have created a weight-training program with a personal trainer.
>I have to go to bed earlier than I did before surgery - around 9-9:30.
>I'm continuing to go to the Barrie Support Group
>I'm continuing to track everything I eat.

On 5/6/08, I had an attack which I now suspect was a gallbladder attack. Here's what happened:
>For breakfast, I ate an Atkins protei bar for breakfast. These are relatively new to me, but this was my third & I'd not no issues earlier.
>When I had eaten about 2/3 of the bar, I started to feel a bit of indigestion. I set the bar aside for about 1/2 hour & then finished it around 10:00 am.
>After finishing the protein bar, I felt more indegestion, but thought this would pass. I tood a Gas-X strip.
>As the morning progressed, the indigestion became worse & I developed a pain in my mid back (around the bra-line). The pain became so severe, I couldn't sit & paced around.
>At lunch, I felt I should eat & bount a bowl of soup. I tried to eat it but every time I tried to eat or drink, the indigestion & back pain worsened.
>I was very red in the face & felt hot. It hurt to breath deeply.
>I felt so badly, I finally called Dr. Starr's office around 1:00. Mary-Jean paged Dr, Starr. She called back shortly to advise: 
     >Dr. Starr thought part of the protein bar was stuck.
     >He advised to continue drinking water
     >If the pain had not passed in 2 hours to go to HRRH ER
>Although I didn't feel like something was stuck, I took a chewable papaya extract tablet.
>At this point I decided to leave the office & go home. I felt so badly, I started to well up with tears, but talked myself out of crying as that wouldn't make the pain go away or help with my drive home. 
>At home, I took another Gas-X strip. I still felt extremely gassy & bloated. The Gas-X strip made me feel nauseous. I didn't throw up, but I hugged the bowl for a while. 
>I tried lying down on my back to see if this would help with the pain but nothing seemed to help. 
>I called my mother & asked her to leave work early so she chould drive me to HRRH. 
>When my mother arrived I grabbed my purse, put it on my shoulder & as quickly as that, the pain passed. 
>The incident lasted about 5-5.5 hours.
>My mother was worried for a while afterwards because I had a sickly green complexion. 
>Since this event, I've had occasional mild discomfort on the right breast area & right shoulder area when I breath deeply. 
>Since this event, I've been diagnosed with a gall stone.
>I've documented my symptoms because a gallbladder attack is often hard to recognize & misdiagnosed. If you have symptoms similar to the ones listed above, go to the ER right away. 
   

Dr. Starr weighed me & felt that my weight loss was good. This is good to hear. Compared to others, it looks like my rate of weight loss is low. I have to remind myself that I’m a light-weight & my rate of weight loss will be lower than others who have more to lose. 
Dr. Starr asked if I'd thrown up. I have twice: 
>4/22/08: Ate some salmon too fast. This caused terrible pain & gas & I felt flushed. After about 45 minutes, I threw up. The pain continued & after another 30 minutes or so, I threw up again. Then I felt better. 
>4/25/08: Ate quartered B-12 pills with yogurt. The pill pieces got stuck. This caused pain, gas & gagging. After about 45 minutes, I finally threw up the yogurt, but not the pill pieces. This took a couple of hours to breakdown & pass. Will buy some papaya extract. 
Because both events could be attributed to specific activities (ie: eating too fast & getting pills stuck), Dr. Starr was confident everything was OK. 
I told Dr. Starr that I intended to go to my PCP to get B-12 shots. He thought that was a good idea. 
I asked Dr. Starr if I was OK to join a gym & start working out. He said I'm fine & have no limitations. 
I asked him to feel one of my incisions, which was very sore after housclening. He said all he felt was what remained of an internal stitch. No hernia as I'd feared. 

Results: 
>Lost 16 lbs on Optifast & an additional 16.6 lbs since surgery for a total of 32.6 lbs.
>My BMI is 39.3 vs 45.5. I am no longer morbidly obese!
>I've lost 29.5% of my excess weight
>I've lost a total of 11.5 inches:
     >.5" from my waist
     >.5" from my bust
     >2" from my chest
     >4" from my hips
     >2" from my upper arm
     >0" from my thigh
     >.5" from my calf
     >.5" from my knee
     >1" from my neck
     >.5" from my ankle
>I've gone from sizes 24-26 to 18-20!
>In March, I consumed an average of 324.7 calories/day (please remember I had surgery on 3/19/08 & only started eating & tracking on 3/23/08, so this represents only a few days of post-operative eating)
     >10.4% of calories came from fat
     >33.7% of calories came from carbs
     >55.9% of calories came from protein

Observations:
>My stomach muschles are back to normal & I have no trouble getting out of bed anymore.
>My belt doesn't fit me any more & my pants want to fall off
>My underwear are waaaay too big. I can feel them working their way down my thigh
>I'm back to work
>I've gotten a few comments about weight loss but so far mostly from my family, who know what kind of surgery I've had
>My work colleagues, who don't know what kind of surgery I've had notice a change, but think it's my new glasses. . .
>I have absolutely no appetite
>I'm continuing to go to the Barrie Support Group which is excellent
>I'm traking everything I eat.

One-Month Update with the Dietician, Denise Poirier:
Denise weighed me & calculated my BMI. I've been losing around 5 lbs/week. She made no comment about whether this is normal, bad or good. I assume no comment means normal.

Denise asked me a lot of questions about my diet
     >I'm able to eat everything from puree diet fine
     >So far, I haven't thrown up
     >I can tolerate eggs & milk
     >I'm getting good quantities of protein & water in my diet, which is good
     >I need to increase the amount of fruit in my diet

I asked Denise about the number of calories I should be consuming daily. She advised that I should be focusing on protein & water only & not to worry about calories, carbs, or fat - although I should keep low carb where possible.  

Denise gave me the go ahead to slowly introduce normal food, leaving bread, rice & pasta for quite a while. 

I celebrated by having chicken quesadillas at Jack Astor's for lunch.

So It's been two weeks since surgery. I can't believe it. The pain I initially experienced at my surgical incisions has decreased significantly. I still find it difficult to get out of bed, but I now have a technique which involves the headboard. LOL! I can walk with a straight posture now. My back does hurt if I walk too much or carry my heavy purse. LOL! I've been out of the house a couple of times: My mom took me to GNC a few days after I got home to check out some protein powders. I also went to the mall last Friday to see my Optomitrist - where I discovered my purse was waaay too heavy. Finally, yesterday, I want to see Dr. Starr for my 2-week check-up. Afterwards, I went to the bank & to Wal-Mart to check out more protein powders & protein bars. I finally feel like I'm getting back to the land of the living. 

My appointment with Dr. Starr went well. I haven't had any trouble consuming anything from the full fluid diet (My usual day = 1/4 cup cottage cheese for breakfast, Pro ISL Protein Drink for lunch & strained cream soup for supper - YUM!). Dr. Starr said I was good to gradually move into the pureed diet. For dinner I had 1 oz purreed chicken breast with chicken gravy, 2 tbsp mashed potatoes with chicken gravy & 4 small mashed carrots. I ate it over 1.5 hours & it went down fine. I ate slowly & chewed, chewed, chewed. So far so good. I'm looking forward to trying a scrambled egg this morning with some grated cheese on top. 

Dr. Starr said I was OK to remove the steri-strips from my 5 surgical incisions. So, as soon as I got home I did that. They were starting to look raggedy. The incisions all look very good & clean. Yeah! 

I made a list of things I wanted to mention or ask of Dr. Starr before I went into the appointment. I mentioned that I'd had a low-grade fever since returning home from the hospital. The highest was almost 102 the first night & now I'm consistently between 99 & 100. I didn't panick about this. My body's been through a shock & it's not unusual for it to react this way. My sister had a hysterectomy in January & had the exact same reaction. He was not concerned. I also mentioned that I have a 5" by 3" numb spot on my tummy. Again, he was not concerned. He said that should go away soon. 

In addition to giving me the green light to start purees, he told me that I did not need to follow up with self-pay Detician - I could follow up with OHIP-covered dietician (Denise) so I'll be making my appointmet shortly. He also told me that 2 children's chewable vitamins was all I needed to take at this point. The dietician will advise if I need to take any additional calcium, iron or B-12 after analyzing my bloodwork at the 3-month mark. Good to know. 

In any case, I'm feeling pretty good & eating well - so far.

03/19/08: Surgery Day
Arrived at hospital at 10:00 am with my mom & 2 sisters as surgery was scheduled to begin at 12:00 pm. Met a girl named Denise from Ottawa who was having GP surgery at the same time with Dr. Wing. 

My Mom went with me to the surgery floor. A very nice nurse named Sharon confirmed some information with me & then walked me into the surgery theatre. I laid down & the anesthesiologist inserted an IV. He complained that I didn't have good veins. I told him "I'm not surprised, I haven't had anything to drink for over 12 hours." Anyway, he found the vein & before long I tasted something very medicinal in my mouth & was out. 

The next thing I remember was waking up in Recovery feeling a bit queasy. I let the nurse know & she offered me some gravol via IV. I didn't turn that down. Then they moved me to my room. I got a semi-private room & was all by myself the first day. As soon as I got to my room, I really had to use the washroom. I was surprised that I was able to walk so soon after surgery. I was feeling some pain in the stomach area so they gave me a bit of morphine. Didn't turn that down either. Later in the day, they switched me from morphine to toradol (sp?). Didn't mind that either. I had one or two bad moments of nausea. I didn't spew, but heaved a bit. Really sore on the tummy. More gravol. Because of the nausea, I didn't get any dinner. Oh well! 

I think Ida called, but she spoke to my mom.

3/20/08: Day 1
I slept sporadically thoughout the first night. The nurse kept coming in to take my temperature, my blood pressure & my oxygen levels. My oxygen was a bit low, so they gave me a bit through the night. Then they came with the heparin shots. Trust me, if you see a heparin shot coming, run screaming, if you can. I have bruises all over my arms from that. They gave me a shot on my left arm. It was my left arm that they kept taking my blood pressure from so they kept irritating it. The bruise today is about 4 inches around. Very sore. Believe it or not, the shot I got in my stomach didn't leave any mark at all.

Dr. Starr & Dr. Glazer stopped in at different times through the day. Dr. Starr told me the surgery was "by the book". He looked at my incisions & removed the gauze. He thought I looked good. I also had a visit from the physiotherapist. She took me for a walk & asked me to walk 2 more times thorughout the day. It was OK as long as I walked slowly. I walked a bit hunched over.

Jo-Anna & Ida called & I spoke to them both. Welcome back to the land of the living.

I woke up a few times through the night. I found it hard to stay in the same position all the time. Thank goodness for in-room TV's & headphones. 

03/21/08: Day 2
Dr. Starr came by around 7:00 am. Told me everything looked good & I could choose to leave anytime or stay until the next morning. Until this point, I really wasn't eating or drinking much, so was worried about getting unhooked from the IV. I finally decided to break loose once the IV ran out. That happened around noon. The nurse unhooked my IV & I asked if Dr. Starr had left any prescriptions for me. He hadn't! So I went home. I did have a bit of a headache. I got my mom to buy easy-to-swallow tylenol. I cut them into quarters, but still found them hard on my tummy & I was worried about hurting my tender little pouch. 

3/22/08: Day 3
The quest for pain medication continues. I had a bit of an uncomfortable night. The thought crossed my mind that children's liquid Tylenol might just be the ticket. Sent mom to the pharmacy. When she got home it turned out there's corn syrup in it. Rats! So she called the pharmacy & asked if there was a surgar-free liquid Tylenol. The Pharmacist asked how old her child was? Ha Ha. Anyway he recommeded Tempra. Yeah! It's alcohol, sugar & ASA free! I put some (about half the container - 500 mgs) into a bottle of water! Now I'm motivated to drink & it tastes not too bad! Remember this if you're about to have surgery! Buy some in advance.

So, now I'm looking forward to each day getting better. Tomorrow - I'm going to introduce protein to my diet as I slowly move from clear liquids to liquids.

08/10/07: Annual Physical with GP
I spoke with my GP today about WLS. She calculated my BMI at 45, determined that I would quality for it & asked if I wanted a consult. While I waited, she made some inquiries & advised she would be contacting Dr. Starr for an appointment. I was so pleased. I had already heard about Dr. Starr online. Within 1-2 days, I received my appointment with Dr. Starr. My GP rocks!

09/07/07: Consultation with Dr. Starr: Not a character flaw
While waiting for my appointment, I overheard one patient ask another how long it had been since her "surgery". She advised 2 months. The first patient advised she was 6 months out & the 2nd month was the hardest, but once that was done, things improved dramatically. At this point, I asked how long from consult to surgery. Both answered less than 1 year. Others piped in with the same response. Wow! Less than a year! I was expecting 2-3 years. I was advised that the way to speed things up is to pay out of pocket for consultation with Dietician & Social Worker - about $350 total. 

Once I saw Dr. Starr, he explained that once a BMI of 40 is reached, general medical opinion is that the situation has become virtually impossible to reverse without surgery. He performes Roux En Y surgery (Gastric Bypass) laprascopically. He also advised that my current weight 240.6 was important. I was not to exceed this surgery - ever. I had to demonstrate a willingness to change behaviours to ensure commitment to long-term success. 

So, I've decided to make some changes with the goal to maintain current weight: 
1) Break meal routine - start eating breakfast
2) Buy a proper scale
3) Buy a treadmill
4) Snack less in evenings
5) No 2nd helpings at dinner
6) Leave food once full

Co-morbidities: 
1) Joint problems
-Arthritis in knees (arthroscopic surgery on right knee in 2002)
-Chronic foot pain & occasional ankle pain
-Occasional back problems which may be caused by large breasts
2) Mild Sleep Apnea
-C-PAP machine not yet required

Family History of Co-morbidities 
1) Obesity 
2) Type 2 diabetes
3) Heart problems
4) High Blood Pressure
5) High cholestoral
6) Asthma
7) Knee replacement
8) Circulatory problems in lower legs & feet
9) Breast cancer

I received a checklist of things I need to do before receiving a surgery date from Dr. Starr's assistant Tracey:
1) Book appointment with Dietician (Dorreen Klar)
2) Book appointment with Social Worker (Shelley Aronov
3) Attend Dietary Class/Nutritian Seminar
4) Once 1-3 are booked, call Tracey for appointment with an Internist
5) Once all appointments are completed, call Tracey for follow-up appointment with Dr. Starr. May received surgery date at this point.

10/16/07: Nutrition Seminar at Humber River Regional Hospital (HRRH) with Denise Poirier
Pre-registered at PATT desk & received Hospital Card. Required Health Card, Insurance info etc. 

Mechanics of REY surgery: 
1) Surgery results in forced portion control with small pouch (2 oz after surgery - 4-6 oz after recovery)
2) Surgery results in limited absorption of calories
3) Surgery results in limited absorption of nutrients which may result in malnutrition

General Notes: 
1) Surgery will take 1.5-2 hours long
2) Hospital stay = 3 days
3) Time off work = 2-4 weeks
4) Follow up visits with Dietician: 4 weeks, 8 weeks, 6 months, 1 year
5) Surgery to remove apron (pani) on stomach & lift breasts may be covered by OHIP if medically required

Pre-surgical Diet: 
1) Purpose is to shrink liver prior to surgery to facilitate access to surgical site laprascopically
2) 2 weeks prior to surgery
3) Liquid diet: 4 packages of Optifast mixed with water/day
4) Clear liquids & zero calorie drinks allowed

After Surgery: 
1) Chew, chew, chew, sip, sip, sip
2) 3-6 small meals per day
3) Eat slowly (30-60 minutes/meal)
4) Pay attention to signs of fullness
5) Focus on protein intake (lack of protein = hair loss, among other things)
6) Limit sugar & fat intake to prevent "dumping"
7) Take multi-vitamin daily for life (chewable or liquid at first)
8) Buy food scale

Clear Fluid Diet: 
1) 1-2 days after surgery
2) Includes water, diluted fruit juices, clear broth, diet jello

Full Fluid Diet: 
1) 2 weeks after surgery
2) Focus on protein intake
3) Lots of <2% milk products
4) Drink protein shakes and eat strained cream soups, 
5) Add bene-protein powder or carnation skim milk powder to food to increase protein intake

Pureed Diet: 
1) Starts approximately 2 weeks after surgery
2) No bread
3) Pasta & eggs may not be well tolerated
4) Continue with protein shakes
5) Slowly introduce blended food

10/18/07: Appointment with Dietician, Doreen Klar
Current eating habits: 
1) During week, no breakfast, only coffee
2) Large lunch (volume, volume, volume)
3) No snacking during day - too busy at work
4) Large homemade dinner with meat, starch & veggie or salad with no dessert. (Thanks mom!)
5) Lots of diet pop
6) 1-2 alcoholic drinks/month
7) Friday nights = restaurant (Keg, Montana's)
8) Sat/Sun = large brunch with eggs, bacon/ham/sausage, hashbrowns & toast
9) Minimal exercise = limited dog walking

Weight Gain History: 
1) Always 95-100 lbs (I'm only 5'1") through high school
2) Increased 10-20 lbs during University (Thought I was huge!!!!!)
3) Increased significantly during work travel & with increased work stress
4) In last 17 years, I have gained approximately 140 lbs

Diets Tried: 
1) Weight Watchers: several times
2) Diet-of-the-week (cabbage soup, low carb etc)
3) Dexatrim: 2-3 times
4) Trim Spa
5) Phen Fen from Clinic in Phoenix
6) Muscle stimulation from weight loss clinic

Why am I a good candidate for surgery?
1) I've thought about this for 1-2 years. This is not an impulse.
2) Researched weight loss options
3) Good support system with family & friends
4) Currenty healthy, don't drink or smoke & this should help recovery
5) Flexibility at work which can allow for reduced travelling & work from home
6) Have worked to reduce work hours & stress over last year
7) Financially able to manage costs associated with surgery & diets
8) Motivated to use surgery as a tool to lose weight

10/25/07: Appointment with Social Worker, Shelley Aronov
Describe Support System: 
1) Mother lives with me & can take time off work during & immediately after surgery
2) Sisters support surgery
3) Good friends at work & outside work

How did I made decision to have surgery? 
1) Gradual decision based on lots of small events
-Heard of surgery from celebrities (Rosanne, Carnie Wilson, Al Roker)
-Neighbour was told to have surgery 2 years ago, waited & now too ill for it
-Having difficulty fitting into airplane seats, restaurant booths, theatre seats
2) Acknowledged that weight is not within my control
-All I can control is what I chose to do about it
-I chose surgery before my health gets any worse
-Ten years down the road, I will be fatter & less healthy & will regret not having surgery 10 years earlier
3) Did extensive research on surgery
4) Took 1-2 years to made decision to have surgery

Weight Gain Triggers:  
1) Loss of portion contol 
-Due to regular work travel. Eating 3 meals/day in restaurants in Phoenix has replaced my concept of a proper portion with a Phoenix restaurant portion
-Raised to believe you have to eat everything on your plate
2) Increased work stress
-There is a clear correlation between increased work responsibility & stress & weight gain
3) Evening snacking

Exercise Plan:
1) Continue to walk dog
2) Use treadmill in basement (installed cable TV)
3) Enroll in dance/water arobics at Rec Centre

Changes in Eating Habits: 
1) Leave food on plate when portions are big
2) Always leave some food at restaurants
3) Eat things one at a time (ie: popcorn)
4) Replace chips with popcorn, ritz chips, pretzels
5) Replace sugar with splenda

Research: 
1) Books:
-WLS for Dummies
-I'm still Hungry by Carnie Wilson
-Gut Feelings by Carnie Wilson
2) Internet: 
-www.obesityhelp.com
3) Television:
-Big Medicine

11/29/07: Appointment with Internist, Dr. Glaser
Dr. Glaser's Role:
1) Dr. Glaser will be my doctor after surgery 
2) He will manage pain & deal with any infections or complications
3) Current appointment will determine if I am healthy enough for surgery
-Took EKG, blood pressure tests

Questions asked by Dr. Glaser: 
1) Do I understand risks associated with surgery? 
-Yes, infection, leaks, blood clots, death
2) What percentage of surgeries result in death? 
-0.5-1%
3) Knowing all the risks, do I still want surgery? 
-Yes

01/09/08: Follow Up with Dr. Starr for Surgery Date
Surgery Date: March 19, 2008

Questions for Dr. Starr: 
1) How long has he performed gastric bypass surgery
-3 years
2) How many gastric bypass surgeries? 
-70
3) What are most common types of complications
-Bowel obstructions
-Leaks
-PE - most common source of surgery-related deaths
4) Does he remove gallbladder? 
-No
5) Will he personally be performing surgery? 
-Yes, with regular team of assistants
6) How long will surgery take? 
-1.5-2 hours
7) How long in hospital? 
-3 days
8) How long before I return to work? 
-2 weeks
9) Frequency of follow up appointments?
-2 weeks, 1 month, then 1-2 months for 1 year
10) Does he offer support group?
-He is starting one shortly

02/26/08: Appointment with Tracey at Dr. Starr's office:
1) Weight less than initial consultation weight
2) Submitted Short Term Disability forms
-Tracey recommends requesting 4 weeks off work vs 2
3) Purchased Optifast for $180
4) Confirmed Support Group should start shortly

02/26/08: Appointment at Pre-screening Department at HRRH
Lasted 4.5 hours

Procedures Completed: 
1) Blood pressure/pulse
2) Bloodwork
3) EKG
4) Chest X-Ray

Consultation with Admitting Nurse (Liz):
1) Asked health questions
2) Asked about current prescriptions
3) Asked about pain threshold
4) Advised to do the following after surgery: 
-Deep breathe & cough 
-Leg exercises
5) Confirmed that I will be taking Optifast prior to surgery
6) Confirmed I will be in hospital for 3 days

Consultation with Anesthesiologist: 
1) Asked health questions
2) Asked about current prescriptions
3) Asked about my history with General Anesthetic
-1971: Remove cyst from eyelid
-1972: Remove tonsils
-1980: Remove wisdon teeth
-2002; Arthroscopic knee surgery
-No issues or nausea with anesthetic

Notes About Quick In-Province Surgery Date: 
My experience is not typical. I have been especially lucky about my surgery date:
1) I had a great GP who didn't give me a hard time about referring me to a WLS surgeon
2) I was able to afford to use private-practice Dietician & Social Worker
3) I am relatively healthy & didn't require additional testing (ie: stress test, sleep apnea test etc)
4) Timing of follow-up appointment coincided with opening up of some surgery times from Ontario government