How did you first find out about bariatric surgery and what were your initial impressions of it?

I first heard of bariatric surgery more than 30 years ago when a family aquaintance had the surgery. At the time, she was signicantly heavier than I and I have to admit that I thought it was extreme and could not see myself undergoing a surgical solution. My friend had complications, but also lost a significant amount of weight and has maintained that loss. I started seriously considering a surgical solution about 10 years ago, but had some serious depressive issues that needed to be addressed first. The depressive issues had been addressed when I got the Type 2 Diabetes diagnosis and at that time I decided it was time to make a significant change to improve the length and quality of my life.

Describe your experience with getting insurance approval for surgery. What advice, if any, do you have for other people in this stage?

I had a fairly easy time getting my insurance approval. I made sure to document all of my co-morbidities and my attempts at weight loss. I think that my primary care physician played an invaluable role in supporting my efforts to have this surgery. I went to my surgeon with most of the tests already performed and had a 6 month, physician supervised weight loss attempt in hand. I think the combination helped move the process forward. I also made sure to know what my insurance provider required prior to submitting the information to them to ensure that the package that they received was as complete as possible. I appreciate the support I received from my PCP and surgeon's office in putting everything together. I do have additional medical issues that needed to be considered and I believe that contacting those physicians and having them provide letters indicating their approval of my decision and their considered impact on my short term and long term health were a big help.

What was your first visit with your surgeon like? How can people get the most out of this meeting?

My program requires that you attend an informational seminar. Following that you may apply to the program. Upon application, you meet with the nurse practioner, nutritionist and psychiatrist. Once you meet with these professionals, any additional tests or requirements are identified. The notes from the visits are transcribed and the test results are compiled. When this happens, your 'package' is submitted to insurance for their approval. It is only after the insurance approval that you actually meet with your prospective surgeon. My meeting with my surgeon honestly did not go well. My program is at a teaching hospital; I met with the Dr. doing his fellowship and the lead surgeon was unavailable to meet with me because he was 'too busy.' That didn't sit well with me and I contacted their office; I came back in and met with my surgeon. I took a number of quesitons with me. These questions were answered by both the fellow and the lead surgeon. I took my husband with me so that he could hear the responses to my questions and so he could ask questions. I have to say that I felt like I understood what to expect prior to my meeting with the surgeons, but was glad to be able to talk with them prior to surgery.

What made you finally decide to have the surgery?

After more than 40 years of obesity, I honestly think it was the only way to ensure that I could get AND keep the wieght off. There are times that I wish I would have, could have done it otherwise. That said, this has been lifechanging for me and my only real regret is that I didn't do it sooner.

How did you decide which proceedure to have?

I had the RNY. My surgeon's practice and insurance limits the possiblities to the RNY and LapBand. I initially thought I wanted the LapBand, but changed my mind because of two factors. The RNY has shown great promise in controlling and/or reversing Type 2 Diabetes. Since the diagnosis of Type 2 Diabetes was the catalyst for my decision to undergo surgery, the fact that there was so much research pointing to resolution of Type 2 Diabetes with RNY was compelling. I also have a condition called Hemochromatosis which is an Iron loading disorder. While malabsorbtion of Iron might be a negative for most, it was positive for me. This would not have been a benefit with the lapband.

What fears did you have about having complications or even dying from from the surgery, and what would you tell other people having the same fears now?

I have always been and probably always will be afraid of surgical procedures. However, I was more afraid of living a significantly impaired and shorter life if I didn't get my weight under control. My father died of complications of his diabetes and hemochromatosis at the young age of 58. My mother has has mulitple heart attacks, strokes, and was recently diagnosed with stage 3 kidney failure. Both of my parents lives have been seriously and negatively impacted by the complications of their own obesity and resulting Type 2 diabetes. I was more afraid of what I saw as the "handwriting on the wall' than I was of the complications, which of course could include death. When I looked at the percentage risk of doing nothing, trying and failing again to lose the wieght successfully ... meaning losing it and keeping it off ... and the percentage risk of surgery, the surgery won out each time. My mother was just terrified at the prospect and is now one of my greatest cheerleaders. I'm only 8.5 months out, but I will be eternally grateful for the improved health I enjoy. My husband is in the process of applying to have the surgery himself.

How did your family and friends react to your decision? Would you have communicated anything differently if you could now? How supportive were they after your surgery?

My mother and sister were both very afraid for me to have the surgery. I included them in my research and invited my mother ... who lives with me, to accompany to any appointments she would like to attend so that she could directly ask any questions she had. This was a big help to her and ultimately to me. I considered all of their concerns and did my best to address them. I also shared my desire to have surgery with a couple of close friends. Two were very supportive; concerned but supportive. One had several friends who had undergone the surgery and had bad experiences; she was also concerned, but ultimately supportive. I didn't share my decision with extended family until I had made the decision to have the surgery. I felt that I owed it to them to share, because I know that I would want to know if they were about to undergo major surgery, but by the time I told them they were not a part of my decision making process. I have found all my friends and family to be very supportive since surgery. My mother would bring 'contraband' into the house early on. She has been visiting with my sister in CA and will be home soon. I let her know that we no longer keep 'contraband' in the house. If she wants something, she should get it and enjoy it, but when it's gone, it's gone ... I just can't have the stuff around. She has agreed to support me in this.

How did your employer/supervisor react to your decision? What did you tell him/her? How long were you out of work?

This does not apply to me as I am disabled.

What was your stay in the hospital like? How long where you there? What things are most important to bring?

I was put in ICU the first night because I used a CPAP and it was protocol at the time. They no longer do that. I was up and walking within hours, multiplie laps. I was moved to the main ward the next morning. The room was small and not very comfortable. The bed was awful. When I was taken off of the pain pump, my pain was not effectively controlled and got 'out of hand'. Once I realized what happened, it was managed better. You need to have an 'active advocate' with you. While my mother and husband were often there, they didn't think to check on my pain level, which is something I am accustomed to do when I'm advocating for a patient. It's much easier to stay on top of pain, than it is to get control of it once it's out of control. I was kept longer because I hadn't passed a BM and I had a complication that required resection of the colon. While they kept me an additional day, I still hadn't had a BM when they finally let me go home. That didn't occur until I was getting something other than clear fluids in me.

Did you have any complications from the surgery? If so, how did you deal with them?

My colon was perforated during the initial laparascopic incision. My surgeon was able to resect the bowel laparscopically, without incident. I have healed well, without any negative repercussions to date.

In the weeks after you got your surgery date, how did you feel? How did you cope with any anxiety you might have felt?

I had a couple of 'melt downs'. One at about 10 days out another at about 4 weeks. I seriously questioned the wisdom of my actions. However, to be honest, all has gone quite well and my only real regret is that I didn't do this many years ago. Being able to talk to others who have walked this path before was probably my single biggest support. I appreciate the support of my loving friends and family, but they haven't been there and done that. Being able to talk to those who have has been invaluable. My husband is planning to have the surgery and I know that my experience will be a big help to him ... just having someone who understands and can tell you that 'yes, this is normal' or 'this too will pass, just hang in there' is truly helpful.

Describe your first few weeks home from the hospital. What should people expect from this period?

I think that the biggest thing you are aren't prepared for is the first stall that occurs often somewhere during the first 2 to 6 weeks post op. You have so much riding on making the most of this opportunity and when you see the scale just stop dead for weeks, it can truly be daunting. It takes a while to learn to work with the new pouch as it heals. This learning curve can be a bit steep sometimes and therefore challenging. It's hard when you want to stop and go back, but you can't.You are stuck. Of course, that's also the reason to do this. There is no turning back. It's probably most important to stay hydrated, rested, walk, talk to those who can reassure you that it will get better. I think that the first few weeks are the most challenging. I found that it got much, much easier with each passing week.

How far did you travel to have your surgery? (If far, how did this affect your aftercare?)

The Duke WLS Center is very convenient to me, only about 40 minutes from my home. This has had a positive effect on my aftercare because it's close enough for me to easily attend most of the support group meetings offered by the program. I honestly believe that significant support after the surgery is critical to your short-term and long-term success.

Please describe in detail what things you could and couldn't eat in the weeks and months following surgery. What foods have been off limits? Please explain how your dietary tolerance changed week-by-week, and then month-by-month since surgery.

Each program has it's own protocol. The protocol at DukeWLS is relatively strict. First 3 weeks post op ... -- 64 ounces of fluids daily (fluids must be clear enough to read through) -- 40 to 60 grams of protien daily -- no solid or semi solid foods are allowed -- no pureed foods allowed -- medication and supplements are to be crushed 3.5 weeks to 3 months post op ... A whole new world of foods reappears -- only add one item per meal to ensure tolerance, if not tolerated wait at least one wk before trying again -- 40 to 60 grams of protien daily -- min 2 ounces of protien per meal to be consumed first -- min 64 ounces of fluid daily -- do not drink 30 mins prior, during or 30 mins after a meal -- 900 calories per day -- all foods to be 'fork tender' -- no cruciferous foods such as broccoli or cabbage -- no foods with skins ... i.e., apples, grapes -- no simple carbohydrates ...i.e., rice, pasta, potatoes 6 months post op -- same as above, but now all foods are okay -- always lead with protien, follow with complex carbs -- limit fats -- skins and cruciferous foods are okay

What was your actvity level in the days and weeks after surgery?

I was incredibly fatigued early on. As my endurance improved, I often thought I could do more than I could. That all improved with time. I have more energy and endurance now than I have had in decades.

What vitamins and/or dietary supplements have you taken since your surgery?

-- prilosec OTC -- centrum silver (I can't have iron supplementation due to a medical condition) -- citracal w/D -- sublingual B12

What side effects (nausea, vomiting, sleep disturbace, dumping, hair loss etc.) were worse for you? For how long after surgery did they persist? How did you cope with them?

I don't 'classically' dump. I do have 'food coma' events when I over indulge, but honestly, that doesn't occur too often anymore. I have had hair loss that started at about 3 months post op and abated at about 6 months. While it was disturbing and noticable to me, no one else seemed to notice. That said, I have a full, thick head of hair. There wasn't much to do about the thinning, except that I wore my hair shorter for a while. I did continue to color it and am glad that I did. According to my stylist and my nutrionist, the damage from a perm should be avoided because it can lead to breakage, but the color doesn't cause breakage and if anything seemed to make the hair appear thicker. I sometimes seem to have issues with becoming very cold or very hot. That seemed to be worst while losing wieght rapidly and seems to be better now. I still tend to get cold much more easily that I used. I just add clothes or take hot bath if necessary.

What was the worst part about the entire bariatric surgery process?

-- Waiting for insurance approval -- discomfort at the surgery sites -- the hospital bed -- learning to use the pouch ... i.e., foamies, not overeating, finding that I had eaten the 'wrong thing'

What aftercare support group/program do you have? How helpful/important is this?

My program has monthly 'support group' meetings. These are really more like informational seminars than support group meetings. They have about 15 mins at the end of the meetings where you can network. While I think that this is very important and do attend all of the meetings, I think that the networking aspect is undervalued by the program. The program provides a 'forum' for posting questions, comments, etc. This is somewhat helpful, but to be honest is generally not active enough to be significantly helpful. The program requires that you attend counseling sessions prior to surgery, at 3 wks, 3 months, 6 months and 12 months. I have attended the sessions and found them to helpful, but I wish that they happened more often. I would like to see something similar to these facilitated sessions be available as a support group in addition to the informational seminars that are provided

What is your scar like? Is this what you expected?

I had a laparascopic procedure and my scars are barely noticable. To be honest, you are more likely to notice the sagging skin than the actual scaring resulting from the incisions. I have one incision where it seems to have an adhesion to some underlying tissue and it so it is somewhat dimpled. The others are not noticable at all.

Please describe any plateau experiences you have had since surgery.

My first 'stall' occured at about 10 days out. I was distressed and concerned that I was the one person that this was not going to work for. I met with my Dr. at about 3 wks out and he said that the vast majority of people do some thing that he calls 'drop and stop.' He explained that our bodies are trying very hard to hold onto these precious resources that we are trying desperately to rid ourselves of ... That's the stop ... Eventually, the lack of caloric intake wins out and you'll see a drop. I started charting my weight loss once a week. That helped me a great deal. While I still got on the scale more often than that, I was able to see patterns that helped realize that the loss or lack of it was normal for me. I also used a tape measure which often showed progress when the scales did not. The last thing that was an incredible help to me was a website created by a fellow WLS patient; www.thinnerself.com. I was able to enter my surgery weight, date, height, age, sex, activity level, current date and weight and it would do some calculations based on the demographics I entered. It would show me my projected % of excess weight loss based on my performance to date. This was helpful to me because I was able to see that I'm actually doing better than I thought. I often was comparing my weight loss to others, but the demographics were so different that the comparisons were not only meaningless, but gave me a skewed vision of my performance.

Do you notice people treating you any differently now?

I can't say that I've noticed any difference in how people interact with me. But to be honest I was what many would consider a light wieght to start with, at 5'6" I was nearly 250 when I started this oddessy and wore a size 22/24. Many didn't recall my being 'so big' and are surprised when they see old photos of me. They didn't perceive me to be 'so big.'