Jeffrey Thomas
Gastric ByPass Journal
Jan 01, 2010
November 7, 2009 Catch-Up
I thought I would share and open up about my journey with a gastric bypass surgery and weight loss as an outcome. It has already been quite a long process but I will first tell you about what has happened so far and then will give you date to date of what happens as it happens.
I am at a BMI of 38 with about 100 pounds overweight and 6′1″ and have a series of problems that are fondly called the “big four”: Sleep Apnea, Diabetes 2, High Blood Pressure and High Cholesterol. The recent diagnosis of diabetes 2 is what made me start on this venture thinking I would want a lap-band.
I talked to my doctor (Dr Zachary Hansen) several months ago after diagnosis of Diabetes 2 about the fact I needed to know from him, if he would support my decision, as I knew without his help it wouldn’t happen. That question was would he support me if I made a decision to go for a weight loss surgery. He said he would and I took a deep breath. I had already known a little about the process to get Medicare, Medicaid and Tri-Care to cover this $20,000 surgery.
We talked about the requirements which I had already started one year ago with taking an active approach to regain my health with the heart problems and weight. One of the requirements for most insurances is that you have a monthly visit with your doctor and have a supervised dieting plan in effect for that time (usually 6 months). So this was already done… one step completed!
I was told of the doctor which he knows that does the surgery locally and told me I should have confidence in him as he has a very good reputation for doing this surgery. I would first have to call Dr Neases’ office and find out when the next seminar he gives would be and attend. I did just that and during this seminar I was given a packet which contained various information but the most important is the checklist. What I would need since I have Medicare was a reference letter from my doctor supporting me in my decision, outlining my co-morbid health problems (the big four) and details of my weight loss attempts. Medicare actually doesn’t require a series of monthly visits to your doctor of progress notes but I still had them.
I called Dr Nease the next day and spoke to Kim who is the insurance and surgery co-ordinator and told her to send further information and a week later I received a packet which contained more helpful information but the most important was a letter for me to take to Dr Hansen my GP and what in the letter was needed. I also needed to log into the internet and do a lengthy registration and I got this done within the next few days because I had to gather some history for it.
I did just that the same day I received the packet and a couple weeks later the dictated letter was sent to Dr Nease. This letter wasn’t just right so Dr Hansen was sent a letter back with notes for the changes. Dr Hansen got it right out as I informed him I was a little impatient and he said he understood. The problem was that he dictated these types of things into the phone and they had to be transcribed but he would put a rush on it.
After that was completed I was called from Kim for my appointment to see the doctor for the first time which was November 6, 2009.
Now you are current……………
NOVEMBER 6, 2009 APPOINTMENT WITH DR NEASE
I had already heard I would wait sometime to actually see Dr Nease once I arrived for my appointment as he is swamped. My appointment time was 10:45 but I actually wasn’t called to go back until 1:00…. uhh the wait killed me..lol
I was immediately weighed, height taken and temperature taken and was escorted back to my room.
The nurse came in and talked briefly.. I was so good at filling out my registration form that she said pretty much everything was covered and she didn’t have any questions because of that.
The next person to introduce themselves was the dietitian. She told me of her responsibilities and told me about my responsibilities and one of these was that if Dr Nease thought I was a candidate for surgery then I would be coming to her class which was about four hours.
Then I waited and Dr Nease finally came in the room with a nurse and a medical student. He talked briefly about my history, medical problems and the differences between gastric bypass and lap band. He also suggested the gastric bypass because of my medical problems. I agreed and he said good and that was that. He told me the nurse would come back with instructions of what was the next phase.
When the nurse came back in she handed me a sheet of paper with Psychiatrist’s names and told me I do need to get a psych clearance stating I was competent about what I was doing and that I could make that decision to have the surgery.
The second sheet of paper was an order for blood (lots of them) for a series of tests and an order for an EKG and another for a chest X-Ray. All these tests and the psych evaluation were required by the insurance.
On November 8th I will get all of the tests done and make my appointment for the psych evaluation.
NOVEMBER 8th:
Well I spent three hours at Cabell Huntington Hospital… registration, blood lab, EKG department and X-Ray (for chest) department….. wait wait wait… then hurry to a new department so I can wait wait wait…. ughhhh. They took a total of nine tubes of blood… about made me sick to my stomach and made me feel like I was seeing stars.
There were two blood tests PTO (I think it was called that) and a calcium blood test that medicare wouldn’t pay for but they said I could have them billed and if they didn’t pay I would be responsible or I could just pay… $350.00 umm… go ahead and bill Medicare and I will fight is what I said. I can’t have this surgery if all of these tests are not done and get to the doctor so I guess I will deal with it when it comes.
I have been trying around here for some time now to get a quick appointment for a psych evaluation… it is a bit of a pain… I am just making appointments and canceling them if I can find an appointment sooner… so far December 2nd is the earliest but I am still trying to get a quicker one.
The sheet that Dr Nease’s office gives you for the psych evaluation has only four. All take medicare BUT Brian Baily… but he is a really nice guy and if i had the money I would just go to him for $250.00 because he was going to see me in just a few days. MU University Physicians and Surgeons, Huntington Behavioral Health and Oasis Behavioral Health Services are the others and they all take Medicare.
I am trying to call Prestera and see if they can be of any assistance but so far all I have gotten is an answering machine. I feel I am running into the wall and will have to accept the December 2 date…. that sucks.
November 16, 2009 Nutrition Class
The nutrition class was not very long and it was very informative and the instructor was very nice. Unfortunately she had a family of very sick people and one she was with overnight while they were being checked into Cabell for being sooo sick so she was in a hurry. All was alright though as I felt she covered everything in enough detail since I have already read for hours upon hours of the subject.
I was given a nice booklet that talked about nutrition and gastric bypass before and after. I am going to scan this so you can read it… its very informative… a book definitely worth keeping to review as you go through this process.
She had several samples of items to be used by gastric patients and it helped to understand more clearly where to get protein from, what kind was the best (yes there are several different kinds of proteins) and where to purchase at the cheapest price. She also talked in depth about what vitamins will be needed and at which times.
The room only had about twelve people with all of us sitting at tables with very wide chairs that are comfortable. It didn’t feel cramped in the slightest and guests or “supports” were welcome also.
November 18, 2009:
I have settled on my December 2 appointment for the psych evaluation with Huntington Behavioral Health at 1415 Sixth Avenue in Huntington, WV 25701 (304)523-1142. I have already received their paperwork and have gotten through some of it with the rest that will wait till I can go dig up the details (history, all my medications, dosages and strengths).
Since I have Medicare, Medicaid and Tri-Care I won’t have to pay a dime for the $350.. the cost of this appointment!
November 19, 2009:
I was floored when I opened the mail from Cabell. The total for the blood tests from Cabell I had done $1800.00… glad I have enough coverage to pay for it all.
December 2, 2009:
I went to the Psych evaluation and was talked to for about ten to fifteen minutes and took a hundred sixty question test. He told me he supported me in my venture and would send word to Dr. Nease.
December 14, 2009:
It is really hard to get a hold of Kim Yates which is the person I have to talk to. I have left messages and am still waiting to hear if they get everything. I guess I will wait till Monday and call non-stop to her direct line until she picks up. It makes me a little mad that I have to keep waiting but wait I will.
December 15, 2009
Ok, finally got a hold of Kim Yates and she says they have not yet received a fax from Behavioral Huntington Health…. take a deep breath ….. called Huntington Behavioral Health and asked if they had faxed my report to them. They said it was faxed to (the correct number) on the 7th and the fax transmission said it went through just fine. … deep breath ….. OK… I asked them to fax again and they said they would and asked me to verify through Dr Neases office if it had gotten through…. LOL … getting a hold of anyone is the problem…LOL. So I called and left a message on Kim Yates phone and in an hour she called back and said they had gotten it and she was going to forward everything to (cant remember who) and they would be in touch in about a week…. A WEEK… hurry hurry up and wait…. erghhhh… so I am now waiting to hear from Dr. Neases office and I am sitting here waiting…. deep breath.
December 28, 2009 The Call
I got the call that I have been waiting for... my surgery date is 1-13-2010... YEAH... wait... so many things to do and get and am I making the right decision?... deep breath.... I placed it all in God's hands and he will do with it as he pleases... everything else has just fallen into place so far and I have to know that was with his direction so on I go.
January 1, 2010 Walmart Visit
I made the visit to Walmart that I know is pretty much the last thing to do and shelled out about 150.00 in groceries and products including blender, vitamins, calcium, prenatal vitamins (even though I am a guy... say what?!?!?)... anyways if my teams tells me to do it I'm gonna.... and the protein powders.
Went to my pre-op class this morning and it was very informative and quick and to the point. It was very well done and I enjoyed it. Got our "bible" and it is really nice. Was told about the catheter, the drainage tube and possible the feeding tube since I am having the bypass and have sleep apnea. Interesting... was told that you are more likely to have a feeding tube since patients with sleep apnea and bypass risk leakage at a higher frequency. We also practiced our breathing device (suck in on the tube and make the ball go up for breathing stimulation thing).
I then went to Cabell Huntington Hospital and waited on pre-registration and then stood in line to talk to an admissions nurse and sort of check in... talked about anesthesia, my meds, allergies and that type of stuff. Then walked over and got my lab work (3 tubes sigh... lol... nothing like the last set).. in and out in about 2 hours. Not to bad.January 8, 2010
I went to Cabell Huntington Hospital and waited around after registration for my gall bladder test. They didn't take that long and I went back into a small room/ I took off my shirt and lay on my back and the tech put globs of gel over my stomach area and thank the lord it was warm. She then continued to press the little wand down into she got the images she wanted and told me to take deep breaths when she did. I then lay on my left side and she continued. I was in there maybe 20 minutes and was done.
Directly after that I went straight to my appointment with Dr Nease. I went in early because I wasn't going to go home in that weather and then come all the way back. Good thing because the nurse at the front counter said they had cancellations and I would be able to go right back. Which I did... yeah... no waiting. The first to come in was the nurse who took weight, temperature and blood pressure. Then the nutritionist came in and she told me to know the phase two diet like the back of my hand and asked if I had any questions. Then Dr Nease and Jackie came in and he examined me, gave me the speech about dangers of surgery, and then described exactly what was happening on surgery day. Then after I asked a few questions he said I was free to go and would see me on Wednesday.
Then I went and got a fill up of all my medications so I was set to go and didn't have to worry about any of it. When I was getting my medication Jackie called and asked how prepared I was and I said I was all caught up. She asked if Monday was too soon for the surgery.... I said heck no... two more days is two less days for me to worry. So now my surgery is Monday the 11th, 2010. yeah!
January 11, 2010 Day of Surgery
We entered the hospital and went to the surgical floor where we waited for about 45 minutes. I went back and changed into a gown and footsies and then put on a robe. The bag with my personal belongings was put into a locker and I was ushered back to a curtained room and told to take off the robe and lie in bed and they put a sheet over me. The nurse came in and asked all kinds of questions because half my chart wasnt in my folder because of surgery date change. Oh well they figured it out and all was good.
The nurse put the IV in and then said the anesthesiologist and Dr Nease would be in shortly. I first saw the anesthesiologist and he went through my medication list and past surgeries and all that type of stuff and gave the go ahead. Then the nurse for the anesthesiologist came back and checked vitals and asked a few other questions. Dr Nease came in a joked a little with my two kids and with me and made me at ease and told me they are ready for me and they will be around in a few.
The orderlies came bustling in and took me off, me and all my fat... good riddance is what I thought. Then I looked up and told God that everything was up to him now because I was done. They got me in the operating room which was full of every which type of thing and its brother and moved me to another hard table and before I knew it my gown was off and I was covered up. Very nice... my fat doesn't need an audience any more then it already has. They stuck my iv and the nurse leaned over and said your just gonna feel like your going to sleep and then put the oxygen mask on and in about 1 minute I was asleep.
I woke up abruptly in the operating room I believe as they pulled the tube out of my throat cause I had a choking gaging reflex for a few seconds. The nurse leaned over and said I was getting two types of pain shots and to hold on because they new I was in pain. Once the first shot went in I felt better and then they gave me the second shot and I felt dang sweet.
I was wheeled back to the recovery room and swarmed with people and awareness came about me very quickly and I was hot as hell.... I was actually sweating up a storm so the nurse put this bedside fan on the bed and I felt like I went to heaven. I was there for awhile and nurses came and went but I didn't care much I felt rather nice.
Eventually they came back and started wheeling me to my room, which through the windows I became rather bewildered as it was dark and snowing and I remember thinking that it should only be 3:00pm what was going on. So I asked what time it was and they said it was 6:45pm.... WHAT?... and they said that Doctor Nease would explain.... oh man now something happened and I was scared. "Did the operation happen"... "Yes they replied."
I got into the room and it was very spacious and private with a overly automated bed, a side chair, a bench that folded out and yet another chair. The far wall had all the furniture against it and it was a massive floor to ceiling window which I thought was very nice. The private bathroom was in one caorner the bed to one saide and across from that was a sink, counter and a flat screen tv. I was moved over to the other bed and felt all the pain for awhile.
The wife and kids came in but since it was so late I told them not to stick around because it was snowing and dark and was going to continue snowing all night. So they left and I was happy to know they were getting home.
The nurses came and went taking blood, taking blood sugar levels, and helping in different ways that they could. My throat didn't hurt actually but was extremely dry and voice was almost gone.
I had that pain pump put into my hand and got it set to the clock so every ten minutes I clicked the hell out of that thing. I wasn't in to much pain but I didn't want to get into any either. At 10:30 at night I had to do my walk. Now I was told the walk doesn't hurt but the getting up to where you can walk is another story.... let me tell you I thought I was gonna hit the roof. But I did get up and did do my walk like a good boy. Once I got back into bed panting like a rabid dog from being exhausted I fell asleep.
January 12, 2010 Day Ofter Surgery
The night was bad,, really no sleep at all. Besides the pain my feet were cramped against the foot board of this bed (no one explained that it could be adjusted to go out some duh!) and that coupled with the constant stream of people wanting blood or to give me something or other I had maybe a combined sleep of an hour.
My family comes in and I ask what in the world had happened.... Dr Nease hadn't been in yet.
Wife Explained: When they did the leak test afterward they found air bubbles so
while I was still opened up they re-sutured the edges of both the new stomachs
and that why I was in there so long. I was also given the G Tube along with
the J Tube I already knew was going to be there. Then my wife looked at me
and asked if I wanted the bad news.... I about jumped outta bed.... she told me
the drivers door of the car had been hit in the parking lot. As if we don't have
enough to worry about.
So the family came and spent some time with me and they took off and then Dr Nease comes in and says right off that I gave them a problem but everything was alright.
I was started on tube feedings which are extremely weird. Not painful just weird to feel part of you filling up without eating or drinking.
The techs finally come up to get me and take me for the swallow test.... man I felt like crap but I knew I had to do this if I wanted to drink anything at all. So off we went. I was first escorted to a wall board and pictures were taken and then placed against another wall where I took one sip of this gross stuff and pictures were taken and then yet one more time with yet another sip... gross. Then placed against a table that was up in the air... they had me stand on the little ledge and lowered it when I was on it.... pretty cool and little pain. Sweet.
After I got back to my room I asked for lip balm and something to wet my mouth. Was given this great cherry Vaseline lip care... smelled like candy. I was also given these swabs of lemon water to wipe in my mouth.
That's it for this day... I wasn't offered any liquids as I was told I would so I asked whats up with that. I was told my swallow test still showed a small leak... oh brother.
January 13, 2010 Last Day In Hospital
I felt so much better today.. I did my walks and was complying with everything I was told to do. I waited for Dr Nease and he came in about 3:00 and looked me over and told me I had to continue my tube feedings through the J Tube until Tuesday 8:30am. He gave me a list of my home meds and what he wanted me to take and what he didnt want me to take but all had to be crushed and given by the J Tube. I said I agreed and I was discharged..
We waited for about two hours for a nurse to get around to getting me unhooked and I was anxious to get outta there. Car ride home was a little weird... I felt every bump and swerve... my wife drives like a bat outta hell (Love you honey)...lol... just kidding! I got home and immediately washed down and got some sense of me back with clean clothes and slipped into the newly washed bedding... that was a blessing... and fell asleep.
January 14. 2010
I am continuing the tube feedings and still find it strange. We had to buy a pill crusher to crush all my pills and those went into the tube also. Day continued in less pain but I did my walking and feeding like a good boy. Last night was up and down trying to get comfy and feeding in the middle of the night and every four hours I WAS getting my pain medication come hell or high water.
Also today I put a call in for something more to help with a herniated disk problem.. having to sleep on your back with disk problems is a son-of-a-b. They prescribed something that was a muscle relaxant... it better work. The pain meds don't touch my pain in my back by a thousand yards.
January 18, 2010
I am feeling really good with no meds for almost 40 hrs out. I can gently move on my side with no pain and walking doesn't hurt at all. Really the only pain I am in is where the tubes come out of me... they are sore and irritated and hurt a lot whenever they hit my shirt. These tubes better both come out on Tuesday morning when I see Dr Nease or he may see me actually turn into a madman.
January 19, 2010 J Tube Removal
I went to Dr Nease in the morning and found out I have already lost 16 pounds and can't believe it. Although I wanted to have both the G Tube and the J Tube taken out I only got the J Tube out. He wanted to keep the G Tube in for scaring or something not sure. The first tug on the J Tube felt like someone grabbed my stomach and was squeezing but was so relieved when it was out. Dr Nease sent me over for bloodwork, lower cat scan and chest xray because my blood pressure was 155/80 and I had a fever of 100 to rule out an infection or water build up.
So over to Cabell Huntington Hospital we went.... had to wait in registration for no time at all then went to get the bloodwork done first. Then we got the chest xray done and then they did it... they did what I feared... they brought me the glass with that cocnut lemon smelling crap and told me to sip it... blahhhh. I got that down got the IV in and they did their thing. I didn't even feel the dye go in... they warned that it would make me feel warm and tight in teh throat. So that was done.
We went home to wait and hear from the doctors office what if anything was found from test. At 3:30 I got a call saying eveything was alright and I could advance my feeding stage. Later that day I felt really really sick.... I didnt know what I had done to make me feel this way. I was hot and I crammped and it wasnt because of food because I hadnt had anything since the night before worried that the tubes couldnt come out if I had something in my system.
I tried going to the bathroom and nothing helped. I did a tube feeding in case it was hunger... that helped me go to the bathroom yeah! Then all of the sudden I burped a whole lot.... and all the sickness went away completely. I wasnt nauseated or sick and figured it was from trapped gas?
Janaury 21, 2010
I am able to get around, still doing tube feedings but just once in morning and one at night, but have a burning sensation that just wont go away from where they took out the J Tube.... I feel pain where the tube was and it makes me feel like I have some sort of set back since I cant get along as well as I did right before they took the tube out.
February 5, 2010 G Tube Removal
Went to the doctors early in the morning and had my G Tube removed. The Dr told me its gonna hurt and it did... he pushed down made a cut (which I guess releases whatever holds it in) and pulled... it was a searing burning pain and was the first time through any of this that I had tears. After he pulled it out he put this medication in to promote healing and it had alcohol... I could smell it and it burned bad bad... with me he had to put a lot of pressure on it to keep me from bleeding. After ten minutes it was all over... it was much less pain and I was ready to get going.
The nut told me to go to next stage so off I went.
