Starting weight: 349.7
Current weight: 164
Goal weight: 134.7
Starting BMI: 53.1
Surgery date: Wednesday, June 18, 2003
Age at surgery: 41
Weight loss to-date: - ~185
The original words below are written by myself.
The profile below is a personal journal that I keep on my own PC to chronicle my weight loss surgery journey.
I have agreed to post and grant permission only to the domain ObesityHelp.com to display portions of my journal. However, ObesityHelp.com in no way holds any copyright, ownership in any capacity, or claims to this original work. Furthermore, I only grant permission to the domain of ObesityHelp.com to display my original work. I do not grant permission to have this profile linked to or from any other Web site, be it either personal or commercial.
This is in "reverse" chronological order (I've always been a little backwards) ...
so start from the bottom if you want the "whole" story!
NOTE: This profile is a work in progress (but then again, aren't we all?)
... I'm trying to organize my thoughts (which hasn't been easy these days). 02/10/06 kzb
FLASHBACK ... to some of my efforts of losing weight throughout my life:
10 years old (1972) ... my first "experience" with Weight Watchers
12 years old (1974) ... my second "experience" with Weight Watchers
14 years old (1976) ... taken to a hypnotist (psychologist, I believe, really don't recall his credentials, but he was called Dr.). I don't remember too terribly much from this experience. I believe I saw this person for about six-eight months or so, I don't recall how much (if any) weight I lost. I do remember that I could only use Prell Shampoo, could not "touch" the food (don't want to get the grease into my pores ... had to wear gloves to "touch" food), and some other pretty silly things. I also remember one session where he walked me back through (under hypnosis I guess) to when I was born and my mother was giving me up for adoption. And another time, he was doing like a word association. Just a bad experience alltogether, not necessarily appropriate for a 14 year old girl, and I still have bad feelings about it ... oh yeah, I do remember one of the hypnosis points was that everything was supposed to taste like "staples" ...
16 years old (1978) ... sent to Weight Watchers camp held at Lakeland College in Wisconsin. Lost 21 pounds over a seven week period (from 181 to 160). I had a great time, was more active in that 7 week period than I think I had been all my life! I think it was a great setting, but I wish they would have prepared me better for "going home". I think I slept for six weeks straight when I got home.
16 years old (1978) ... I believe almost immediately upon coming back from WW camp, I was enrolled in modeling school (still the fattest one there). I think it was supposed to be motivation to keep the weight I lost at camp off.
not sure of age ... Nutrisystem
~22 years old (1984-85) ... Medifast ... wow, was this a trip. Medically supervised, and I lost 65 pounds in 2 months (stayed on it for about 5 months, don't remember total lost), but was only drinking horrible protein shakes (I did this before Oprah did her Optifast thing). I was an emotional wreck, couldn't stop crying and had THE worst cravings ever.
many ages, too numerous to count: Jenny Craig ... I worked for a radio station and in turn for writing and producing the commercials (featuring me), I was put on the program. I believe I lost about 40 pounds within 2 months or so. The sales account exec had a disagreement with the client or their ad agency and these spots (and my enrollment) was pulled.
35 years old (1997) ... my "eating buddy (and best friend)" from high school had WLS ... was a little "too" encouraging for me to do it. I was not ready or open to the idea, and didn't want to hear about it at the time. Unfortunately, we drifted apart (for a few reasons) .... HOWEVER ... through these boards, she recently contacted me, and hopefully we'll be able to rebuild our friendship.
37 years old (~1999) ... discussed WLS with my PCP, she didn't recommend it, suggested I go on Meridia. I didn't. Eventually got a new PCP.
41 years old (June 18, 2003) ... RNY surgery
MORE to come ...
12/11/06: Wow ... three months since I've posted! Let's see ... weight has been holding still, I'm told because I'm not really near what I should be getting calorie-wise.
Saw an endocrinologist just today for the hypoglycemic issues. I haven't passed out or had a seizure since August, but I guess the doc just wants to check all bases, especially since hypoglycemia issues are popping up all over with further-out post-ops. The endo essentially is having me journal what I eat (and when), and then test my blood sugar level. He also said I should stay away from fruit juices and fruit juice, and instead of having 8 oz of skim milk, I should be drinking whole milk, as the fats slow absorption ... that's a new one on me. So ... we'll see how this all goes.
Still not doing to well after eating though ... all I want is my soup and coffee. That just feels the best. Eating solids still causes pain, followed by sweating, nausea, bloating, etc. My one doc suggested I go off the Nexium (due to a study I showed him about proton-pump inhibitors causing gallbladder dysfunction, but possibly function returning by going off the PPI), which I did ... about a month ago. Well, I hadn't started the Zantac he prescribed (by that time), and he believes that going off the PPI hasn't helped restore function to the GB, and I gave in and started the Zantac (pain and burning getting worse). He also gave me something else, will have to double-check the name, but sometimes you don't realize how much pain you're in ... until you don't have it. I swear, the first time I took these two meds, I noticed a HUGE difference. He is still convinced that the GB needs to come out though ... I may actually have to give in on that at some point. But I do still have issues that if I have it taken out, there will be nothing to stop me from eating more, especially because I cannot trust myself.
Case in point: About three weeks ago, I had a crew working on the house, so I provided breakfast and lunch for them. The last day I bought them 2 dozen donuts (this was a Friday). The following Tuesday I went downstairs and noticed there was still a box there. I opened the box and there was a dozen donuts still in there. WELL ... immediately ... my mind just went into a spin. I was deciding in which order I was going to eat ALL OF THEM. I first thought that the bismarks were probably the most dried out, but I could scoop out the inside, but then I eyed the coconut and butternut ones, thinking that the oils in them would have most likely kept them the freshest ... and without even thinking, I grabbed the coconut donut. The doorbell rang. Divine intervention? Nope, just the delivery guy. I hurried back to my donut-in-waiting ... still not in my right mind, unable to talk myself "down" ... I tore about a third of the donut off and shoved it into my mouth as fast as I could ... probably didn't even chew it ... Extremely ashamed, I ran upstairs and started to beat myself up. And dumped on top of it (but not as bad as I thought I would ... which is BAD). I told DH he had to throw away that box, so he did. In the garbage can UPSTAIRS in the kitchen. So the box was open, and I could see all the donuts staring at me. I had to dump cat food on them. Then I began to wonder, "how bad could cat food really taste? And how much protein could be in it?"
Geez, I really wasn't kidding that the surgery was the easy part. I don't know what/why I'm going through this. I can't eat, I don't want to eat, I feel sick when I do eat.
I recently attended a holiday party for one of my WLS support groups, had pics taken ... and I HATE HATE HATE the way I look ... I feel as huge as I ever was. I am so disappointed in myself.
Still dealing with the brain fog and lack of concentration ... frequently light-headed. Also have noticed that particularly in the cold, my fingers turn all white (nail beds and all) and get excruciatingly painful (not just the three fingers that were affected by the nerve damage due to the dog bite, but all of them). Someone suggested Renaud's (sp?) ... I'll have to look into that.
Speaking of the dog bite issue, I did get a second opinion from a hand specialist, and he is suggesting I use a tens unit for a bit (they used this on me during my occupational therapy for the six months after my wrist surgery), and then I should see another specialist in St. Louis. So much for my new year resolution of not seeing any docs in the new year. :-(
Just over a month since my seizure, and its been nothing but a circus. My neurologist ordered an EEG, which came back questionable, so now he wants an MRI. My doc I consult regarding WLS wanted me to do a glucose tolerance test, and although I put it off for a bit, I finally did it last Monday. Ick. The doc and I talked before he gave me the paperwork for the lab, and he said I wouldn't have to drink the sugar-water, there was a different method they could use, however, when I got to the lab it was a different story. I guess they didn't believe me and either couldn't read or didn't interpret the docs instructions on the orders.
So, I just did the Oral Glucose Tolerance Test. I'm kind of surprised that I didn't dump the way I thought I would (no palpitations and sweating, in fact I was excruciatingly cold), but I did have SEVERE nausea and cramping for the four hours plus of the test. I called the doc who ordered the test and left a message asking if other patients had gone through this, and told him how bad I felt. He left a message for me later that afternoon that they weren't supposed to give me the glucose challenge! Sheesh!
Anyway, the doc called with the results last Thursday, said that the blood draw after the first hour was 38, and only in the 50s the second hour. I didn't think to ask what my baseline was and what its "supposed" to be after the first and second hours. He suggested that I eat every 2-3 hours and make sure I get complex carbs. He also said that I should "probably" see an endocrinologist, I believe he's following up on that and planning to send me to one, but I'm not all that certain of where we are on that.
I'm seeing others on the grads list and other sites with low blood sugar issues at 2-3+ years out, and am trying to find out more about reactive hypoglycemia/late dumping, etc.
I'm also noticing that I seem to mini-dump every time after eating. Getting flushed, sweaty, nauseated, bloated, and now I also get a prickly, tingly sensation on my neck and face and my legs (particularly calves) feel strange, almost as if they're "just about to" cramp (but they don't).
Oh, I also have an update on the dog bite from July 22, 2005 -- I saw the surgeon on Fri (Sept 15) because my wrist is still bothering me (I can't wear jewelry, long sleeves, or even brush against it), and he said that the only solution is another surgery, WHICH, will still leave me with some numbness. I am going to get a second opinion on October 23rd.
I did have a thought provoking meeting with my therapist last Thursday. I've been seeing him for about a year, and I don't think that I've mentioned anything this time that I haven't already mentioned throughout the year, but it seems that perhaps some things may have started coming together? Time will tell, and I don't necessarily like what we came up with (and it scares the crap out of me), hopefully I won't do my "usual" and hide my head in the sand to not deal with things.
I'm still being told the gallbladder "should probably" come out.
OK, I *know*, I just *know* things will be turning around at SOME point, right? Well, just as I've been trying to wean myself off doctors, I guess that wasn't in the immediate plan.
I went to the Renaissance Faire last Sunday. Apparently I was walking around (just after we got into the Faire), and after about 20 minutes, I remember reaching out for my friend and saying "I think I need to get something to eat" ... the next thing I knew I was coming-to in an ambulance.
Apparently, my blood sugar had dropped to 23, and I had a grand mal seizure. The rescue squad was able to get my blood sugar up to 177, but it tanked again in the hospital to the 50s. By about 2:30, they felt they had me stabilized enough to go home, and I felt fine (I wanted to go back to the Faire!!). Very strange. I went to see my doc (you know, the cute one at Res) last night ... he also believed that I may have had a seizure at the end of May (see entry below), when I was in Dallas as well (that's why he had me see the cardiologist and neurologist). I did speak with the neurologist yesterday, and I told him what had happened, and he wants me to have an EEG (although it is most likely sugar-related). My Wellness Center doc also thinks I should have a "prolonged glucose tolerance test and have you closely monitored for hypoglycemia."
SO, as I'm trying to wean myself OFF of docs, I'm just getting in deeper!! Ish!
Got the results of my thoracic spine MRI and my bone densitometry.
The bone density test states a T-Score of -1.9; and a Z-Score of -1.1 (whatever that means) ... from what the results say, I have a moderately reduced bone density (Osteopenia). Was prescribed
Miacalcin nasal spray
(to "build" bone) to try for one month.
The spinal MRI showed disc herniations (demonstrated hypertrophic spurring at multiple levels, representing degenerative thoracic spondylosis). The neurologist said surgery most likely is not necessary (whew!), but physical therapy and perhaps spinal injections (ick) may help.
Was in a car crash yesterday (ok, since its 5am Thursday, I guess this happened Tuesday night) ... kind of minor, but this woman did clock me pretty hard. I've had a headache, my vision is a bit skewed (but getting better) and general aches from being jostled around. I got a little scared when I put my laptop backpack on yesterday morning, I felt a sharp shooting pain go down my spine, so I caved into peer pressure and saw the doc. He's not concerned, said possibly a mild concussion (if that) ... he probably thinks I'm nuts for just coming in.
My nutritionist had me do a metobolic rate assessment (I'm sure to prove a point) ... which basically showed that my metabolism is a little lower than normal, and that for me to maintain my current weight (with my current activity level -- which is "not much"), I should consume 1426-1852 calories, and my "weight loss zone" is from 1142 to 1426 calories. OK ... this makes sense, I understand it ... but why can't I just "get it"? My weight has not moved (other than maybe 1/2 pound either way) in about 8 weeks or so and my nuts tells me my current calorie intake (not quite 1142) may be the reason why ... I did find the evaluation interesting though ...
I also think I'm kinda on the edge right now. I'm trying to survive a person close to me with a substance abuse problem (I thought we were supposed to support one another, but everytime I've needed support ... its all about him ... and he goes off MIA for a few days ... yet, I have always, ALWAYS been there for him). I don't have the energy to get into it right now ... all I can say is this is draining me, and I don't know how to survive it myself ... I really don't like airing a lot of private things, and I know I have kind of skirted around some of the issues here, I don't like to make anyone look bad, but I don't know how/where to go from here ...
OK ... am I supposed to feel worse when I leave my therapist? This has happened quite a bit. I don't know what that means. I left the office and just sat in my car and cried for a bit. I know I'm somewhat frustrated, because sometimes it seems he doesn't remember a lot of the things we've talked about previously (but can I really expect him to?), so I often feel like I'm explaining things over and over ... but maybe that's his tactic?
Anyway, I kind of feel like we're spinning our wheels, and I don't know if we're getting anywhere. I've got a few "issues" going on and maybe we're working on the wrong ones? I truly don't know. I'm thinking maybe I need to take a step back from doctors/nutritionists/therapists and just see if I sink or swim. I can tell I'm frustrating everyone (including myself), and I don't want to be wasting anyone's time, especially when perhaps they can be helping someone else. I've always pretty much kept to myself (its hard identifying and announcing your flaws), and maybe that's how its meant to stay.
After seeing the gastroenterologist (a nightmare) earlier this year, and my surgeon last October about the same problem I've been experiencing since last August (and I was actually diagnosed with a dyskinetic gallbladder at a different hospital ... full story below) ... my surgeon's office called, saying they understand I have a problem with my gallbladder and my surgeon now wants to see me (my original surgeon, not the doc that diagnosed me). I just have mixed feelings here too. I feel like, why were you not interested in October, when I complained of the very same symptoms I mentioned to the doc at the other hospital that diagnosed me? Same question to the gastroenterologist. Because I asked if it could be "in my head"?
Maybe I was HOPING it was in my freakin head.
I guess that's where the doc who did diagnose me made the difference ... he said, "well let's find out". Do I really want someone who's going to yell at me, not return my calls or take me seriously, or one who will push a little and maybe go above and beyond? I have this stupid loyalty to my original hospital (have been going there for 20 years) ... should I not? Well, once again, my thoughts are to just give up on the docs/nutritionists/therapists for a bit and I guess what doesn't kill me will make me stronger?
Kind of in a pissy mood today ... can't you tell?
Saw the neurologist today (one of my docs wanted me to follow-up with my cardiologist, a neurologist and new GI guy because of my "episode" in Dallas last month ... personally, I think he's going a little "over the top", as I believe it was late dumping or hypoglycemia that made me black out). Anyway, I saw my cardiologist, had a stress test (all was fine, with the exception of a slight abnormality with my EKG, but was told not to worry about it unless I start having chest pains). The neurologist today said there doesn't appear to be anything neurologically wrong (I probably could have told you that) ... but he does want me to have an MRI because of the pain in the upper left quadrant of my back (just under the shoulderblades, which to me ... is symptomatic of gallbladder probs, ALTHOUGH ... this is the upper LEFT back, whereas gallbladder tends to be on the right side). I'm still pretty constantly feeling quite nauseated though (moreso after eating), and the pain radiating across my back across the shoulder blades but which is more prominant on the left side also feels kind of "numb" ... or "tingling" ... I dunno anymore. Do I keep pursuing all this? Or am I spinning wheels?
When I told this neurologist about what had happened in Dallas, he too was appalled and extremely surprised the paramedics left me at the club (as was the doc who ordered me to followup with these other docs). The reaction from these 2 docs caught me a little off-guard.
Sheesh. I think I'd like to just hang all this up for a while. I know I'm repeating myself ... but I just DO NOT DO WELL AT NOT BEING WELL
I do have an appointment this Friday, however, to have my metobolic rate tested ... I think that will be pretty interesting.
3 YEARS POST-OP TODAY!!! Where did the time go? Sometimes I forget I had surgery, sometimes I think I still need to go have surgery ... I would have thought things would have been smooth sailing by now. Its occurred to me that this will ALWAYS be a struggle. That the first year is almost a "free" period, where we will lose, and SHOULD take that time, while we CAN'T eat the way we used to ... we should take the time to break the bad habits, its an opportunity to start new. Unfortunately, some of the old demons aren't kept at bay forever, and if you're not prepared to deal with them, your journey will be that much more difficult down the line.
I am still not at goal. 3 years out ... and not at goal. I have about 40-50 pounds left to lose, and yes, I am disappointed with myself. There are a lot of messages I would like to (and do) pass on to pre-ops or new post-ops ... but I think the most valuable observation I've made is: The people who are truly "successful" with this surgery (and by "successful", I mean who get to goal and stay there long term), are the ones who incorporate exercise into their normal routine (actually have it planned into their day, not just "whenever" ), and those who have completely changed their eating habits (and I don't mean substituting sweets for sugar-free stuff).
So, where do I think I went wrong? #1 - Exercise.
Although I've taken the doing it "here and there" approach, that won't cut it in the long run. #2 - Not having a goal.
I guess I've always expected my surgeon or weight loss program to help me set a goal (so three years later, I kind-of have one). I think I've expected too much from others, BUT if I was able to do this on my own, I wouldn't have needed surgery in the first place. #3 - Not having a structured food plan.
Not having a plan on what to do if I'm not at goal at one year, or two years out (or when the honeymoon is over), and then ... how to maintain (ok, well, I'm not quite there yet either) ... OR, even how to deal with a gain!
I'm glad to have made it to this point, and I know I've got quite a ways to go ... and although I've recently had some problems, would I do it again? You betcha. In a heartbeat.
Thank you to those of my docs/therapists/nutritionists and especially FRIENDS who got me this far, and who have not given up on me, even though I've been close to that point myself.
I'll get there.
continuing from the birthday story ... after I got home (and got the flowers and SF chocolate cream pie from DH), he took off for a softball game (which goes from 6:30 to 7:30). He is still not home. He's been on his partying binges for the past few weeks ... but did he deliberately do this on my birthday? Last thing I said was I'll wait til you get home and we can have the pie. I'm just very crushed (again). I can't even explain the gamut of emotions I go through. Hurt, disappointment, anger, hate, fear, concern, numbness, and everything in between. The flowers, pie and card are now in the garbage ... as may well be my marriage.
Birthday day today. I was really surprised at the calls I got today (usually don't expect much on my birthday). I am surprised that I did get flowers from my DH, since we haven't been talking to one another for weeks. Is that supposed to be a truce? Or maybe he just wants to make sure he gets something for HIS birthday next week? ;-)
Oh yeah, BTW, I posted on May 14th that someone (my height) said they were 5'4 or 5'5 ... and I've always thought myself almost 5'8 ... so I was kind of freaking out! My therapist measured me and got 5'6 ... which didn't set well with me either, so I had my nut measure me ... and yes, I AM 5'7-1/2. whew.
OK ... after scheduling gallbladder surgery a few times, the date was supposed to be tomorrow. The last date I was scheduled for was July 7th, but the surgeon's office called and needed to move it up, so we set June 2nd. I've been kind of freaking out about the surgery, and have really wanted to cancel it. Well, you know the saying, "be careful what you wish for?" (hold that thought, I'll get back to it in a minute)
I went to Dallas last week for meetings, and the week or so prior to that I was working on my project for the meetings night and day. SO, I didn't get a chance to do my pre-op testing (which was suggested to do about 2 weeks before surgery, so I was freaking out about that a little too). Anyway, our group rented out a trendy club for the evening last Wednesday. The food was pretty much hors d'ourves, which I think I had 2 chicken bites and a veggie kabob, and a couple of drinks (a Riesling wine, and mango martini) over about a 3 hour time frame.
Later that evening, paramedics were called because I was found on the floor in the ladies' room. They took my blood pressure and just assumed I was intoxicated (which I can tell you right now, I *know* I wasn't). I honestly believe that I became hypoglycemic (from dumping?), but they never checked my blood sugar level. I did find some interesting information, and I think it all fits perfectly.
Dangerous Side Effects of Gastric Bypass Surgeries
-- discusses hypoglycemia and dumping ... NOTE: The doctor on this site is anti-WLS ... but I still find the info interesting.
St. Vincent's Medical Center -- Possible Long-Term Complications of Gastric Bypass surgery:
-- discusses EARLY and LATE dumping, etc.
I also found some information about wines (from a search on this site):
Info about California and non-California wines: "After speaking with the head wine maker at one of the major wineries in the Napa Valley, he informed me that if it is a California wine, it CAN NOT have added sugars. One of the regulations for wine production and judging quality in California is that the wine has to rely on the natural sweetness/quality of the fruit used. He did say that different states/countries have different regulations. But I know that if it says California on the back, then it won't have added sugar. I live in Michigan and checked with the St. Julian wineries....they add different types of sugars to their wines....particularly beet sugar, which I understand is a no-no for RnY-ers." (provided by Lynette B.)
Whether this, or the sugars in the mango martini, or even the sauce into which I dipped an egg roll or chicken bite was the culprit, I really don't know.
, I went to see my doctor last night, I told him about what had happened, and he said to cancel surgery (that its "not good to pass out before surgery"), and he wants me to see a cardiologist, neurologist AND a GI doc (my GI doc that I've seen twice has been a complete jerk to me) ... basically he wants to make sure I didn't have a siezure or something. NOW ... is he a little over the top or what? (I mean I really like the guy a lot, and I printed out info from the links I provided above (and more), and although I really didn't want to do my surgery this week, I think this is a little extreme.)
I think one of the reasons I don't want to have this surgery is that the pain when I eat kind of keeps me in check. I'm still horrified about the 20 pounds I had gained (in a 10 month period), and I feel if this pain when I eat goes away, I'm going to gain again. I've been told this is an irrational fear ... but geez, aren't most fears irrational?
It's been another rough couple of weeks. I don't know if this downward spiral is ever going to loosen its grip. I still crash pretty much in the evenings ... almost gets to a panic, where I am just looking for someone to talk to. Why does it seem that people (sometimes especially good friends) tend to run the other way when they sense someone is troubled?
The more I think about this possible gallbladder surgery, the more upset I get. I've talked with the surgeon who wants to do the surgery (of course, sooner rather than later, according to HIM) ... I always seem to think of questions to ask AFTER I leave the doc's office, so I faxed over about 30 questions, which I was hoping his nurse could answer most, and then ask him whatever she couldn't answer. Well, she contacted me and said he had filled out all the answers, but she may need to interpret them since he writes like crap. Well, I went into the office to see her and we had a great talk. Some of the questions for him were a little off-the-wall, and his answers to those in particular, really made me like him all the more.
What does frustrate me more and more though (I know, I should just let it drop), is that this doc isn't associated with the hospital with which I've had a relationship for the past 20 years. And I really would have preferred to have had my surgery at this particular hospital (since I don't particularly care for the one where I'm "tentatively" scheduled to have gallbladder surgery), but the more I think about it, the more upset (and hurt) I get about the way I was treated at "my" hospital by not only my surgeon, but by the gastroenterologist. Someone I know who has had similar pains as me is also seeing this gastroenterologist this week, but that just kind of stirred up these feelings again. I know this is stupid, but I just want to take a break from EVERYTHING ... ALL docs, or anything related.
I also am dealing (or maybe its NOT dealing?) with my marriage, which is failing. And maybe its just all too much for my pea-brain to handle right now (plus my failed IVF attempt, difficulties at work, my eating issues, my wrist, which seems to bother me more and more ... GEEZ ... STOP THIS RIDE, I WANT TO GET OFF!
). But I've been struggling to try to understand my purpose in life, and have not been able to come up with anything.
I SO do not recognize this person.
Oh ... also interesting that I wanted to note ... at my support group meeting last week, we were talking about how tall we were ... and I've always passed myself off as 5'8" (actually I think I was always at 5'7-1/2") ... but one of the girls, who is about the same height as me said she's about 5'4 or 5'5!! SO ... I am very anxious to get a correct measurement on that (actually, I would also like to get just overall measurements ... haven't had that done in over 2 years) ... I am panicking that I could have gotten that much shorter!!
I just want this all to go away. WITHOUT surgery. I want to start working out ... filling in for Kathy's MOvE to LOSE post really inspired me (although I have wanted to start working out before that). I've "kind of" been told not to start a workout program because my calorie intake is a little on the low side. But I'm thinking of Yoga ... that shouldn't take too much, just to get moving, you know?
I have learned a valuable lesson throughout the past nine months. DO NOT EVER ASK A SURGEON IF YOUR PAIN COULD BE "IN YOUR HEAD". I've had 1 doc stand up and end our visit right there, and the other one "went off" on me (his office won't even return my calls now).
So, I have an appointment to have my gallbladder taken out on May 5th (completely different doc) ... but I'm seriously considering pushing it back to June. This doc doesn't know my eating issues for the past nine months, could that cause potential problems?
And I think one of the BIG things that's bothering me is since my 20 pound weight gain from September 2004 through July 2005, yeah, I have lost about 65 pounds since then, but I'm also horribly afraid that after gb surgery, when I do start eating again, I'm going to gain again. That ABSOLUTETLY terrifies me.
OK ... cause the folks were over, I felt pressured to try to eat. Big mistake. Pretty bad abdominal pain which eventually subsided, but left me feeling nauseated and bloated throughout the evening. It's really strange though, since I've been told that my gb hasn't been funtioning properly, and that it ISN'T just all in my head, I'm not necessarily as agitated, and feel that maybe I can "deal" with the situation a little better (or maybe I'm just not beating myself up as much anymore)? And despite the eating issues, I've been told I look great, and if it wasn't for the pains I get after eating and occasional dizzy spells, I really do feel OK.
Seeing Kathy S over the weekend (she just had her plastics done on Friday ... she is just something else) ... I've kind of started to get the itch to have mine done (but I still have at least 50 pounds to go, and I do need to be in "better shape") ... BUT, then there's the issue of trying to concieve ... something I have been deliberately NOT thinking of, because my last visit to the RE ended that he doesn't think I should even try again ... and I won't let myself process this yet, I really don't think I can handle it right now. BUT, plastics would mean the end of my quest to get pregnant ... oh geez, I thought I could at least write about it ... I just can't. Not right now.
very nauseated since yesterday (about 5:30pm). The doc I met with today does want to take out my gallbladder. They wanted to do it next week, I said NO WAY. It is "tentatively" ;-) scheduled for May 5th. The "impression" from the HIDAscan says: Fatty meal augmented hepatobiliary scan demonstrating mildly decreased gallbladder ejection fraction, 30%, indicating dyskinetic gallbladder.
I need to do a little more research ... I don't want to do this just for the sake of doing it ... (and I may have mentioned once or twice ... I just don't do well at not being well).
OK ... good things this week: thanks to the Florida Gators (my new FAVE NCAA team), I took third in my March Madness pool (only if LSU would have beaten UCLA, I would have taken first!!)
Last Sunday, I also treated myself to a massage. First one, actually, and did this girl BEAT ME UP!! My shoulders are still a little sore (I think I saw a bruise on one of them) ... I'll definitely go for another one (when I recover), but I think I'll try someone else.
OK ... a few days ago I took my profile (this profile) down because as I looked back at it, I feel that I've posted a lot of negativity. But as I thought more about it (and a good friend mentioned it as well ... thanks B!), I realized that this IS what I'm going through right now. I'm not looking for pity, its just that these things have been weighing on my mind, and hopefully a lot of the negative ones will fade and be replaced with positive ones. When that happens, I'll want to document that here as well. SO, good, bad, happy, sad, glad, mad ... whatever/where ever I may be at the time I write, that's what will be here.
As I mentioned previously, since I was hospitalized for my dog bite last July, I have been getting a pain just below my breastbone whenever I eat most solid foods. The pain sometimes has me doubled over, goes away in about 20-30 minutes, but then I feel a more dull pain just above and to the left of my belly button, and then it moves to an even more dull pain toward the right side. This may (or may not) have something to do with my current eating issues.
I saw a gastroenterologist in January, who was really nice and conversational on my first visit ... he did an endoscopy, had a ct scan done and a small bowel xray series ... and nothing.
I specifically asked him about my gallbladder, and he said, "that's my specialty, and its not that". Well, then out of frustration (on my second visit), I asked him if this could possibly just be "in my head." He went OFF on me. Said, "that's not MY specialty" and he went on and on, I think he must have had me mistaken with someone else because he said, "that's YOUR field, dealing with people's heads, thats your profession" (huh? um, no) ... and then he said "well, YOU made this an urgent appointment to see me" ... I'm like ... huh ... my orders after the endoscopy were to see you in two weeks, so I called the office and made an appointment per the orders.
Unfortunately, I wasn't able to say a thing (brain fog, and sometimes its been difficult to pull together words, and I think I was kind of like a deer in the headlights), and I didn't even get a chance to ask him the questions I had wanted to. I felt like crying (probably did) when I left the office, and at that point I think I swore off all doctors. Well, now his office hasn't even called me back.
SO, I happened to see the GP (associated with another hospital) who was following up with me on this dog bite stuff and a few other small things (since it takes about 3 months to get an appointment with my PCP who's located at the same place as the gastroenterologist) ... and right off the bat, he said, "I'll bet its your gallbladder" ... and he had me do the test where they take pics for 2 hours and you have to drink the cream (I think the HIDAscan?). WELL, I got a call from his office last night, he's referring me to another doc (a surgeon) because apparently my gallbladder is not
functioning properly, and he wants to get a second opinion. (I don't know if this has been my problem, or maybe one of them? I honestly don't know if I have the energy to find out.)
I've also worked out a deal with my nutritionist ... she made two suggestions for me to start with to hopefully get my eating issues under control, and I've actually been sticking to them almost all week (or trying to).
well, for the past six weeks I've been on an IVF cycle. It came to a screeching halt yesterday, and after 8 days of stims, my cycle was cancelled. I KNOW that I didn't necessarily have the best circumstances for me to go through a cycle (because of the eating issues, etc.), BUT, after several months of my previous docs not even willing to try anything, I just HAD to jump at this opportunity when it came up. I'll be 44 in June and the odds get MUCH worse for 44 year olds than 43s (not that those are good to start with). My fertility doc also said I probably shouldn't even try again ... which, if I do, will be at least $18K out of my pocket, since my $20K lifetime fertility benefit is now gone (and I haven't even been able to do one full cycle of ANYTHING!) I'm just so crushed. I don't think it's really hit me yet though. Maybe I know I just can't handle this right now, so I'm not letting it out? I really don't know.
I don't know ... did I somehow sabatoge myself? This is one of the main reasons I had WLS ... so now what? Which way is up? How do I move my feet? How do I breathe?
: I've reached out in the only way I know ... and I don't know where I go from here. I've been trying to reach and grab on to something solid. Maybe it IS just something I need to figure out for myself. Someone asked me if I thought the car I was riding in had no brakes ... and after thinking about it, I'm really not sure about the brakes at all ... but I do know that my hands are gripping the steering wheel so tight, that I cannot pry them off. I often have dreams that I'm going through the process of having WLS again, and I think I am more than 100 pounds overweight ... sometimes I do forget that I had surgery ... and I still can't see it.
: OK ... kicking and screaming all the way, I have been on my ADs for 4 weeks this weekend. This past Sunday my dose was upped from 150 mcg to 300 mcg. When exactly is all this supposed to kick in? I'm feeling really really weird ... mornings aren't too bad ... but by this time (6:30pm or so), I really start crashing. Could it be because I'm on an extended release? I'm extremely jittery, nervous, can't sleep, mood swings, crying at the drop of a hat ... I just look at myself and say, what the hell has happened to me? I'm still quite "overwhelmed" (I definitely want to pick a new word-of-the-year SOON).
>> I'm having eating issues ... I've been trying to work through them, but I'm just not listening to myself. I've had a difficult time eating solid foods (getting pains), so I've pretty much been doing soups and lattes. I really have no appetite, no desire for food. At all.
>> Things have been falling apart at work (still plagued with brain fog and lack of concentration, HOWEVER, I did notice that a month or two ago I had a difficult time pulling 10 words together, and now I can probably pull 10 sentences together). Still having difficulty making decisions (but I think that's been a life-long prob) ... I don't know whether to do acupuncture or join a health club ... get a part-time job (try radio again?) or go back to school ... if I go back to school, what do I want to study (besides everything)?
>> My wrist may need surgery again to "bury the nerve" (from a dog bite wound last July) and it bothers me quite a bit.
>> Oh yeah, I'm starting my first (and if its up to insurance, my last) IVF cycle NOW. Am I ready? I'd like to have better circumstances, but I've got to take what I can get here ... my time is just about out.
>> and on a really sad note ... a friend was killed in a car crash last night ... a great person ... a forensic scientist for the Illinois State Police ... he'll be missed by many (there are 4 pics of his car here) ... NBC5 News-Chicago
I would REALLY like to stop posting all this negativity, but maybe I just have to "get it out"? I want to be inspirational, talk about the good things, aspirations, plans ... I'm hoping to get there.
Well DH is in Vegas for a bachelor party ... all I told him is I don't want to see him on an episode of COPS.
: I was at a support group meeting tonight. Actually, it was the "networking" part of the support group meeting, where prospective patients can talk to those of us who had already had the surgery. I didn't want to be on "the panel" ... I just wanted to sit in the audience, but my nut kind of pushed me up there. Of course I was positive when telling the group "my story" ... but what I REALLY wanted to say is: I do not feel that I am a success on this program. No one has ever helped me set a goal, nor have I had a plan on how to get there (calories/carbs/etc.).
I was only ever told to get 60-90 grams of protein in. No food plan for what I should be doing if I hadn't made it to goal by one year out, or even 2 years out, and I suspect there probably is no plan how to maintain IF I ever got there. No guidelines on what I should or shouldn't be eating at each stage, especially now that the honeymoon is over.
Sure, the "program" has me tagged as a success, because I've lost 75% of my excess weight, and I guess that's what counts. I know I need to think this over, but I'm thinking of leaving the "program" all together. I usually end up taking a half day off work for each appointment I have, and I really don't feel in any better a situation at all. I think I just need to call it quits.
I changed my surgeon info from Dr. Murayama (who technically was my surgeon), but Dr. Nagle assisted, and actually, I believe he really did my surgery anyway, since Dr. Murayama left for Hawaii within a week after my surgery.
: Valentine's Day. It was the words Happy Valentine's day and a peck on the cheek from the husband, and a cuddle with the cat. The day actually doesn't have much meaning to me anymore ... sure it was great when there's passion, and little gifts mean something, I don't know I guess I'm just not "into" the Hallmark holiday that much anymore, so I'm really not disappointed. Maybe my "passion" is just gone (hopefully temporarily) ... and I don't necessarily mean the "love passion" ... I've realized I don't have a passion for anything in my life right now. And to me, that is sad.
My word of last year has kind of poured into this year ... that is "overwhelmed". Hopefully that word is only temporarily here though. I wake up in the middle of the night and can't get back to sleep. I don't know if its pain from my wrist waking me up, but it's the first thing I do notice when I'm awake. I still having problems with the scars and nerve damage from my dog bite last July. I feel a burning sensation, like someone is pouring hydrogen peroxide into an open wound, the sensation is at both the scars ... one more prevelant than the other though, AND a burning down the back of my hand. My thumb, forefinger and middle finger also are cause of great pain when exposed to cold, and sometimes one of the scars has a "wet" feeling, like its dripping liquid, but its not. I've been through the occupational therapy, took 2 cortizone injections, was prescribed a Category C medication (which I was advised by another doc not to take) ... and the surgeon said if all this doesn't work, he'd have to "go back in". I guess maybe its time for a second opinion.
I was also trying to just deal with my neigbhor's insurance company directly (didn't want to bring a lawyer into it), but its just been too much for me, especially if I'm looking at potentially another surgery? Uh oh, here it comes again ... it's just overwhelming. I cannot sort through all the (what seems like endless) doctor/occupational therapy/ambulance, etc. bills ... just can't seem to be able to focus on it.
After fighting my depression denial for several months now, I've finally given in to my "consipirators" (I say that with affection) ... and have started anti-depressants. I know it takes a few weeks to "kick in", but I've been feeling worse now that I've been taking them the past 10 days. Last Wednesday and Thursday were extreme lows for me. I was ON THE EDGE. BIG TIME. Then to top it off, I left a message for my psychologist Thursday night, thinking he'd get back to me Friday (I really don't even remember what the message was at this point), but no call. Then Monday, no call. SO, I've come to the conclusion he's either on vacation, or (duh) I may not have left my name on the message?? Or even better, maybe I didn't hit the "send message" button? I don't know, but that hasn't helped my mood any.
My eating issues also haven't changed. Just no desire, no appetite ... I've tried talking myself into it, and I guess nobody, including me, is listening to me! Ah ... if anyone out there has an extra life preserver (or even a floating noodle) ... can you throw it my way? Please?
: What was I thinking? Why do I feel worse when I leave my visit to the psychologist? I walked back to my office (about 10 blocks) in tears, oh yeah, I did stop to buy a pack of cigarettes and stood on the Michigan Avenue bridge while I took a few puffs and put it out. But why did I buy that pack of smokes? I haven't smoked in over 6 years. Sure, I've had a craving for one the last few months. But what set me off? Why today?
: OK ... I must have hallucinated my halllucination when the gastroenterologist mentioned that my CT scan showed a cyst on my ovary. I actually DO have a cyst on my ovary! Go figure.
: Disclaimer: I may still be under the effect of a sedative, so if this makes no sense, please pay no attention (to the man behind the curtain).
OK ... had my endoscopy today ... good news (I guess) is that I don't have an ulcer, meaning ... the Nexium I've been taking since September has healed it, or ... more than likely, everything must just be imagined and in my head. I'm now questioning and doubting everything and anything I feel. My wrist from a dog bite ... am I really feeling a constant burning sensation at the scars and down the back of my hand? I don't know. Is an old injury to my knee really causing me pain? I DON'T KNOW.
I don't feel like I was given a sedative at all, I was awake, and even reading in the recovery room (to the nurse's amazement). The only part that confuses me more than slightly is that when the doc came in when I was in recovery, he mentioned the CT scan I had a week ago also looked fine ... (but here's the kicker) ... but it showed a cyst on my ovary. WTF? OK, wrong doc, wrong procedure? ... its at that point I know I must have been a little loopey AND looney. Anyway, I've made a decision. No more docs. No more. I just need to shut up and deal (whoa, where have I heard that before? oh no ... that's "shuffle up and deal" ... sorry). I'm apparently making stuff up, and honestly, I just feel like I've wasted a lot of people's time not to mention resources.
Oh, I'll still go for my annual labs and pap ... but that's it. I will need to find a way to deal with my "so called" pains ... and my first step will be getting back into working out (mind over matter, sounds like a plan), thanks to the inspiration of a fellow OH member. SO ... since my problem has been eating solid foods (the only things that have "felt good" and not cause pains when I eat are soft foods, mostly "warm" soft foods, in particular, soups and coffee ... I'm sure it could be any warm beverage, but I've been on a coffee-kick), I will continue with my soups. I guess I can live off that. Especially since I just haven't had an appetite for a while now.
New rule (I wonder if this would make Bill Maher's list) ... I will no longer acknowledge pain ... I will find some way to divert my attention from it (it would really help if I was a believer of taking mass amounts of recreational drugs or alcohol, but I think our minds are so very strong and capable of so much, I've never really understood the attraction ... although I will indulge in an adult beverage from time to time) ... after all, if my head creates it, it should be able to take it away, no? My new mantra: NO PAIN, NO PAIN ... If I AM in pain, you won't hear it from me. No more crying ... time to put on the big girl panties and deal.
So, I haven't slept in quite a while and feel a bit wired too ... maybe these past six months have actually been a "dream sequence", liken that of Twin Peaks. How did I get here? and better yet, how do I leave?
LATER ... same day
... I wanted to mention that last Thursday, I finally attended another support group meeting where I had my WLS (hadn't been to one there in maybe 2 years). The "topic" was personal accountability for your weight loss. So I think ... then why would I have ever needed WLS to start with? I think a very important part of that "personal accountability" was not even discussed. It's being able to reach out for help when you need it. I'm SO not good at that ... but I think that by writing on this site (either here on my profile ... which I prefer, because I can always delete it, or responding to posts) I've made a lame attempt to reach out (maybe a start?), but am and always have been stymied about asking for help. After all ... I should be helping others, that is my forte ... maybe if I can do more of that, I will actually be helping myself.
My last thought to take into the night ... Why are some taken and some allowed to stay? The ones that are taken are loved and needed, and complete a family. So why must that be disturbed?
: Hmmm ... Friday the 13th ... actually they are usually pretty good days for me (it's Saturdays, the 14th that are pretty lousy!)
... anyway, on Wednesday I met with the gastroenterologist who would be doing my endoscopy ... he also ordered a CT Scan, which I had done this morning ... nothing like a smooth, frosty barium drink for breakfast ... wonder how much calcium is in one of those?
Actually, I was light-headed after the test (they made me stay and have orange juice), and I've been doubled over in pain this afternoon, most likely cramping from the barium? time to get the heating pad ... I'm scheduled for the endoscopy on the 23rd ... but I think I'm chickening out (plus you have to have someone go with you? I think that's more difficult than getting the courage to go through with it in the first place!! IF I had people available to go, I couldn't ask them to take time off work and impose on them like that! ... uh oh, Little Miss Independent showing up again I guess).
I just don't do well with NOT being well, or the thought of it ... I often feel things may just be in my head and really don't want to waste anyone's time. I also hate not having answers, and don't want to go "looking" for things to be wrong. WLS was the first surgery of my life (at the age of 41) ... and I've seen more docs in the past 6 months than I have in my life ... ENOUGH already!!! No more!! I'm a healthy person ... the only two times I ever want to see a hospital again are to give birth and for my plastics, OK?? (although, is it my imagination, or are doctors getting cuter these days?).
: Well, I for one, am very happy to say goodbye to 2005. It's been quite a year! And Thursday, December 29th was a day to end days.
I've finally given in to my WLS doc and half-heartedly agreed to an endoscopy, since eating is still an issue for me (has been since July) ... I AM eating, and although as I've mentioned below, Nexium has helped the pain I was getting (wasn't excruciating, but it was there), however, I'm still feeling quite bloated and nauseated if/when I eat ... and this has been going on since I was hospitalized for the "dog bite" in July. I guess we're going to find out if this is a physical thing, or if its all in my head (an effect of depression?).
There, I've said it, Howard. Depression. In a funk. Blue. I have "brain fog", can't remember things, cannot concentrate, cannot put thoughts together ... apparently, I've been in "depression denial" ... oh yes, fighting it with all my might (still am I guess). Anyway, its embarassing ... for "little Miss Independent" to possibly NOT have it "all together", or God forbid, let anyone SEE she hasn't got it all together. This post will probably be gone before anyone sees it, but I guess maybe its somewhat theraputic to spit out the words? Just reaching out I guess ...
I've also been released FINALLY from occupational therapy for my wrist (dog bite) ... but I have mixed feelings. One is that I'm glad to not have to go twice a week, but on the other hand, I'm still in pain, actually a burning sensation under my skin where the scars are, and numbness and occasional burning or stinging down the back of my hand. The doc gave me 2 cortizone injections and prescribed Lyrica ... he said if that doesn't help, he'll need to go back in and most likely bury the nerve (he mentioned something else too, but my concentration was a little off).
SO ... we'll see how this goes. I've also been seeing him about my knee (thinning cartilage plus an old injury which moved my patella off-center, so bone was grinding on bone) ... it was giving out on me after workouts on the treadmill ... I had a series of 3 injections of Cortizone/Synvisc which helped to a point, but the pain has been coming back ... and he said my next step was arthroscopic surgery. Puh-leeze no! The only time I've been in the hospital (well, with the exception of one other time, which I won't talk about) was for my WLS, and I'm afraid I'm not very good at not being well. I guess I have a difficult time admitting when something's wrong ... and I just cannot ask for help. Like a defiant 2-year old ... "I can do it myself"!! I've been getting a little better at that though (the help-issue), I think that's actually why I came back to these boards.
Still nothing and getting nowhere on the ttc issue.
: I just had to get this out ... its not WLS related, and I kind of didn't want to post it on the messageboards ... but OUUUUCHH!!! I am in pain ... my dog bite scar (from July) on my wrist has still been bothering me (pain-wise), and my occupational therapist has been puzzled as to why the scar hasn't been healing as it should.
I just had a follow-up with the surgeon, and he gave me not one, but two cortizone shots in my wrist ... yeaooowww!! The one on the under part of my wrist has been bleeding (a LOT through the bandages), but it seems to have slowed down ... but this is nuts!! NO MORE CORTIZONE FOR ME PLEASE!!
: Thought it was about time for an update ... I've been away from here for a bit too long. I'm almost 2-1/2 years out, down about 125 pounds or so (still have about 60 more to go).
This year has been a bit traumatic for me ... on February 1st I lost one of my adored cats, to stomach cancer (he was 8-1/2). He was "Mr. Personality" and is missed each and every day. His "brother" misses him too, nothing worse than looking into a sad cat face.
Also, I've finally convinced my husband (after 10 years) how important it is to me to have a kid (one of the reasons I had this surgery was to do just that ... hubby said he'd "consider it" if I lost 100 pounds). Well, at the age of 43, its been more than challenging trying to conceive, and I'm not any closer at this time.
Throwing another wrench into it, this past July I was bit on the wrist by a neighbor's dog. I was rushed to the emergency room (I had passed out), they patched me up and sent me home with augmenten and vicadin. They told me to come back two days later to have the dressing changed, and as soon as the doc removed the bandages (two days later), they said "you need to see a hand surgeon TODAY". The wound had become infected. They were calling their "group" of hospitals as it was Sunday, and they were looking for an orthopaedic surgeon who would to this, so they sent me by ambulance to another hospital where I had surgery that night.
A five-day hospital stay followed, as they wanted me on an antibiotic IV, since I still got the infection despite being on augmenten orally. While in the hospital, I had to have four deep puncture wounds "packed" twice a day, and had to continue that with the doctor every other day once I left the hospital. About a week and a half later, I was in the doctor's office having the wounds "packed", and he noticed I didn't look that great, and asked if I felt ok. I mentioned to him that my heart was palpitating earlier that day, I felt real lightheaded, and had a hard time catching my breath. Well, he made a very quick call and took me to the emergency room ... he was concerned about blood clots, since I was laid up for 5 days recently. ER did some initial tests, everything looked OK (except that I was very clammy), but they wanted to monitor me overnight, as my heart rate was about 40 (my husband says they said it was AT 40, I think they said it was "in the 40s") ... and I guess because I didn't look like a "well-trained athlete", they were concerned that the heart rate was so low.
For the next four days, I went through a series of tests, CT scans, ultrasounds, venous doppler tests on both legs, pulmonary tests, stress test, D-Dimer, and whatever else. To this day, we still don't know exactly what happened (which bugs the crap out of me!)
Anyway, since my initial hospital visit, I have lost my appetite. I blame it on the pain medication I was on, but I still haven't gotten it back. Or I should say, whenever I do eat, I would get a sharp pain just under my breastbone, and then another pain about 2 inches to the left (and slightly above) my bellybutton. The doc said it "might" be an ulcer (and I "could" get scoped), but they would treat it with Nexium, which is what he put me on anyway, so why subject myself to the scope if I was getting the treatment for what I might have anyway? Well, the Nexium does seem to help ... a bit. The surgeon also said I might have a hernia, and we "could do" a CT scan to find out ... but I'm sorry, when a doctor says we "could do" something, that doesn't sound like its a necessity to me ... whereas if he would have said we "should", or "I'd like to" do this or that, THEN, I would think it was a recommendation.
I don't know, I always feel like I'm wasting a doctor's time, plus I just don't have the energy, so I just dropped it all ... and for the meantime, still have a difficult time eating. I did notice, however ... I am still attending occupational therapy for my wrist, and sometimes you don't realize how much pain you're in, until you don't have it anymore!!
My therapist occasionally hooks me up to what I call a battery charger, and he puts pain med on the pad and it sends the med through my skin via electric charge (or something like that). I do tend to have more of an appetite after that treatment ... so maybe it is pain-related? I don't know. I do know that just today after therapy I did have something to eat (I was hungry!), and now I feel very bloated and the same pain. I'm writing it off to it all being in my head due to this trauma (I think) ... I'm trying to force myself to eat, and eat correctly (not quite there yet though), and hopefully the routine will kick in.
One other reason I think this might be in my head is that from September 2004 to July 2005, I hadn't weighed in, or visited the doctor ... and when I finally did (just a week or so prior to my dog bite), I had gained about 20 pounds. Needless to say, since all this, that 20 plus a few has come off. SO ... in a nutshell, I think I'm caught up in a whirlpool that won't loosen its grip ... my emotions are all over the place (maybe we should throw early menopause into the mix?) ... I don't know ... I can't think anymore ... Whew ... that was a bit long-winded, but who knows when I'll post again?
P.S. ... still don't see any visual difference pre-op vs. post-op!!
: Today is seven months ... haven't weighed in for over 2 weeks, but I was down 85 pounds at that time. Holidays went well except for this cold!! I'm really challenged with not being able to take advil or nyquil (so I've given in to nyquil ... just to get some sleep!) Some days I'm amazed how much I can eat, some days its not much at all ... but still don't reqret my decision!
: just passed my four month mark last Wednesday. I've lost not only 68 pounds, but some of my hair too! That is very disturbing to me ... I may need to chop it all off! After being plagued with nausea for about my first six weeks after surgery, but I'm doing much better now .. still have some problems with chicken, but I'm almost scared about the amount I can now eat! Sometimes I even forget I had surgery! I was at a picnic, and someone said "let's get a diet coke", so we went to the cooler, and only when I saw the bottles of water in there did I realize ... "I can't drink diet coke!" I also don't see that I've lost ... sure, some clothes are bigger, but I still don't "see" it.
: well, one week out (and no, I didn't chicken out ... even though my husband was a little surprised that I didn't back out) ... I was able to have the surgery laparoscopically (yeah)! ... one of my biggest hurdles in the hospital was the nausea ... and it hasn't completely left me ... about 75% of my waking day is consumed by it. I've also tried the protein drink ISOPURE, am starting to not be able to tolerate it (especially the chocolate) ... I also cannot tolerate the idea of pureeing chicken, etc. and it's kind of like my brain hasn't caught on to what's going on here ... it wants pizza and a burger!! I haven't tried that (nor do I plan to anytime soon), but cooking anything, or trying some of these recipes I've got just doesn't appeal to me at all (and I normally LOVE cooking and creating new recipes!) I don't know what the deal is, hopefully it gets better ... I haven't weighed myself yet, I'm waiting for my post-op visit with Dr. Murayama this Friday.
: A voice in my head is still telling me I can back out until I get to the hospital next Wednesday! we'll see ... I'm scheduled for surgery next Wednesday and I'm freaking out a bit! YIKES! Other than that consuming my time ... I have always been a pretty athletic person, and hope to become that again. I love music (making it and listening) ... sports (playing and watching) ... eating & cooking (well, that I guess is going to have to change)!!
Karyn's (kayzi) FitDay Profile
Free Website Counters
FOR REFERENCE (note, this is updated periodically and I will replace when available):
MEDICATIONS AND THE GASTRIC BYPASS PATIENT
by Michael McEvoy Pharm.D.
As a medication travels through the body, it undergoes four* distinct phases:
Metabolism * Not all drugs are metabolized, some are excreted unchanged
Patients with liver disease may have problems metabolizing medications; patients with kidney disease may have problems excreting drugs. Gastric bypass patients will have a variable absorption of medications, based on the chemical characteristics of the medication and on the physical properties of the dosage form (meaning: "the finished product" tablet, capsule, etc.) containing the active ingredient.
First a chemistry lesson (it won't be too painful). Medications, like all chemicals can exist to two states: ionized and un-ionized. When you dissolve a teaspoonful of table salt in a glass of water, the sodium ions (represented by the chemical symbol Na+) separate from the chloride ions (represented by the chemical symbol Cl-). The Na+ and CI- are said to be 'ionized.'
When you dissolve a teaspoon of sugar in a glass of water, no separation into electrically charged particles takes place. The sugar is in an un-ionized state. Salt and sugar serve as examples of what happens to medications.
Medications are best absorbed by our bodies in the un-ionized state. Most medications can be described as the salts of weak acids or weak bases. By 'salt' we mean that one chemical combines with another chemical to make a new compound. The salt of a weak base and a strong acid, such as ranitidine HCI (Zantac ®) is un-ionized in the presence of a stronger base (like small intestine juices.) The salt of a weak acid and a strong base, such as sodium phenobarbital (Luminal ®) is un-ionized in the presence of a stronger acid (like stomach juices.)
The small intestines are bathed in secretions which are basic (meaning alkaline, not acidic), so drugs that are salts of weak bases are best absorbed there. Gastric bypass patients should have no trouble absorbing these types of medications.
A clue to whether a medication is the salt of a weak acid or base can be found in the generic name. Medications that are "sodium something", "potassium something", "calcium- or magnesium something" are salts of weak acids.
Medications that are something-HCI (hydrogen chloride) or something-HBr (hydrogen bromide) are salts of weak bases.
The "sodium or potassium-something" drugs present the most problems with absorption. They are best absorbed in the presence of stomach acid, which is in very short supply on our pouches. There will be some absorption in the ionized state in our small intestines. Fortunately, our small intestines are VERY LONG and have a large surface area to absorb the medication. Medications are absorbed in the small intestines by passive non-ionic diffusion. Think of the intestinal wall like a sponge that picks up the medication and transports it from one edge of the sponge to the other, delivering it to the bloodstream. The rate and extent of absorption in passive non-ionic diffusion will be erratic and may vary from one Gastric Bypass patient to another.
A recent report in the April 27th 2006 issue of the New England Journal of Medicine again shows the importance of stomach acid in the absorption of certain medications. Patients who were on proton pump inhibitors (medications such as Prilosec ® (omeprazole) , Nexium ®, Protonix ®, and Prevacid ®) as part of the treatment of the ulcer causing bacteria Helicobacter pylori were found to have mal-absorption of the thyroid drug thyroxine sodium (Synthroid ®).
The study stated patients with impaired acid secretion require an increased dose of thyroxine, suggesting that normal gastric acid secretion is necessary for the effective absorption of oral thyroxine.5
Many patients who have had gastric bypass surgery also have other medical problems which require medication for their treatment. In the May-June 2005 issue of Psychosomatics, a study was published which looked at the dissolution of common psychiatric medications in a Roux-en-Y gastric bypass model. It found that ten of twenty two psychiatric medication preparations had significantly less dissolution and two of twenty two medications had significantly greater dissolution in the post-RYGB environment, as compared with a control group. The medications were crushed in this study, which differs from clinical practice and that may account for the greater dissolution of the two medications. This study made no attempt to determine differences in absorbtion, however. Further study into the effects of RYGB surgery on serum blood levels is required.6
Some guidelines for your physician came from a review of this and other recent studies. Immediate release medications are preferred over time release medications. Monitor the levels of medications in the blood, if such monitoring exists (not all drugs can be monitored in this way). For drugs with a small volume of distribution (Vd) [this will mean something to your doctor, as a patient you need not worry about what this means], a lower maintenance dose may be required because of a decreased glomerular filtration rate which follows marked weight loss. Drugs such as lithium carbonate, valproic acid and oxcarbazine are common psychiatric medications with small Vd.7
The good news is that most patients after RYGB surgery require fewer medications, or at least reduced dosages of medications then they needed prior to the surgery.8
Other considerations: Enteric coated tablets are designed to pass through the stomach acid intact and be dissolved in the small intestines. They should present no problem to the Gastric Bypass patient. Controlled release dosage forms, however, may have erratic absorption as many (but not all) controlled release dosage forms depend on stomach acid to dissolve the coatings of the "tiny time pills". Suggest that your doctor prescribe immediate release preparations, even though this may mean that you have to take the medication multiple times a day instead of only once or twice a day.
Medications that require stomach acid for activation are another matter. The ulcer medication sucralfate (Carafate ®) (which I hope none of you will need!) requires stomach acid to attach itself as a protective coating over the ulcer. More important to us is calcium carbonate. Calcium is largely absorbed from the duodenum by an active transport system, which is bypassed during Roux-En-Y surgery. Calcium carbonate (Turns®) is frequently recommended for calcium supplementation because it contains a higher percentage of calcium than other calcium salts. But Calcium carbonate is a less soluble salt, which requires stomach acid to get into solution, which makes it absorbable. Ionized or un¬ionized, the medication must be in solution to be of any use to you: if it is not in solution, it does you no good.
Gastric bypass patients should take a more soluble form of calcium, such as calcium citrate (Citracal ®), or better yet, get your calcium from your diet (Got cheese?)
Do not forget to take your vitamins. Because of impaired absorption, you should be taking at least two times the RDA of most vitamins. Dont worry about the water soluble vitamins; you body will discard those in excess of your bodys need. You may find that the excess riboflavin colors your urine a bright yellow; this is normal. Fat soluble vitamins (A, D, E, and K) can accumulate if taken in great excess, but this will not be a problem, unless you take large doses. And these fat soluble vitamins are important. There can be visual problems in post RYGB patients who do not get enough vitamin A, such as dryness of the conjunctiva and cornea. The condition can even progress to night blindness with severe vitamin A deficiency.9
Roux-En-Y patients should get at least 7000 10,000 international units (IU) of vitamin A daily, 400 800 IU of vitamin D daily, and 400 800 IU of vitamin E daily. For duodenal switch patients, whose absorption is even more impaired, the recommendations are 1 ½ times the recommendations for RNY patients. Lap band patient do not suffer from malabsorbtion, but should consider supplementation at least to the recommended Daily Value, as indicated on the package label as 100% DV.
Dosages of vitamin A greater than 10,000 15,000 IU of vitamin A can result in adverse affects to the liver, skin, hair, and can cause visual changes. Pregnant females should consult their obstetrician for guidance, as high intake of vitamin A can have risks to the fetus.11
Calcification of soft tissue or hypercalcemia can occur with vitamin D intake > 2000 IU per day.
Doses of vitamin E up to 1000 IU per day are commonly prescribed in Alzheimers patients, yet some gastrointestinal (GI) effects can occur, along with blood thinning anti-platlet effects with daily intakes of greater than 800 IU per day.
The %DV for vitamin K is approximately 75 mcg. Patients who are taking the blood thinner Coumadin ® (warfarin sodium) should only take vitamin K supplements as advised by your physician, as vitamin K opposes the effects of Coumadin®; indeed vitamin K is given as an antidote to patients whose blood has been overly thinned with Coumadin®.
So take your vitamins! But dont over do the ADEKs.
Vitamin B12 (cyanocobalamin) requires both stomach acid and a substance secreted by the stomach called "intrinsic factor" for absorption via the oral route. You should be using a sublingual ('under the tongue") tablet or spray as your B12 supplement, as this bypasses the absorption problem altogether.
Iron, like calcium, is largely absorbed in the duodenum. Like calcium carbonate, ferrous sulfate is frequently recommended for iron supplementation because it contains a higher percentage of iron than other iron salts. Also like calcium carbonate, ferrous sulfate is a less soluble salt, which requires stomach acid to get into solution.
Gastric bypass patients should take a more soluble form of iron, such as ferrous fumarate (Ferro Sequels ®, Femiron ®), ferrous gluconate (Fergon ®), or a polysaccharide iron complex (Niferex ®). Remember to separate your calcium and iron supplement by at least two hours.
Some references for you and your doctor:
1. MacGregor AMC, Boggs L. Drug Distribution in Obesity and following Bariatric Surgery: A literature review. Obes Surg 6:17-27, 1996
2. Chaymol G. Clinical pharmacokinetics of drugs in obesity. ClinPharmacokinet 25.103-114, 1993
3. Malone M. Altered Drug Disposition in Obesity and After Bariatric Surgery Nutr in Clin Practice 18:131-135, 2003
4. Fussy S. The skinny on gastric bypass: What pharmacists need to know US Pharmacist 30: HS-3-HS-12, 2005
5. Centanni, et al Thyroxine in Goiter, Helicobacter pylori Infection, and Chronic Gastritis. N Engl J Med. 2006;354:1787-95
6. Seaman, JS, et al Dissolution of Common Psychiatric Medications in a Roux-en-Y Gastric Bypass Model, Psychomatics 46:3, May-June 2005
7. McAlpine DE Current Psychiatry Vol 5 No 1, Jan 2006
8. Malone M and Alger-Mayer SA Medication Use Patterns after Gastric Bypass Surgery for Weight Management, Ann of Pharmacotherapy 39:637-42 April 2005
9. Lee WB et al Ocular Complications of Hypovitaminosis A after Bariatric Surgery J Optha 2005;112:1031-34
10. Evanston Northwestern Healthcare Bariatric Services. Long-term vitamin supplementation. June 2004
11. J. Canadian Med Assoc Vol 169 (1), 8 July 2003
**UPDATE** -- I had my surgery about a week prior to Dr. Murayama left Northwestern for Hawaii. I do believe that Dr. Alexander Nagle pretty much performed my surgery.
I first met Dr. Murayama after I met Dr. Prystowsky (I was impressed by both). I had been informed that I was now eligible for laproscopic surgery with Dr. Murayama vs. "open" with Dr. Prystowski.
I was originally scheduled for surgery with Dr. Murayama on June 30th, but found out he was leaving the practice, so I was bumped up to June 18th.
Dr. Murayama's staff has been a guiding light and extremely helpful to me, in particular Liz Haney.
Dr. Alexander Nagle (the new hot-shot at Northwestern ... ok, not-so-new anymore) assisted Dr. Murayama on my surgery(ACTUALLY, I believe Dr. Nagle most likely did my surgery, or most of it anyway) and I follow-up with him, although I really would have liked to go to Hawaii for my follow-ups, but insurance wouldn't go for it. Go figure.
I feel that surgical competence is #1 ... bedside manner a very very close second ... and if you get both, that's the absolute best.
I'll save rating him however, until after my surgery (ha ha)!
Well, in order to be scheduled for surgery, I had to be "screened" by the Wellness Institute (meeting w/their physician, nutritionist/psychologist), and get "accepted" into their program (which I did in July 2002). I phoned BC/BS the day before my consultation at the Wellness Institute and they said "my company doesn't want them to approve this type of procedure" ... so, I got very depressed, and thought I was going to have to fight my company. I let it go for a bit ... was "accepted" into the program, and met with the surgeon, Dr. Prystowsky in September (who would be performing open RNY) ... he said his staff would submit paperwork as a medical necessity to BC/BS ... about 5 weeks later, I was copied on a note from BC/BS saying they would approve the surgery at 100% ... and less than a week later I was phoned by the surgical staff saying that I was now eligible for laparoscopic surgery, and I set up an appointment to see Dr. Murayama. His staff then needed to update the BC/BS approval (different surgery & billing #, and different surgeon) ... and BC/BS kept giving them the runaround saying they should just use the approval received for Dr. Prystowsky. FINALLY ... just two weeks ago (this is now June), I got a letter stating my surgery date, they've approved 3 days in the hospital with the correct surgery and surgeon ... SO ... I feel much better ... I think most of the effort came from the surgeons and their staff, so I am very grateful.
Personally ... I would see if the surgeon/staff could exhaust all of their possibilities before getting involved ... I also think the program you're involved in makes a difference. The Wellness Institute carefully screens, counsels, and offers other options, and I think they have a reputation of careful acceptance.
NOTE: Don't take the insurance company's first word as their last. I got so bummed when they first said they wouldn't pay. Hang in there ... it might take a while. And maybe you can even negotiate ... maybe say you'll pay 10% if they cover 90 (but use that as a last-ditch effort) ... ALSO .. if insurance doesn't pay for it (or some of it) ... most medical expenses can be written off your taxes ... I know that's still not an option for the majority, but its something if you can use it.