Narkolepc

Send Message

Block

Add Friend

So, i think i've decided on Sinai.  I turned in my packet at the GBMC seminar and haven't heard a thing....same thing happened w/ sinai but i called them to find out what was happening.  and someone told me 'i'm sure we have it, i can't find it.  don't worry, someone will call soon'.  then 2 weeks went by.  i called again, still no packet.  however, the person who answered the phone was the program director, a previous patient of WLS herself.  i really like this about sinai, most of their staff are previous bariatric patients, so they know that you are nervous anxious impatient b/c they've jumped through the hurdles themselves.  so, this woman told me to come to that evening's seminar (which i wasn't planning to do) and i could personally give her my packet again. 

well when i got there and spoke to her, she told me she was so distraught over it being 'lost', she tore up the office herself looking for it and Found it.  she said she'd made sure i'd be getting a call the next day to schedule appt.  which made me happy but i really wish i'd followed up sooner b/c i was hoping to get my supervised weight loss documentation started so that surgery was possible a month sooner instead of 1 month later.  oh well, its all God's will, so i just need to be more patient.  My consultation is sept 4th....2 days from today.  i'm excited to talk to the surgeon and i think i also talk to the nutritionist that day and pay my $150 program fee.   
At first i was totally against the idea of having to pay ANYTHING out of pocket, but after going to GBMC's seminar and learning their fee is like $500, $150 at sinai sounds pretty darn good.  That and after doing the math, to do weight watchers for the next 6 months would cost me $240 minimum.  To get back on phentermine 6 months of prescriptions ($140) + 6 months of $15 copays to see my PCP monthly ($90+140=$230).  so i'm actually getting a great deal out of that program fee now that i know i have to do the supervised weight loss and i can do it w/ the sinai program dietician as part of being a program participant. 

So, Tues it is.  i'll post what i find out then.  During this seminar Dr Li (the other surgeon in the group) mentioned that she didn't believe BCBS of MD approved gastric sleeving under any circumstance.  This worries me b/c that's the surgery i've decided on AND b/c sinai had me call the insurance company and ask them, using the codes for each surgery, what the coverage was.  I was told by the rep that the codes the gave me for all three surgeries were covered (banding, bypass, and sleeve)....so, i hope that is still true!

So, i had my psych evaluation today. I haven't seen this guy in 3 years and i only started seeing him b/c the 17-year cicadas were invading my life and i wanted, no NEEDED to be put on some form of anti-anxiety drug or risk losing my job for not leaving my house.  i stopped seeing him b/c he kept making me take this mundane and overly simplified 'quizzes' that seemed like something out of a Cosmo magazine to describe my behavior instead of sticking to the issue at hand.  AND HE HASN'T CHANGED!  AAARGGGHHH!

Which I should have known i shouldn't go back to this guy when i tried to change the appt to and the receptionist said 'well, dr. weinman doesn't usually do these and he's kind of doing you a favor b/c you are a former patient'.  Well, i didn't ask for a favor, i asked for an appt and i guess i carried the mistaken belief that Dr. weinman was a psychiatrist and therefore he would be 'paid' for giving me a psych eval vs it being a 'favor' he was doing for me. WTF????

Anyway, i went b/c they made a big deal out of it.  and i needed a psych eval if i'm going to pursue any sort of WLS.  Which, btw, is my every intention of doing.  All Dr. Weinman was supposed to do was figure out if i'm mentally competent enough to understand the risks, and dietary restrictions associated w/ WLS.  HOWEVER, i'm not sure if Dr. Weinman is at all clear on what his job was today b/c again he started having me fill out all these freaking questionaires.  Asking me all sorts of irrelevant questions like 'when you saw me last time you had a number of compulsive behaviours you were engaging in.  When was the last time you had a compulsion?'  and i'm like....uhhh, i don't know.  not anytime recently.  'but when, when was the last time?'  i almost feel like i was having to make stuff up. 

Then he starts telling me that having a smaller stomach won't deal w/ my compulsive eating.  Which at that point, i said, no it won't but i didn't get 80lbs overweight b/c of compulsive eating...there's a lot more at play here.  'well, what do you think would happen if you started eating paper again' (i compulsively ate paper in college and when had started again when i saw him 3 years ago).  My response 'i have no reason to believe i will ever eat paper again.  even though i haven't seen you, i have been seeing your associate Barbara on and off for the last 2 years and as i've gotten older and w/ her help, i've learned how to deal w/ my stress in much more appropriate fashion'.  But what if it happens again?  How will your tiny stomach be able to handle it?  HOW IS THIS RELEVANT!  I DON'T EAT PAPER ANYMORE and i haven't in years....can a person not GET BETTER?  or am i suppose to wrestle w/ the same shit forever and let that stop me from making positive changes in my life b/c 'what if i start eating paper again?' 

And then he was concerned that i wasn't on any sort of medication b/c there are so many out there and why won't i stick to my medication regiment?  especially since i have a degree in pharmacology and KNOW drugs can help....  Well, b/c i don't like how they make me feel.  He had me on 3 different drugs.  one for obsessive-compulsivity, one for bipolar depression, one for sleep apnea and attention-deficit.  i felt like a freaking zombie.   No, i didn't give them a total chance, but when i couldn't really afford to fill the prescription and didn't really care for the 'even flattened blunted' personality that resulted from taking the samples he gave me.  'Well, how do you expect to follow a strict dietary regiment if you wouldn't stay on your meds and then just stopped seeing me?'  Ok, i can admit that i'm am a thoroughly non-compliant patient.  i don't stick to much of anything in any aspect of my life.  however, surgery is IRREVOCABLE.  i can't just decide to not comply.  its one of the reasons i want it.  b/c unlike taking tons of pills every day, my stomach won't let me abuse it after surgery.  it will MECHANICALLY produce compliance.  So, i may attempt to step out of line w/ the surgery...i absolutely probably will, but that's one of the perks....when i do, i will pay a price.  and those IMMEDIATE consequences are what i learn from.  STove hot.  don't touch.  I have a hard time seeing the connections between fatty foods will make me fat an a couple months....immediate consequences for my actions. 
Needless to say, the guy was not gung-ho about me seeking surgery. he didn't believe i'd looked at my options...what about meridia, what about zonegram...you could lose 10% of your weight.  Ok, 10%.....you are so not getting it.  I need to 40% of my current weight.  40%.  and i'd still be in the average range if i lost 50% of my weight.  10% AIN'T GONNA CUT IT!  Then he said something totally ludicrous...if you lost 40lbs you'd be perfect. you are a beautiful woman....40lbs is enough.  which then i had to give him a reality check.... i pointed to his BMII scale and said 'i'm supposed to be 130 lbs at the most to not be overweight'....  then i slid my finger over to where i am right now....into the morbidly obese range.  'if i lost 40 lbs, i still need to lose 40 more pounds to be healthy'. 
His response 'that's unrealistic'. 

I'm not totally at prey to the american obsession w/ skinnyness.  i just want to be healthy and this guy is telling me being at the upper range of healthy is UNREALISTIC.  And you know what, he's right.  He's right b/c based on medical studies, losing 80lbs the 'medical' way (diet, exercise, and meds) is UNREALISTIC. 

After i've looked at many medical journals, i've noticed that people can lose weight w/o surgery (DUH!! ) but  w/o surgery 3-4 years out,  only 11.5% of excess weight was lost. There's that  10% number again.  I've done extensive research and even w/ weight loss drugs, people typically lose AT MOST 20% of their total weight.  I'm sorry but i can't live w/ that.  in fact, losing 20% and still being obese keeps you at risk for all of the top killers...sleep apnea, heart attacks, diabetes, stroke.

Whether he knew it or not, he totally made my point for me. 

Beautiful girl yes, but also a beautiful morbidly obese girl.  People look at me and say 'why? you are so curvy...def. not fat enough for surgery'  I go to the bariatric seminars and i just might be the smallest person in the room....but those people were me once.  they were where i am not so long ago.  and after 12 years of being OBESE, do you really think my body's going to just LET GO of all this fat?  No, Not w/o one hell of a fight!  and i have been fighting.  but to lose this kind of weight takes severe calorie restrictions....  and how do you do that long-term w/ your body screaming 'I'm starving...feed me!'   People lose as much as they do w/ surgery b/c they eat 600-800 cals a day.  Now who could do that w/o a stomach that felt full after several oz of food?  could you?  who could force their body to eat its own fat when all it wants to do is maintain status quo, no matter if status quo is morbidly obese?  I'm up for the challenge, however, i want the best tools for the job.  and i don't think its UNREASONABLE.  But what do i know?  i'm just the obsessive-compulsive, bipolar, ADD beautiful girl that carries 80lbs of excess fat around to the detriment of her psyche and physical body.  There's something I do know, I WILL die too early if i don't get this weight off me and that is completely unreasonable. 

so now i'm not sure what he's putting down.  he kept saying that my desire for surgery was 'irrational'.  he even went as far as to say that i want this and my state of mind is being affected b/c 'i'm in love'. WTF?  i just had a horrible breakup w/ my best friend, yes, but i've been considering this surgery long before that went south....plus, all he was supposed to do was make sure i realized the risks of surgery.  that i knew what sort of restrictions i'd be living w/ and whether or not i was psychologically competent enough to get that.  which, if he answers honestly, there's not doubt of my competence. so hopefully, he'll just stick to answering what i asked instead of going off on his tangents about past behavior and 'love'. 

so, i think Sinai is still my first choice.  I went to GBMC's seminar last night and was not throughly impressed.  Although I know GBMC has a great reputation, i didn't get that warm fuzzy all over feeling from their group that i did get at sinai.  Maybe some of it is b/c Sinai was the first seminar i went to, but, Dr. Moie came off as very ackward speaker and a bit arrogant to me (plus a read on here a bad review from a patient that had lapband w/  him).  Dr. Von Reuden was better and more comfortable, but i just didn't feel like i'd want to be sitting in front of either of them discussing my surgery.  Additionally, they only do the bypass and lap-band.  i'm still leaning towards the sleeve, so that kind of knocks them out of the running.  ANOTHER huge 'no' was they have a $500 program fee.  Sinai's is $150.  That alone almost sent me screaming out the room.  They didn't have their dietician there, like sinai did.  they had one of their nurses, who seemed sweet, but unlike sinai, she hadn't been a bariatric patient herself.  GBMC only had one patient present to talk to us and it was a male, so, i didn't really relate to his struggle.  sinai had 3 people, w/ 2 different surgeries represented (1 sleeve and 2 bypass).  even w/ only one of the surgeons present, sinai put on a much better and comfortable seminar (they even had tea, coffee, and water there). 

in other news, i found out that my insurance covers all 3 surgeries, bypass, lapband and the sleeve.  however, they require a 6 month supervised weight loss program and i don't think they will accept the year i've spent w/ my PCP b/c we only met once ever 2 months, not every month.  SUCKS!  i'm trying to nail that down b/c having to start a weight loss program now mucks up my plan.  i won't be eligible for surgery until Jan or Feb.  which puts a tremendous strain on me since i plan to teach the spring semester and missing a lecture is really NOT DOABLE. 

i saw my PCP today and told her of my plans. I gave her the sample letter the sinai group requires for my 'file' and requested my med records to help things go a bit faster and smoother.  she's not as 'convinced' as i thought she'd be.  i specifically remember her mentioning WLS a year ago before i told her that i'd rather try a WL drug before going the surgery route.  She wants to see me in a month to talk about this more and for me to pick up the sample letter since i was there for my annual gyn appt and we could only talk about it briefly.  she did however give me the referral to the sinai group, so hopefully they will be contacting me soon to make my first appt!

So, i just got back from my first bariatric seminar and although i was pretty darn set to go w/ the lapband, i'm not so convinced anymore.  the doctor did a presentation on the 'gastric sleeve', previously only used as a 2 part surgery for high-risk patients that needed to drop a lot of weight before they were safe enough to continue to the bypass.  here are some of the specifics:

 It generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption.  It is a purely restrictive operation.  It is currently indicated as an alternative to the Lap-Band® procedure for low weight individuals and as a safe option for higher weight individuals.The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume.  By removing this portion of the stomach rather than leaving it in-place, the level of Ghrelin is reduced to near zero, actually causing loss of or a reduction in appetite (Obesity Surgery, 15, 1024-1029, 2005).  Currently, it is not known if Ghrelin levels increase again after one to two years.  Patients do report that some hunger and cravings do slowly return.  An excellent study by Dr. Himpens in Belgium(Obesity Surgery 2006) demonstrated that the cravings in a VSG patient  3 years after surgery are much less than in LapBand patients and this probably accounts for the superior weight loss. these stats are from obesityhelp.com

so after this seminar, i've got to say i'm seriously considering this instead of the lapband.  Although i believe i would lose w/ all surgery options my main concerns about the bypass was the malabsorption side.  in this case, my stomach will still have all components intact, however, it will just be smaller, like a banana.  my main issues w/ the lapband are having to have to constant post-op visits for fills.  a lapband that hasn't been filled to the right amt will not stop work and w/ my life so much in flux, well, what if i can't get the fills regularly...not to mention 20 years from now...silicone breasts leak, why should i believe the band won't need to be replaced?

of course, this surgery is no magic bullet.  i don't like that its not reversible...which my sister put it bluntly 'why do you think you need a bigger stomach, obviously the bigger stomach has not served you well and if you needed more nutrients, you could eat smaller meals more often, like if you were got pregnant'.  and i was 'damn, she's right, i don't need to be able to go back to a bigger stomach....how would that serve me?'  but then there's the issues of the staples to close off the part where the stomach's been removed.   well, i don't think that's an issue that any of the rny patients don't confront w/ all the sutures necessary for redirecting everything.  then there's the fact that it hasn't been used very much....not nearly as much info as the band or the bypass....but, scientifcally, i don't see how it COULDN't work....


anyway, i'm all a fluster now.  reconsidering.....

So, i kind of think its a bit backwards to schedule an apt for a psych evaluation until i know that a doctor will determine that WLS surgery is medically necessary for me.  However, i went ahead and called my insurance and got pre-certified to see a psychiatrist i saw like 2 years ago b/c 2 of the hospitals recommend taking care of this PRIOR to surgical consult.  i wanted to use my usual therapist (even though i hadn't seen her in like 6 months), but she seemed to think that a MD has to do these, even though the form says a psychologist OR psychiatrist.  i don't want to chance her being right though, so i got the appt.  august 17.

i'm attending my first bariatric seminar next monday at sinai.  the doctor i'm interested in isn't speaking, but its the only way to actually OFFICIALLY start the process and get a surgical consult. 

b/c i don't know which dr and hospital i want to go w/ i've got another bariatric seminar to go to later that week at GBMC and probably another at the end of the month for St Agnes. 

am i being too thorough? is there such a thing? i'm hoping that whenever i chose a dr/hospital, these extra seminars will apply towards however many they require before surgery, despite them all being at different hospitals. 

i have an appt w/ my PC the day after the second seminar.  its an annual gyno appt but i'm hoping we can do some talking about WLS during it.  i'm hoping she'll right up the refferals for the 3 hospitals i'm into right then so that everything takes less appoint and time in the long run.  that and i want to try the new smoking cessation drug, chantix.  i want to start getting rid of all of my body-destroying habits before my new life begins...that and i know its a requirment for any surgery and proper healing.

i started considering who my support system would be by surgery time and i drew a couple blanks.  the obvious choice is my best friend, however, that friendship just dramatically became severed, so i'm not sure who i can lean on for something as private as this.  my sister has volunteered to be there, but she lives out-of-state.  and since its my plan to do this sometime in dec, flights will probably not be very cheap for her to fly up and then fly back and i know i won't be able to do a 13 hour drive w/ her.

in my imagination, i'd like to have the surgery sometime during the 3rd week of december..  recover a couple days here in MD, then fly home to spend 2 weeks w/ my family in Atlanta.  i think i'll be completely rejuvenated and i'll have my mom, stepdad, sister, and doggie Momo to watch over me.   and i'll be away from prying eyes.  plus none of my friends are reliable enough to actually tolerate babying me for very long....  or maybe i'm underestimating them. 

well, those are my thoughts. i'll hopefully have more to update in the next couple weeks.