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Just now I got a call from the bariatric surgeon's office. The nurse said they'd received the results of my abdominal ultrasound and wanted to follow up about something. Apparently there is a thing on my liver.

She assured me it's almost definitely a benign clump of blood vessels. (I think the word she used was “process,” as a noun, like “a process of blood vessels” and now I really wish I'd written it down.) Still, they want to know what it is and whether it's changing over time. (AND SO DO I.)

Anyway, she said they'd debated whether to have me go through an MRI soon or just wait six months and have another ultrasound. They're recommending I wait the six months and get another ultrasound, which is fine by me. They'll be forwarding the results and other information to the internist I'm seeing on Monday, so I guess if he has other ideas I'll hear about them then.

Weird. I don't like having a thing on my liver and I really hope it's exactly what they think it is, and it's harmless. The nurse said it shouldn't interfere with surgery, although now I wish I'd asked if that means I can go ahead as if there were no mysterious liver-thing (requesting insurance approval; scheduling a final consultation; getting a surgery date) or if it means I'll have to wait six months till the next ultrasound and THEN resume the trudge toward bariatric surgery.

No time to stew over it, though. I have to go pick up my mom and get ready for the pre-op class tonight. I hope I'm as close to surgery as I thought I was this morning...

Stupid liver-thing.  

“So what are you doing today, Horrible Monster?”

“Oh, you know. Peeing into a jug.”

Taking care of the 24-hour urine sample. Good thing I was able to just stay home today. Lugging the “hat” and the jug around while running errands would have been a bit of a bummer. Doable, sure, but a bit of a bummer. (Totally feeling good about my otherwise reckless and selfish decision to quit my job a couple weeks ago.)

Tomorrow afternoon the plan is: pick up Mom from her job, run the jug back to the lab, pick up my husband from work, run back to the hospital, attend the mandatory pre-op class. Nervous, excited, ready to hand over my jug of pee. Also very grateful for the support of my parents and husband.

Unrelated to pee: on the first of the year, our insurance changed. Unfortunately I forgot to tell the Center for Weight Loss Surgery. Well, I didn't so much “forget” as I “mistakenly assumed” that the Center was part of the hospital. It turns out the surgeon has hospital privileges but doesn't actually work FOR the hospital so when I went for my endoscopy, that was “the hospital” and not “the weight loss clinic,” even though the bariatric surgeon performed the procedure.

Anyway, I assumed when I gave my new insurance card and information on the day of the endoscopy that I was giving the information to the Center for Weight Loss Surgery as well. A week or so ago someone from the weight loss clinic called and asked what was up and I let her know the insurance changed and all that. So I wasn't surprised when I received an angry-looking FINAL NOTICE in the mail today. I guess they'd tried to submit a claim to our previous insurance company and it was denied and blah blah. It was only for about $11.00; I popped a check in the mail and it should be all good. I already confirmed with the patient coordinator that I can bring my updated insurance card and info to the class tomorrow. Unnerving, though, to make a mistake like this when I'm trying so hard to stay on top of everything.  

The barium swallow was the worst part.

Yesterday I woke up extra early and drove to the hospital that houses the Center for Weight Loss Surgery. I arrived at 7:15 so I could check in at the women's health center for the first of a morning's worth of tests. First was a bone density scan, which was pretty simple: lie down on a bed, get scanned. Repeat with both wrists. Off to a good start!

After I was done at the women's health center I headed over to the outpatient center at the hospital, where the nice lady at the check-in desk knew where I was supposed to go. First I was sent to a little room where I did the spirometry test (blowing into a tube, basically) to make sure my lugs are in good enough shape for surgery. That went fine. The same lady who administered the spirometry test did my EKG. I'd had one before so it was no thing—slap some diodes on my chest and abdomen, fiddle with some knobs on a machine, all good. (The lady who administered these tests was very friendly and chatty. She did express some surprise/skepticism that I'm planning on bariatric surgery. I guess I don't look fat “enough” or something? I mentioned the Horrors of Sleep Apnea and she seemed to get it.)

Next was blood and pee. A very nice lady took what looked to be about eight thousand vials of my blood, told me all about the 24-hour urine sample adventure I get to go on some time this week, and had me pee in a cup. I expect to do the pee thing on Tuesday, I guess, and will try to get it back to the hospital by Wednesday. (I hope that's enough time, fret fret, as the results of all these tests need to make it to the internist before I see HIM, and THAT appointment is coming up a week from Monday. Yikes.)

After the blood-n-pee extravaganza I was sent to diagnostic imaging. I got an abdominal ultrasound from an amused-seeming young man who commented that “all the cool kids” are getting vertical sleeve gastrectomies. Okay. He was nice, though. Nothing too exotic about the ultrasound: get some warm gel smeared on one's belly, get wanded, hold your breath when he says, etc. After that, an x-ray tech led me to a changing room and told me to undress to the waist and put on some gowns. Did so, followed the tech to the x-ray room, got my chest x-rayed. Took hardly any time.

THEN CAME THE BARIUM SWALLOW. Which was seriously just super gross. I knew it would be gross but here it is one more time for posterity: gross.

They had me stand up against a slab and take a few mouthfuls of the barium nastiness: hold the mouthful, then swallow, while the doctor aimed some sort of camera device at my chest/abdomen. Did that a few times. Then I had to chug a big cup of some fizzy substance, which was also pretty unpleasant. Then I had to chug a big cup of barium nastiness. Then they made the slab tilt back until I was parallel to the ceiling.

Once I was flat on my back they had me twisting and rotating like a rotisserie chicken, all the while looking at my guts through the camera-device-thing. Finally I ended up on my side, holding a cup of barium nastiness, and sipping mouthfuls through a straw: hold, then swallow. A few dry swallows in there, too. When it was over I was told to make sure to drink LOTS of water all day, since the barium “basically turns to concrete in there!” Apparently constipation can be an issue afterward. I drank more than 64 ounces of water and ate normally the rest of the day. No constipation issues yet, and it's been more than 24 hours. I think I'm good? Anyway.

All in all, even the SUPER NAST ICKY GROCE barium swallow ordeal didn't last too long. I was there, getting tests, from about 7:30 till around 10:30 in the morning. Not bad; I'd expected to hang out at the hospital till at least noon. Had to double check that all my test results would be sent to the internist (as well as the bariatric surgeon), and I'll be seeing that internist on the eleventh. Just now I emailed the patient coordinator for the Center for Weight Loss Surgery to make sure I'm on track with everything. I think I am. The biggest THING ahead, I suppose, will be making sure my insurance company is on board with this whole crazy project. Fingers crossed.

Otherwise, things are okay. I've been tracking food and exercise via My Fitness Pal, and that's been illuminating. I've made some major improvements in my diet though there are still changes that need to take place (fewer convenience foods/more from-scratch cooking, for example.) Should exercise more, too. Anyway, doing all right. Not great but not bad. Lost a few pounds so far.

Had some big emotions about this whole process, about weight loss in general and the weird ways identity and feelings of self-worth get tied into one's appearance. Big emotions. Got to spend some quality time with family and friends today, and I needed that. I even told my uncle and aunt that I'm planning to have the surgery. Uncle and I were bonding over sleep apnea war stories and the conversation just seemed to take at natural turn toward my hopes for bariatric surgery—since I'm having it in large part to combat the sleep apnea. Aunt immediately said all the things my mother said when I told my immediate family in December—but she trusts me, and understands.

My uncle's first response was basically “but you're not fat enough?” So I emphasized the apnea, the other activities the excess weight complicates or puts out of reach, and he gets it too. So I ended up talking to my mom, my aunt, and my uncle for quite a while about surgery etc. Felt good. Mom's going to come with me to the pre-op class, bless her. We'd already planned to attend together but I think having such a good discussion motivated me to get in touch with the patient coordinator. I just so badly want to do this correctly—not skip any steps, not make any stupid mistakes. Fingers. Crossed.

Woke up this morning around nine o'clock and by ten o'clock my dad and I were on our way up to the hospital for my endoscopy. No eating or drinking after midnight meant, of course, no breakfast—and no water! As well as no lotion, no hair product, no deodorant. Clad in my favorite gray hoodie and gray sweatpants, I was ready.

At the hospital, the young woman who checked me in did some calling around and let me know that my husband and I will end up paying over a thousand dollars for the endoscopy. Oof. Not really shocking, of course, but kind of a buzz kill all the same. At least they said they'd bill us instead of holding me at gunpoint till we could produce the money that day.

Then my dad and I were led up to the waiting room where he would spend the next several hours camped out with a good (and, luckily, long) book. I was weighed. I was actually pretty eager to be weighed because I've finally started tracking my food and exercise on MyFitnessPal and wanted to be accurate about everything. It was weird, though—the nurse who weighed me asked in hushed tones if I wanted to know what it was “in pounds” (the scale showed 103ish kg, if I remember correctly.) I said yes, she figured it out on a calculator, then showed me the calculator all secretly, with her hand over it. Like it was a big, shameful secret? Weird. I didn't expect that from a nurse at a hospital that sees a lot of bariatric patients, but whatever. (And of course now I'm worried that my just-under-35 BMI will give the insurance company an excuse to be jerks about covering the surgery—but they'll go by my first weight when I visited the surgeon in early December. Right? RIGHT?)

Then I got to hang out in a little room for basically ever. Stripped to the waist, gown on, chilling in the bed. Fortunately Dad had lent me the latest New Yorker so I got to amuse myself with that. Could've watched TV but eh. Nurses went over a bunch of questions, double checked my ID bracelets, confirmed medication allergies, etc. Lots of time went by. An anesthesiologist popped in, said I'd be conscious but sedated so I might remember parts of the procedure. That was cool; I didn't mind. At some point I got an IV put in.

Alone in the little room I started to feel foolish, like I don't deserve weight loss surgery—why should all these professionals make a fuss over me when I'm not even THAT fat in the grand scheme of things, blah blah blah. Just a little pity party, as one throws oneself when left alone in a tiny hospital room with plenty of time to ruminate on one's character flaws. Fortunately there were several good articles in the January 7 New Yorker, so I was able to distract myself.

Finally, I got wheeled into what I guess must have been an actual operating room. The surgeon was there, humming and seemingly in excellent spirits. A different anesthesiologist told me they'd be knocking me out cold—okay! I got oxygen up the nose, they had me turn on my side and lay there with a little tube thing in between my front teeth and then...I was waking up and it was over. Frankly, I was skeptical they even performed the procedure. Felt wide-awake and even refreshed. (Kind of sad that this was probably the best sleep I've enjoyed in months?)

They wheeled me into a recovery room with other patients. I was offered water but wasn't feeling it and the doctor hadn't ordered it so I didn't need to drink any. They checked my blood pressure several times and might have done other stuff. Finally I was wheeled back to another of the little waiting rooms where yet another nurse gave me the run down: no aspirin or other anti-inflammatory meds for at least two weeks (due to biopsies), no driving today, no important decisions...she took out my IV and let me get dressed. They let my dad know to go bring around the car, and I was done. I'm to call the surgeon's office and schedule a follow-up to go over the results. Two weeks.

Got to take home pictures of my insides, which pleased me greatly. And I feel totally vindicated because I SO DO HAVE a hiatal hernia. I just like being right about stuff. There were other findings too, but I guess I'll hear more about their implications when I meet with the surgeon in two weeks.

Been feeling pretty good all afternoon and into the evening—aside from drippy nose, from the oxygen I think. (I get the same thing with my sleep apnea nostril pillows, gross.) And by six o'clock or so I was finally feeling a bit of the sore throat from having a camera rammed down there. But overall? No complaints.

So ready to make appointments for labs, see the internist, take the mandatory pre-surgery class, etc. Getting excited, getting nervous. And realizing we're going to BLOW THROUGH our deductible in record time this year.

Big shout-out to my parents for making so much of this possible. Not sure what I would have done if Dad hadn't been available and willing to drive me both ways AND hang out the whole time. Best dad ever? Yes.

Had a phone call with a nurse this afternoon, to get me ready for Monday's endoscopy. The nurse I spoke to may well be the world's nicest person. She was super charming! Anyway, she asked a bunch of health history questions as well as asking about any vitamins and medications I'm taking. The big surprise for me was that I should stop taking cod liver oil for the time being because apparently cod liver oil is a blood thinner.

Will wonders never cease?

In other bariatric surgery news, I've had a perfectly wretched December. I've eaten the world, out of depression and anxiety and stress. I have attained heights of work-related freakingthehellout that I never would have dreamed possible. ANYWAY, excuses aside, it's time to get serious about losing the 25ish pounds that have to go before my surgery can happen. Ugh.

Typing about it on the internet will make me stick to my plan, right?

Talked Mom into joining me and husband on a trip to Super Supplements. My surgeon (it feels weird to say “my surgeon”) wants his patients to start taking vitamins and supplements—and to explore protein supplements—right away.

I imagined coming home with more than we did. We bought a B complex for my husband, a multi for me, calcium citrate for me, and two single-serving pouches of Raw Protein (brand name seems to be Garden of Life.) I was a little disappointed that Super Supplements didn't have a wider selection of single-serving protein powders; I realize they wouldn't be cost-effective in the long run, but while I'm still figuring things out it would be nice to have come home with a sack of different brands/formulae/flavors to sample. Guess I'll have to start investigating what's available online. (I'm also not 100% sure these Raw Protein pouches I brought home are “complete” in the way the literature from surgeon's office spelled out. Of course I didn't bring those papers with me, but I can compare and see if they're acceptable.)

Of the two Raw Protein pouches, one was unflavored, to be dissolved in water, and the other was vanilla, which said it could be mixed into six ounces of almond milk. I went ahead and mixed up the vanilla with some Silk almond milk. It tasted fine. I added a tablespoon of that powdered peanut butter stuff and it tasted better. I have no idea if this is the kind of protein powder that will really become part of my diet as I get closer to surgery, but I figure it's not a bad idea to start getting used to what they're like.

This is all a lot to take in, worrying about vitamins, supplements, and protein. A good motivator to call on Monday to schedule the mandatory classes at the hospital. Right now I'm just keenly aware of how much I don't even know that I don't know. You know?

Anyway, off to fritter away the rest of my Sunday afternoon at my parents' house. X-Box and DVDs of Dallas await.

Today was a big day, the long-anticipated first visit to the surgeon I hope will perform my bariatric surgery some time in the next few months. Fortunately my husband was able to accompany me. I'd been okay with the idea of going alone but by the end of the day I was very grateful to have had him by my side for moral support—and for his better memory about the insurance questions we needed to ask.

The doctor asked which surgery I'd been considering. I told him that of the people I know who've undergone bariatric surgeries, the woman who had a duodenal switch seemed to be the happiest by far with her results. The doctor didn't dismiss the idea of a DS for me but did present a compelling case for the vertical sleeve gastrectomy. Because I'm generally in pretty good health I guess I don't need as radical an intervention as the DS. Which is good—I was concerned about the malabsorbtive component. If I can get decent weight loss results without messing with malabsorbtion, I'll be very happy.

We talked about the various tasks I'll need to complete before I can be scheduled for surgery: lots of lab work; visit an internist; take some “life after weight loss surgery” classes at the hospital; etc. Feeling pretty good about most of them, although I'm nervous about the endoscopy I scheduled for next month. Not because I'm freaked out by the idea of an endoscopy. I just don't want to have to ask for another day off work already. (A brand new job + initiating this whole wls thing = stressful.) I guess my employer will just have to work with me, though; I'm not waiting any longer.

One thing we were able to knock out today was the psych eval. The surgeon suggested calling the psych's office to see if they could see me today, and they could! They accommodated me right away and I'm very grateful. The whole evaluation took a little less than two hours: first there was an interview with the psych doctor, then I filled out a bunch of questionnaires.

During the interview portion, the doctor asked lots of questions. About my family (health history as well as relationships—like, if there was abuse in the household growing up), about my expectations for bariatric surgery, what I wanted to get from the VSG, care I've received in the past for depression and anxiety, etc. The three questionnaires were: a “personality inventory,” a bunch of questions about my attitude toward doctors and hospitals, and an “eating inventory” that was a little painful to fill out honestly. (Admitting stuff is hard.) Just hoping that I didn't inadvertently answer all these questionnaires in such a way that I'm labeled too crazy fur surgery...

Then, earlier this evening, I told my folks. They had no idea I've been contemplating bariatric surgery, so they were both surprised. My dad (who is a very mellow guy) brought up the whole “why-not-do-it-on-your-own” thing, which I expected, but he totally got it when I explained that wls could reduce or even eliminate my GERD and might even improve my sleep apnea. Dad has GERD and sleep apnea too so yeah, he GOT IT.

My mother, predictably, freaked out. At first. Again, I expected this. I think Mom's vague ideas about wls were based on band and RNY horror stories. She listened, though. It was difficult to admit to my family (including my little sister) how bad it's gotten: how difficult it is to exercise, the exhaustion, the joint pain, the much-worse-than-ever GERD, the much-worse-than-ever sleep apnea, etc. But they have my back. I am so grateful for my family. And the husband, wow, enough good cannot be said about this guy. Can't imagine how difficult this process would be without a solid support system. I hope anyone going it alone can secure a good therapist, and cultivate a circle of good friends. Bet the support groups are helpful. Hope to check those out too, down the road.

Anyway, it's been a long day. My head is pretty full. Need to get serious about the pre-surgical diet. They said to go home and throw away all the “bad” stuff but I'm going to ease into it a little; I can't waste food we already have. From this point on, though, all groceries brought into the house will be “good.” (I dislike using moral language to talk about food, but I'm tired and uncreative right now.) I'll be eating some meat and fish again for the foreseeable future, just for the sake of taking no chances with my protein intake. But another thing I like about the VSG is that it sounds like I can look forward to maybe going back to my vegetarianism eventually. (MAYBE—this point requires much more research.)

Oh, and we're switching insurance with the new year so in addition to all the checklist items I need to plow through for the hospital, once January 1 rolls around we'll have to see what additional requirements Blue Cross Blue Shield may have for us. Whee!  

Just got back from an informational seminar at the hospital. Overwhelmed with information, but at the same time some topics felt too lightly dealt with. I want to write more about this but I find myself with a headache and I'm up past my bedtime, so.

Swinging between “what-am-I-even-doing-on-a-wls-website-do-I-belong-here-probably-not” and “oh please, surgery gods: just rearrange my insides and make everything okay again.” I guess what I'm saying is I'm sort of emotional and distraught right now, but that's okay. Just here to learn. I'm attending an informational seminar thing next month and I want to be prepared with plenty of good, thoughtful, useful questions.