preparation steps

Nov 29, 2012

I have been doing a lot of reading lately. Not finding too many surprises anymore. The information remains consistent. This is good, I think.

Last week: surgeon consult (selected RNY) and dietician consult (nice lady!). Began the mighty accumulation of medical records. Hopefully they'll get in to the surgeon's office quickly. My goal is to have everything ready to go to insurance by 12/15. The insurance coordinator said it can take a couple of weeks to hear back. January for surgery looks wide open and they can get me in as quickly as a week after approval. There we go. I really hope I am not denied, but I think there is a risk because my current BMI is 35 with comorbidities written into my insurance contract. Insurance coordinator and doc both assured me that generally the insurance companies follow the center of excellence recommendations and there is not a problem. And, the reality is that if I went off my metformin, my weight would head north again. It's already crept up a few pounds since stopping my phentermine.

This week: upper GI (results were OK, only a little reflux according to radiologist), Psych eval (2 hours down, 1 hour to go), EKG/labs tomorrow (with my PCP, no sweat). The only thing left will be the support group meeting which I will attempt to hit on Saturday, otherwise will need to wait a week due to December starting on a weekend. 

Psych consult was interesting. Went to the practice that family members have used in the past. This psych is their eating disorders specialist. Younger guy. I felt this eval was sort of a tryout for post-surgery work. I think it'll be important to work with him after surgery to help me adjust to life as...not me.

Key themes emerged in our conversation. 

1. I have little to no comprehension of what I actually look like - my body self-image is so messed up. For this reason, I guess I really do have an eating disorder. I have read about dysmorphia in anorexics and bulimics, but I guess it is a real thing that happens to the obese, as well.
2. The need for psych support after surgery because although *I* will be the same person on the inside, the world will be seeing a different person on the outside. I've gotta be ok with that and will need to learn to manage it.
3. I think I can articulate some pre and post surgery differences for the first time. On my previous attempts, I have literally had to drag all of me along for the journey. All 200+ pounds exercising; all 200+  pounds fighting what I eat. After I hit goal, I can focus on keeping my body where it's at. To me, that is a completely different mindset. But, this is going to be work, no two ways about it.

He felt a reasonable goal for me is 180. Interesting, and I think that is a good solid goal, but I will be honest and say I would love to see what I look like at 150. As I calculate different BMI's, 180 would still put me in the "overweight" range. The Weight Watchers site says a healthy weight for my height is 135-169. So, maybe 180 is a bit high, but it is 70% of EBW, if I set my IBW to 150. That is right in line with what the surgery is supposed to provide.

I spent 2 hours talking with him, and I need to go back for another hour next week so we can finish up. I suppose I am doing well because he also wants to discuss a treatment plan that involves pre and post surgical sessions. I suppose if he felt I was not a candidate for surgery, he wouldn't be discussing postsurgical treatment, right?

All in all, I am looking forward to the potential future me. I am enjoying and admiring the stories and photos of others. I am feeling a little impatient at wanting to get all this hoop-jumping finished so I can find out whether insurance will approve me.

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