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Well here I am.  My mom's plane is here in 30 minutes.  My husband is picking up my daughter from preschool and then my mom.  I have my instructions.  I have decided to stop questioning and follow orders.  I am bringing "The Beck Diet Solution", my ipod, my knitting, and a journal.  Am I certain?  Certainly not.  Am I ready for a change.  Absolutely.  I have to force myself to be aware and concious that with each moment I am choosing a healthy, beautiful me over good tasting food.  When I line up the reasons for needing and wanting to lose weight compared to the reasons for wanting to eat what ever the hell I want the scales weight heavily in favor of the former.  Food tastes good, yes, but life tastes better.

                                                                        

I'm pretty tired and overwhelmed.  My surgery is Tuesday.  My mom flies in on Monday to help me with the kids.  I am so lucky.  She's an RN and she has had this surgery.  My pre-op class was today.  The program seems very professional.  There was a little confusion between some of the info the RN gave us and some of the info the NUT presented.  I am terribly worried that I am going to be hungry, that I am going to fail, that all of this work is going to be for nothing.  I can't seem to shake this.  Dr. Mueller leaves you with a 2 ounce stomach and bypasses 100cm of small intestines.  I am worried that this is too much stomach and not enough malabsorption.  I am worried that the hole out of the pouch will be too big.  I guess I am just worried, like so many of us, that this effort, too, shall fail, as all of my weight loss efforts end up failing.  I need to find some bright hope.  I know this is right for me.  I know the care will be excellent.  I hope the surgery is successful... please, please, please take away my hunger.
Here is my Post-op plan

Day 1-2: Water, ice chips, propel

Day 3: Clear liquids and broth (I'm a vegetarian so I cleared veggie broth)

Day 7: Liquids above plus strained creamed soups, cream of wheat or rice, and yogurt

Day 12: Add 2 Protein powder or liquid drinks, and protein powder in soups

Day 14: Bariatric soft including cheeses, eggs, soft mashed fruits& veggies, beans, fish, ground chicken or turkey

Week 4-6 Bariatric regular

It's a long story and I don't want to write it all down, but I've got a new date, MAY 19th.  Surprise!  Start your diet tomorrow, they said on the phone yesterday evening, (which is now today) which I did.  It's three shakes and a high protein low carb/fat meal which is much better than the all liquid.  Still I am finding it tres hard.  Here I go rollercoaster of life.  Hold on tight!  I asked, even begged, for change.  Here it is...

Just needed to sing from the mountain tops!!  The approval letter came today, I called the surgeon's office (they were a little behind the times), notified them and scheduled the RNY for May 26th!!!  I am SO ready!!! 

Naomi emailed.  The paperwork has been sent in to my insurance company.  Here we go!  Her cut-n-paste email said 7-10 business days but in person a month ago she told me that my insurance was 3-5 days.  We'll see.  I'm hopeful, nervous, excited, impatient, and very very tired of lugging around all of this weight.  Reading the main board posts has been a great experience for me because I understand (at least mentally) that at some point I will regret this, that I will hate food, that I will be sick, sick, sick.  There is always a price to pay for what you want, however.  Given the medical news that I received about my liver and gallstones, it is time that I made a REAL change to my life style and I know that this is right for me.  I will get by the hard parts with fierce will, love, and the support I know I am lucky to have.  I will come out on the other side of the "honeymoon" after hard work and emerge healthy, mobile, energetic, and whole.  Watch out world, here I come!

So I finally got my PCP clearance and the paperwork today.  It took a longer time than I had anticipated because my blood work showed a few things.  My PCP ordered an ultrasound and the images showed both a swollen liver and many gallstones.  She called to tell me, and requested I take a blood test to check for clotting and liver cancer.  Turns out I am in a very high risk group for liver cancer.  Thankfully the test came back negative!! 

Little bit frustrated with my doctor because she has only talked to me over the phone about this and also she is always in a hurry.  Reading the paperwork today I learned more about what the ultrasound showed than from her.  She is recommending a liver biopsy and also to have my gallbladder removed.  Nice to know! 

Anyway I picked up the paperwork and hand delivered it to the surgeons office as requested.  Now the waiting game.  My psych eval is in.  My paperwork is in.  Naomi, the patient coordinator will email me when she submits the paperwork.  She said the wait time for my insurance is usually around 3 - 5 days.  I am worried that some of these complications may hamper the situation.  Obviously if there are real concerns I want those worked out first, but in my experience, sometimes these things are a matter of bureaucracy than medical concern.  Anyway the process continues... 

So the psychologist called and said her letter was ready.  I had to fax her a signed release.  I am keeping my fingers crossed.  I am considering emailing Naomi, the surgeon's patient coordinator to tell her it should be there by tomorrow (it was mailed on Monday) and that way I leave the door open in case the letter didn't qualify me and I need to take further steps.  But I also don't want to be a pain-in-the-butt, specifically they tell you in writing not to be.  It's hard to know what to do.  Often times I regret my action, not my in-action, and I think, if only I had left it alone... stay tuned.

In addition, I have been waiting for my labs and tests from my PCP.  I was suppose to have an appt. with her on Tuesday but it was canceled because she was sick.  Of course I understand.  She called today and said I needed a few more tests.  I gave more blood today and I have an ultrasound scheduled for next Tuesday.  She said it wasn't likely that anything was wrong but that we had to cover our bases.  I asked her what would happen after the ultrasound because originally we had had an appointment... she said she'd call me.

Waiting around isn't a strong suit of mine but I need to be patient.  What worries me is that my referral from Dr. Jabro expires on May 5th and I wanted to be approved and scheduled by then.  I assume it won't be too difficult to extend the referral but we are coming up on the 2 year mark for my 8 month diet attempt.  I stopped it formally in June of 07.  Also my mother is going to come and stay with us for a week, thank God!  With the two kids and my husband in the middle of breeding season (with the birds) I am going to need help.  I am SO lucky to have her.  She is a fabulous support and incredibly giving.  I can only hope that I support my own children this much.

Nothing bad, I know.  Just a lot of open ended situations that aren't in my control.  I am trying to plan for something that hasn't yet been approved.  It's difficult.  I know I will see it through, though.

The psych eval was long and draining.  2 50 minutes sessions talking about everything from food (of course) to how my husband and I met, lived together, and got married (and I mean the specific details).  Really!  It's clear, she said, that I am fit to have the surgery and be successful but to complete the evaluation, she continued, she would need another 2 50 minutes session, or at the very least another hour.  I was angry and I expressed this to her.  I felt that everything had been covered and then some.  No, she said, she had to go over my childhood.  I reminded her that on the phone she had said that the eval would be 2 50 minute sessions and she said that I had misunderstood, that it was 2 2 50 minute session.  Oh well that's much clearer, I thought to myself.  I told her no and I threatened to walk out, taking my chart with me.  She said fine, that she would do the letter by next Tuesday but that it would be incomplete.  Incomplete, I questioned?  We talked about EVERYTHING and then some.  If she wanted to cover more ground she should have kept us on track.

Listen, I understand why this is necessary.  But it doesn't benefit me at all.  I am in school full time with two little kids.  The evaluation  is just meant to satisfy the insurance requirement that I am fit to go through the surgery.  It is NOT meant as a psychological profile.  I suspect that she wants to milk my insurance for the full four hours of evaluation services that it covers.  She certainly did NOT say 2 2 50 minute sessions to me on the phone.  She decided this after getting my insurance information.

I hope this doesn't set me back but I will not do any more.  I have a real problem with the pointlessness of further evaluation.  She said it was clear to her that I was mentally ready for this step and that I have good coping mechanisms.  Two hours of talking and we touched on all of the topics that are required.  Further, the surgeon, Dr. Muller, AND my PCP said that I DO NOT NEED this evaluation and yet, to make things easier, I went through it anyway.  I spent a lot of time setting it up.  She wanted further information from Naomi, the coordinator and I emailed Naomi and provided it to her.  At this point there is nothing more to add.  Am I being foolish, what is ANOTHER hour for a clear and finished eval.... and yet I am SO sick and tired of filling out everything in triplicate!!!  With all I have to do in my life... an hour is precious to me.

Here's hoping it works out!

After a frustrating week getting lists of names from Cigna (at least this is covered, no copay, and I am very grateful!!) and calling the names only to have a good portion out-of-service, no longer there, or sorry, we don't do these evaluations... I have found a very nice doctor (must be a psychologist, a therapist will not suffice) who will meet me on Tuesday at her office at 3:45 for 2 50 minute sessions.  I probably shouldn't have said this was just a formality.  I guess it was my small rebellion.  It was hard for me to hear Dr. Mueller say, no this is not required, because the referral covers that (which it did) only to have the patient coordinator, Naomi, say yes it is, without even checking.

Anyway, it is set up.  Better this is done now , than have the insurance reject me because it wasn't done.  Also, I got a nice vibe from the psychologist (which I now know how to spell from writing it so much!) and it will be good to use this time to prepare my tool box of coping skills.

Saw my PCP today.  She was very supportive.  I am hoping that the weight loss will also result in a great loss of breast tissue.  I'm a size L (who knew there was an L?) and my neck and shoulders are killing me.  She was very efficient with my paperwork.  I had an EKG with Dr. Jabro already so I just needed blood work, a chest x-ray, and the pre-op forms to be filled out.  I got the x-ray done today but I need to fast for the blood work so I will have to get that done either tomorrow or Friday morning.  I am having trouble finding a psychologist that does the psych evaluation.  Cigna provided me with a list of covered docs but so far none of them do this kind of evaluation.  My PCP said that she thought it wasn't necessary.  That's what Dr. Mueller had said.  I might give Naomi a call to find out more information.  I am moving right along.  I am interested in a May date after I have finished this semester.  It's really becoming real.  I am nervous but also very ready for a drastic change.