Angela M.

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It involves the following:
 First you must attend 2 General WLS info meetings (put on by all parts of the team including nutrition, internists, behavior, and the surgeon).
 2 initial meetings with a nutritionist (2 months apart) and follow ups as needed after.
 Attend a 6 week behavioral modification group (and a once a month follow up with the group after that).
 Continued monthly weight checks until you lose 5-10% of your starting weight. 
 They also suggest extra counceling and weight watchers to most patients.

After you meet all of those requirements then the team, who gets together once a month- will review your case and either approve you for surgery or continue working with you until they feel your ready. After approval by the team- then you finally are allowed to schedule a consult with the surgeon, and then get a surgery date.
Now I have been in the program for almost two years and I have completed all of the steps for approval EXCEPT my 5-10% weight loss goal. Im hoping to have my surgery done in or around January. My starting weight with nutrition was 364 and I need to be at least 346 to be reviewed. As of 10/5 I was 352, I next meet with nutrition on 10/19.

  10/17/06 - I attended a community support group at Newton-Wellesley Hospital last night and I made an appointment for a consult with one of their surgeons, it isn't until January 10th so I am going to keep on going to Fallon Clinic and keep going to the NWH groups and just see where I end up. I don't think I can continue losing the weight on my own and Fallon won't even think about me until I meet the goal they gave me. I just dont think I can do it. So I'll keep you posted! (I'll put Fallon Clinic updates in blue and NWH updates in pink!)

 10/19/06- I met with my nutritionist today at Fallon Clinic in Aurburn and she was really helpful, she answered all of my questions and was very positive. She told me that surgery is not that far off for me and that she feels like I am ready to be approved by nutrition. Dr. Bourne said Im ready to be approved by behavioral medicine, so now Im just waiting for the team meeting! I am starting a protien/pureed diet tomorrow and I will go in and get weighed next monday. The team meets wednesday! I'll write more about my visit in my blog!

 10/23/06- I made my 5% goal today!!! The team meets Wednesday so hopefully I'll get approved to meet with the surgeon!!

  10/26/06 - Me and my mom to the NWH new patient orientation today. So thats 2 out 3 meetings we've attended so far. We both got our dates moved up to November 15th at 9am with Dr. Pablo Gazmuri. So if I dont hear from Fallon by next thursday I have to call my PCP for a referral. They say surgery is two months after your consult so that would be late January. Im depending on fallon though. Next fallon group is November 2nd, hopefully I'll hear by then!

 10/27/06- Fallon did not approve me. They claim that Im too young to make such a drastic decicion and they think I should try and lose the weight on my own. I am no longer a bariatric patient at Fallon Clinic. 

 11/01/06- Dr. Bourne has called me twice since my last update. I guess she is pulling for me and realized how upset I was and how stupid that decision was so she's been calling around on the team. She is optimistic that I will be approved Nov. 22nd. I'll continue with groups. LATER- Around 6:00pm tonight I recieved a phone call from Dr. Arcand (surgeon) and he told me that its almost definite that I will be approved at the next meeting and that he is pulling for me. He also said that my consult appointment will be scheduled in a more timely fashion then most because I was unfairly overlooked last month. Lets see =).

 11/02/06- Had another behavior group at Fallon. I was in a bad mood afterwards and really depressed because I dont feel like I can trust Dr. Bourne. I feel like she is against WLS and seeing as how she is the head of her department, it doesn't make sense. But I have Dr. Arcand's word and Im meeting with the medical director on the 13th. Also my PCP will send the team a letter on my behalf. Hopefully Dr. Bourne isn't standing in my way.

 11/08/06- Met with my PCP today and my therapist yesterday, they are both writing me notes to the team in support of me getting surgery. They should make the difference, we'll see. 

 11/13/06- Had my appointment with Dr. Shukla. What a waste. She just did some bloodwork that Ive already had and wrote me a perscription for something that another doctor told me not to take. She didnt seem too convincing that I'll be approved. Im not looked as a person- Im looked at more like a potential lawsuit if anything goes wrong.

 11/21/06- I met with Dr. Bourne today, I was supposed to see her at the end of December but they called and had an opening which was perfect, almost meant to be. So I saw her today at 11 and she made me feel a lot better about things. Im really starting to like her, strange. But at least I know that she is really trying to help me out. Im going to call her office tomorrow to find out if I was approved or not. 

 11/29/06- Approved!!!! I met with Laura today and got weighed then she said she would email the team my progress. After leaving her office Dr. Arcand called me like 20 mins later and said that his office will be calling tomorrow to schedule a consult!! After consult surgery is within 30days!!!

 11/30/06- I got two calls this morning. One from nutrition to schedule me for the December 13th pre-op nutrition class that goes over Stages 1 & 2 after surgery, and one from Dr. Arcand's office with a consult date! December 18th!! Great news, Im so damn excited. Man I tell ya its about time!! Now I betcha time will crawl by SOO slow.

 12/13/06- I went to the nutrition group and I lost 1lb. Everyone else gained and Laura wasn't happy. We got samples and learned about the 1 day pre-op clear liquid diet, and the first 3 stages after surgery. I have to book a 2 week follow up with nutrition after surgery before I cant be cleared to the next level of eating. I decided that I loveeeeee everything from Smarte-Forme.

 12/18/06- Met with Dr. Arcand. He was running really late, my appointment was at 1:30 and I saw him at 2:15 and it lasted about 5 minutes. He went over risks of surgery, drew a diagram, felt my tummy, and had me sign a few papers. Then I went upstairs and saw Lisa and booked my surgery date for Jan 17th, and my pre-op testing. Its just a physical and patient education on Dec 29th and an interview with the anesthesiologist on Jan 15th. Im SO excited!!

 12/29/06- Went for my preop testing. It was pretty simple, a couple health questions, blood pressure check, bloodwork, and an EKG. I was out of there in a little over an hour, the longest part was the wating! On the 15th I'll get my blood type drawn and I'll register and get a bracelet, surgery is only 19 days away!

 1/17/07- SURGERY DAY!

 1/24/07- One week post-op and down 14lbs!!!

 1/31/07- Cleared for soft/pureed foods, and moved to 60-80 grams of protein a day. The first thing I got sick on was chicken salad, now clue why. I handle things well one day and not the next! I have no trouble with liquids at all. I have lost 24lbs.

 2/26/07- Moved onto stage 5 "for life" eating. I am now aloud to eat from all food groups and can have 6-8 servings of carbs a day. Bread that is not toasted and meats that are dry give me a hard time. I am down 31+ lbs but I decided not to weigh more than once a month now. I go back to my NUT in 6 weeks. I am working out 5-6 days a week doing cardio and resistance training. It feels GREAT. Im also getting out more and making new friends. =) No regrets! I feel like I didnt even have surgery, I feel pretty free.

 7/17/07- HAPPY 6 MONTHS!!! Wow time flys...to think I'm already halfway to my surgiversarry and it feels like just yesterday this all happened. I've lost 90lbs and I feel great. The only complaint I have is that I need my gall bladder taken out and that is happening August 2nd. Other than that I can eat almost anything and do whatever I want without restriction. I'm much more active and I feel a lot better about myself. No regrets here! 

 8/03/07- Home from the hospital, 16 hours out from surgery. Thank God this gall bladder is gone. Im super achey and my right arm is killing me from the gas pain but I'll live. Hopefully this solves all my problems and that unexplained pain never happens again. Surgery went smoothly as ever and I was in recovery at noon and home by 4, now Im just trying to keep up with my pain meds because if I don't it feels like I can't breathe. I still havent had a BM which worries me just a bit because they told me pain meds cause constipation but the surgery causes diarreah so I should be balanced out. Oh well its still early. I don't have a post-op appointment until the 20th because the Doc is going on vacation I believe but I'm sure everything will be fine. I know where to go with any troubles. No regrets guys, still never any regrets! =) 

Surgeon-

Medical Director- 

Behavioral Director- 

Bariatric Internist- 

My PCP-

Roux-en-Y gastric bypass- This operation is the most common and successful combined procedure in the United States. First, the surgeon creates a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs. Rarely, a cholecystectomy (gall bladder removal) is performed to avoid the gallstones that may result from rapid weight loss. More commonly, patients take medication after the operation to dissolve gallstones.

Advantages:

• greatly controls food intake
• dumping syndrome — dumping conditions to control intake of sweets
• reversible in an emergency — though this procedure should be thought of as a permanent

Disadvantages:

• staple line failure
• ulcers
• narrowing/blockage of the stoma
• vomiting if food is not properly chewed or if food is eaten to quickly
• weight re-gain is known to happen if dietary changes are not followed long term

Note (figure 4): This is the RNY without the stomach being transected or divided.  This type RNY is not widely done anymore.  Most surgeon perform the RNY with the stomach divided with no staple line. Transected means: stomach is completely separated from the new stomach

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