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After receiving notice of a surgery cancellation, I went in for VSG (Vertical Sleeve Gastrectomy) on May 21, 2009 instead of the original July 15 date.  The 90 minute surgery lasted 4 hours due to finding a hernia and repairing it through scar tissue from last year's incisions.  I stayed in the hospital from Thursday through Saturday morning.  I came home knowing that I only had to take ONE of my 4 diabetes meds...that is a gift in itself, as far as I'm concerned.  :)    

Came home to have my mom stay with me for a few days, which was a big help.  My recovery was rough in the beginning, due to acid and nausea.  I kept nothing down for the first 4 days.  I figured out that it was, in part, due to the swelling at my belly button and bottom of stomach, which was swollen due to the hernia repair.  Whatever I consumed could not get past that point, hence, causing it to come back up if I tried to sip again.  I spoke with the bariatric nurse and she advised that I take a few days off of vitamins if they may be causing the acid, but to concentrate on getting in fluids, even if only water.

Then, overnight on Day 5, the acid went away, the nausea was improved and each day has been better than the one before.  For this I am grateful.  :)   I started taking my multivitamin again on Day 7 and am consuming approximately 40-50ozs of liquid daily and most of that is protein.....I understand the process works slowly so my only goal is to improve consumption of protein/liquid each day...increasing walking and exercise is also a daily goal.  Good news is, I feel better.

I still have soreness at 2 sites and some additional tenderness from sneeze fits which have come on during the night the past 3 nights.  I use a pillow to hold tight to my tummy when the sneezes come on and that seems to help.   I have no scale so I'm not sure if/what I've lost any weight, but I feel like I have.  It is obvious that my tummy is still swollen, however.   I go to the endocrinologist on Tuesday and will weigh there.  My first bariatric followup appointment is next week Tuesday, June 9.  I look forward to updating with good news.  :)

OMGOMGOMGOMG!!!!!!!!!!!!!!!   Yesterday I received notice that there is a cancellation for surgery.  This means that my surgery date has been moved from July 15 to May 21....just a few days away.   I am more excited than I have been in a long time.  I have a lot to get ready for the end of the school year, since I now will be missing the last 9 days....but I feel this is the right choice, due to several circumstances in my life right now.  I so appreciate the support from my OH family....your cheers, your tears, and just the overall understanding and faith that everything will be OK.....thank you from the tips of my toes!!

Since learning I was approved for a second chance at weight loss surgery (VSG), I've been waiting for a date that would make this possibility seem more real.  Today I received the call I've been waiting for...to set a date for surgery.  As a teacher, I was hoping for a  date as early in the summer as possible, in case there were any complications to follow. Instead of a mid-June date, like I had hoped, I was told that Dr. Poplawski's earliest date was July 15.....seemed like such a long wait...and so close to the start of a new school year.  I overcame my disappointment when they offered to put my name in BIG LETTERS at the top of the cancellation list.  This means that I'd be one of the first called if someone can't make their surgery date....after June 15.

You know, I get myself worked up about these things when I should just trust and remember that everything happens for a reason.  I've been protected in so many ways and have a lot to be grateful for.  So, now I can say.....I have a date!! and life is good.  Thank you to everyone who is so supportive and patient with me through the emotional ups and downs I've been faced with this year.  You help me in so many ways....more than you know.   Thank you!! 

1-22-09      Made an appt. to see a new liver specialist for a 2nd opinion on risks I may face, if I chose to have ANY surgery.  Here is what I know...or understand.  I have liver cirrhosis.  People w/liver cirrhosis can be placed into 3 categories of "risk"...meaning this is the percentage risk of a person decompensating, or going into liver failure, from anesthesia following surgery.  While a normal and healthy person has <1% chance of this occurring, people with liver cirrhosis are placed into these 3 categories of risk.....Stage A = 10% risk;  Stage B = 20%-80%; and Stage C = 90%-100% risk.....following Stage C is the end stage of liver cirrhosis, meaning the person needs a liver transplant.  I am in stage A.

I will need a liver transplant, we just don't know when.  Without surgery I could live a "normal" life for years.  With surgery, I may also live a "normal" life, or better.  However, surgery is something that is considered an irritant to the liver when in cirrhosis... So, the doctor explained the risks and that it was her job to inform me of them.  She said that if I had surgery and did begin to decompensate, or go into liver failure, it could happen as soon as the day following surgery through the next couple weeks.  She said if I made it 4 weeks without decompensating after surgery, I should be OK, but the cirrhosis I have will remain, but most likely improve with weight loss.  Again she said, I will need a liver transplant, we just don't know when.

If I had a liver transplant, I would first require a donor.  The hospital stay following the transplant would be 2 weeks and full recovery would be anywhere from 6-12 mos.  I can hardly think about that and what it means to my job and future.  And I suppose there is no need to worry too much about it since it hasn't happened.  I just try to be realistic in considering what risks are involved in what could be a life changing surgery.

A friend had a good point in saying that if I chose the weight loss surgery, at least I would be more healthy at the time of the liver transplant.  This would be true if the weight loss surgery helped to resolve my comorbidities of :  diabetes, pcos, high blood pressure, and sleep apnea.  The thought of those comorbidities AND being overweight AND liver cirrhosis, overwhelm me.

The liver specialist requested bloodwork and that a CAT scan of my liver be done since apparently some of my recent ultrasound results were limited.  She talked about the fact that I am at high risk for having liver cancer, so a CAT scan would detect any of that.  My sister-in-law died of liver cancer in June 2008.  If I have liver cancer, treatment would begin right away and the consideration of weight loss surgery would be put on hold.  I will schedule the CAT scan this week.  I have to tell myself not to worry about the things that have not yet happened.  Just need to think that I can still help myself.

So, I thought back to the diet I was given in October....1,300calories and 1,600 mg sodium.  I haven't had one day of success on that yet.  I decided that I am going to follow it strictly from now until February 16, when I have an appt with my PCP and bariatric surgeon...February 17 is when I'll meet with the endocrinologist.  If, with this diet and daily exercise, I lose no weight by then, I will most likely opt for the WLS....based on the things I know today.  If I do lose weight, I'll talk to the docs about whether they feel that is a long term diet that will become part of my life.

This is all I can include for now...that I recall.  The liver specialist is sending me a report which I'm sure will allow me to explain more things better.  Until then, I am trying to maintain any sense of hope while I take each day a few hours at a time.

7-13-08    When I received my discharge papers on Monday, following the endoscopy, I was given a phone# to call in 3 days to get the results of the biopsy on the polyps they found in my stomach.  So, to have missed the call from the Liver Specialist saying they had results NOW, which came 24 hours after, had me very concerned.  Of course because they told me to call in 3 days and now THEY called so soon, I was thinking the worst, but it was after hours so I had the whole evening to wait and wonder about the results.   I started thinking of what bad results could mean..... Malignant polyps surely meant surgery, I thought, and I've been told NO surgery of any kind or liver failure could occur.  So, I then thought, well, if they do surgery to remove the polyps, they may as well do the Vertical Sleeve Gastrectomy and cut the stomach off, especially if the risks of either surgery are the same.  Anyway, it was a rough night so I decided to just face it and call first thing in the morning.

I called the number for results and when she asked how I was, I said "terrified".....and she said there was no need to be because the results came back good..."you're clean...benign" she said.   OK, can I tell you the relief....big sigh....like music to my ears.  I asked what the next step was and she said the polyps would not be removed.  I could speak with my Ear, Nose, and Throat doctor to find out what changes I should make in terms of treating acid reflux since the Prilosec may not be the best option if it causes me to have these polyps.  That appointment is on 8-15-08.

By afternoon today, I was at my appointment with the endocrinologist.  I found out that it's OK for me to go ahead and start taking the bigger dose of Byetta (10mcu) tomorrow.  We reviewed my progress of the past few months and doing so showed that overall I've done really well.  I've lost a total of 17lbs since April.  My A1C went from 8.6 to 7.4.  My sugars have been well maintained through these transitions of med changes.  My endocrinologist is not happy with how I am so hard on myself...always thinking I should've done better.  I continue to work on that and believe getting feedback from her and my other docs will help me with that.

So, for now, the news is good and I can start the school year with my diet/exercise goals in place and am aware of the importance of taking one day at a time, as I try to complete every day on the right track.

8-11-08     A side effect of cirrhosis of the liver is that sometimes varicies of the esophagus can develop and cause potentially dangerous bleeding.  As a preventative measure, and endoscopy was scheduled to see if I have any of these varicies in my esophagus.

I arrived early, with my parents.  They had to drive, as I would be sedated and unable to drive home.  I was very concerned about 2 things.   First, I had to be certain that I would have no feeling or memory of the procedure....I simply COULD NOT be conscious while this was done.  Secondly, I was concerned that this procedure would open concern for more health issues.  I had been surprised with similar "findings" this summer, and with it being so close to the start of the school year, could just not imagine that something new could be revealed.

They took me on time and everyone was very reassuring that this was a simple and common procedure.  Again, my blood pressure was quite low... first 102/58, then 96/62, and the best reading was 113/68...so they could proceed.  I was given Demoral (sp?) and Versed......thank goodness, I thought.  I did NOT want to be conscious through this procedure.  Ugh, can you imagine??

Well, I did not get what I wanted.  I was awake and conscious through it all....I moaned enough for them to know I was awake and in pain and heard them say to give me more sedative, however that only began affecting me in the recovery room.  Sigh.

They found that I have NO varicies in my esophagus....yay!!!   They also found that my stomach has several polyps in it.  I was told that they are most likely from the Prilosec I take for acid reflux.  Several?  I asked if a few was like maybe 10?  He said, well, there are several....I said, like 50??  Doc said, well, I didn't count them, but yes, there are several.  They had to take a biopsy of the polyp.  If the biopsy comes back benign the polyps stay and I can opt for a less potent medication.  If the biopsy comes back as malignant, they polyps will have to be removed.  Here's where I thought I may as well get the Vertical Sleeve, even with the risks to my liver....at least with the sleeve, they can just remove and pitch the bad stomach.   So, again, I wait.

They also informed me that I have a hyetal hernia...a small one, that diet and weight loss could manage.    Diet....something I know a lot about.  Weight loss....I wish would come along with greater results.  

Maybe on Wednesday, when I start the biggest dose of Byetta, can I experience some of the weight loss I've been trying to achieve.   We'll have to wait and see what happens.

8-4-08       For the past 5 days I've been carefully and frequently monitoring my sugars to determine the effectiveness of the new combo of diabetes meds that I'm on.  While my diet and exercise has been very good, I wake up with fasting sugars of 180's and 190's.  I realized that we created the diet BEFORE I was put on byetta so I thought I should contact the dietician as well as the endocrinologist.   I made those calls today.

The endocrinologist put me back on one dose of 1,000mg of Metformin, at dinner, at least for the next couple of weeks until I get the bigger dose of Byetta on August 13.  The decision was an emotional one, especially knowing that it was the Metformin that contributed to my condition, but I figured short term it would be OK.

The dietician helped me look more closely at the plan we made.  Together, we agreed to eliminate fruit entirely.  I could have vegetables in place of fruit, at least during this time when my sugars are running high.  So, that is the primary change that was made.

Today is my dad's birthday.  I took him to dinner at one of his favorite restaurants, knowing that I'd have to be careful with my "dining out choices".  I took my Metformin with the salad, one breadstick and then also had 1/2 a piece of whitefish.  Before dinner (and Metformin) my sugars were 136...and that was with NO food for 5 hours...too afraid to eat.   After dinner and Metformin, my sugars should be 140-160 and mine were 131.  So, it appears that the Metformin was working well.     4 hours later, I felt hungry but didn't eat.....sugars were 178....and even with no food, my morning fasting sugars were 126.   So, for now it seems the meds are working.  I'll continue to monitor and record how my sugars are so we can make an informed decision about medication choices on August 13.  For now, that's all the news I have.  I hope things continue to go well.

7-30-08     Something that I soo looked forward to having back after surgery, is confidence to release the great spirit I used to expose regularly ...it's still in me but withdraws too much of the time.  Insecurities resulting from the weight issues, sometimes cause me to stay reserved when I really just want to let out the old, better ME.  But I fear the judgments that could be made of "that fat girl" now, even though I know full well that I shouldn't care of what people think....fact is, I do. 

So I'm trying to be true to myself and let ME feel strong as I learn to let my true spirit come out again...to anyone.  But, this is not easy for me, despite it being the single thing I want most right now.  So I seek ways to stay faithful, even in times when it appears that I have hope, but may be filled with despair.

When I saw Mamma Mia the other day, tears filled my eyes during Chiquitita and at first I couldn't pin point why.  I just knew I was overwhelmed with the feelings of

*deeply missing someone but not sure who
*love for true friends
*hope for a chance that heartache will end
*joy from support of loved ones
*empowerment that comes from picking yourself up and exchanging sadness with inner strength and passion

I know, I know....all that from a song?  I came home and read the lyrics and can confirm that yes, all that from THIS song... in this song, the current ME is Chiquitita.....the narrator could be the dynamic ME I used to be before the weight gain....and someone I strive to bring alive again...she's in here, just too reserved to come out for now...but she'll be back...I do believe that.   On the other hand, the narrator COULD be God, as if he's talking to me, to my soul.  Please read on...... maybe it will help explain what I'm trying to say.

                                                Chiquitita
                                                   by Abba
Chiquitita, tell me whats wrong
Youre enchained by your own sorrow
In your eyes there is no hope for tomorrow
How I hate to see you like this
There is no way you can deny it
I can see that youre oh so sad, so quiet

Chiquitita, tell me the truth
Im a shoulder you can cry on
Your best friend, Im the one you must rely on
You were always sure of yourself
Now I see youve broken a feather
I hope we can patch it up together

Chiquitita, you and I know
How the heartaches come and they go and the scars theyre leaving
Youll be dancing once again and the pain will end
You will have no time for grieving
Chiquitita, you and I cry
But the sun is still in the sky and shining above you
Let me hear you sing once more like you did before
Sing a new song, chiquitita
Try once more like you did before
Sing a new song, chiquitita

So the walls came tumbling down
And your loves a blown out candle
All is gone and it seems too hard to handle
Chiquitita, tell me the truth
There is no way you can deny it
I see that youre oh so sad, so quiet

Chiquitita, you and I know
How the heartaches come and they go and the scars theyre leaving
Youll be dancing once again and the pain will end
You will have no time for grieving
Chiquitita, you and I cry
But the sun is still in the sky and shining above you
Let me hear you sing once more like you did before
Sing a new song, chiquitita
Try once more like you did before
Sing a new song, chiquitita
Try once more like you did before
Sing a new song, chiquitita

So, after reading that, I looked back at the feelings I listed above, that overwhelmed me at the movie and realized those feelings were at the surface for me because it is what I feel right now, every day, since I came home from the clinic on June 18.  This journey has let me realize.....

*it was ME i was missing...the old, better ME
*I am, for the first time, in a long time, letting people help me, care about me, and support me, which is sometimes a huge risk
*I am becoming empowered as I try to lose the weight again, on my own
*it's OK to be emotional through something like this from time to time as long as the weak moments turn to something positive that helps me.

These lyrics just helped me believe that there WILL be a day that I sing a new song.  I do have faith that a lot of good will come from this.  Let's watch and see what happens.

7-23-08     My appointment this morning was downtown.  I first weighed in and was pleased to see that I had lost 7lbs since 7-14-08, which is when I began the low sodium, low carb diet plan.  That lifed my spirits right away because while it's been difficult, it's doable.   

After weighing in, I met Heather, a dietician and public health nurse, who specializes in Byetta and diabetic patients.  She taught me what I need to know about Byetta and how to give myself injections into my tummy.  She helped me along with the first shot and made herself available by phone or email, should I have any questions.  I was started on 5mcu and will increase to 10mcu at my next appointment on August 13, 2008. 

Until then I have only one goal....that is to live every day doing just exactly what I am supposed to do.  Whatever weight loss MAY result from that will be a gift, I suppose.  While these first 7lbs are most likely from water weight, I'll take it.  The weight loss that commonly occurs from taking Byetta won't happen until after I am on the full dosage.  So, it will be interesting to see what I can manage on my own with just the "Low" diet and increased exercise until then.  Wish me luck!!

7-22-08       Today I saw the endocrinologist, to fill her in on all that has happened since June 18, my original surgery date.   Dr. Levy entered the room with a big smile, cheery voice, and open arms ready for a hug as she asked how the surgery went.  She wanted me to tell her everything.  So I did.  The story just wasn't what she expected.  In her words, she was shocked.  She had never heard of such a case, of there being no evidence to lead one to suspect that I'd have liver disease for who knows how long.

Dr. Levy looked up the report written by Dr. Gordon, the Liver Specialist, and while she did so asked me to remind her what 3 diabetes meds I was on.  I proceeded to name Metformin, Glipizide, and Januvia.  Just as said Dr. Gordon believed that my diabetes meds played no role in the liver disease, Dr. Levy asked again if I was on Metformin.  She wondered whether Dr. Gordon knew that Metformin was one of my meds.   I did tell him so and even handed Dr. Gordon a list that the hospital had printed for me to share with him.   Just then Dr. Levy noticed that Dr. Gordon listed all of my meds with the exception of the Metformin.  He overlooked the ONE medication that has been putting my health at risk.  He neglected to inform and advise me of the danger of Metformin if I continued to take it.

She immediately said that since Metformin is toxified in the liver it could be aggravating the liver which is already diseased.  She showed me the stats on Metformin, and as plain as day, the description states that NO person with any type of hepatatic state (which I DO have) should be taking Metformin because it can contribute to liver disease.  I have been taking Metformin since January 2005 and today was told to NEVER take it again.  The question now is...did I have NASH (Nonalcoholic Steatohepatitis) and the beginning of cirrhosis before or after I began taking the Metformin?  SInce 3 professional doctors (PCP, Liver Specialist, and Endocrinologist) are shocked and stunned at how I could've developed this condition, there is no way to tell when it started.

The blessing in finding this now is that the toxic levels of Metformin could've led to lactic acidosis.   "Lactic acidosis may be caused by diabetic ketoacidosis or liver or kidney disease, as well as some forms of medication (most notably the anti-diabetic drug metformin)."  Lactic acidosis is a life threatening condition from which I have hopefully now been spared.

So, I needed a new medication to replace metformin.  Dr. Levy knows that I am afraid to have insulin so she offered a newer medication which I knew a little bit about.  It is called Byetta.

"Byetta is an injectable diabetes medicine that helps control blood sugar levels. Byetta helps your pancreas produce insulin more efficiently.  Byetta is used to treat type 2 (non-insulin dependent) diabetes. "

As with all medications, Byetta has side effects.  Two less serious side effects of taking Byetta, which may actually be helpful to me, are loss of appetite and weight loss.  As much as I worry about giving myself a shot in the stomach 2x a day, I am hopeful that the potential weight loss will help resolve some of my other health concerns.

So, tomorrow morning at 9am, I am going downtown to the hospital, where I'll attend a class on how to use Byetta properly.  Yes, I'm nervous about it.  But, I'm hopeful that within a few days sugar levels will be back in order and I'll have peace of mind knowing that medication that is meant to treat me is no longer harming me instead.