Beth13743
12-6-06
.got to love this liquid diet~ I am on it !! and almost done with it well so to speak~ I of course will have a few weeks after surgery to continue the liquids only! I ma getting anxious, not real nervous yet! but I am sure I will soon, escpecially while packing my son's overnight bag for three days.
20September2006~ 1st apt with the surgeons Office
27September2006~ Nutr apt
29September2006~psych evaluation
08November2006~2nd apt with Dr. Macenas ( got his approval)
16-November2006~ Insurance submitted late in afternoon ( after 4pm)
20November2006~ (11:58am) Insurance rep called to inform me of the APPROVAL
20November2006~Surgeons office stated they received copy of approval letter~ and will call by end of wednesday with a surgery date!
27-November 2006 Called the office b/c I never got my call, So I have been scheduled for surgery the 12th of December, tentatively. they are going to try to schedule my surgery for the 5th instead. so I will wait today to see if they can sqeeze me in this week for all my apts with the DR.
11-28-06
Waiting for Karen to call from Dr. macenas office to see if she was able to schedule all my apts to see Dr. M this week so I can have surgery the 5th of december rather than the 12th, no big deal if she can't it would just fit into my schedule better. So I will sit here at my desk and wait.
11/20/06
I am going to have to say the 20th is my favorite day~ I just returned the call I missed by like two rings from my insurance company stating I had received approval for my rouxeny, yeah me !! can you tell I'm a tad bit excited~ oh yeah that means no turkey for me bring on those green beans! I want to scream and no one I have told seems as excited as I am, so I can't wait to go to my support group meeting tonight to tell everyone!yeah me
11/03/06
I was so excited yesterday I forgot to share my news, I called the surgeons office yesterday to see if they work with Aetna ( our college is switching to Aetna as of the 1st of the year) and as of Jan 01 they will no longer be excepting them cause they are awful! Great but in the long run this could be a good thing. Rhonda checked my file and said that it was on the surgeons desk for review. And she would go see if anything else was needed and inform him of my insurance changing. I got off the phone with her, I tried to call the gastro section of the hospital for them to resend my upper GI results to the surgeon but couldn't get through, hang up and the phone rings it's Rhonda, she spoke with Dr. Macenas and he had my upper GI results the looked fine and said to go ahead and schedule my 2nd apt. with him everything looked fine. YEAH!! I was smiling all day!! I will see him on the 8th @ 3:45pm. and go from there. I have heard that after you meet with him he schedules your apt. That wold be awesome! I would love to be able to have surgery the 20th of November. It would be great for work also. If I was out from then till December 20the I could go back to work for 2 days and go on a week long college is closed paid vacation. SWEET, and my awesome boss could go to Germany and not worry about the office while she is gone! And to make sure this liquid diet thing is something I can do when i need to I started it this morning! Yummy Yummy good thing we can eat veggies!
I am seeking to have Roux~ EN~Y WLS
I am waiting for my second apt with my surgeon!!!
10/17/06
Waiting thats what I am doing. Trying to be patient. I am waiting to get eh call for apt. # 2 with Dr. M. I have started my letter to him on understanding. Kinda turned into a research paper. WOW.
10/18/06 I have written my letter this is the first draft adn I have done no editing at all except spelling and I know some of the grammar needs work but read if you would like. My Dr. asked for a letter of understanding and stats in the "directions" this requirment is based upon educational research showing that retention of information is improved by asking the learner to think about and write down information. Patients who are not able to understand enough to write a letter detailing the benefits and risks of the operation will be poor candidates for surgery.
the letter must contain an understanding of:
~Clinically severe obesity ~risks of Obesity ~ Expected benefits of surgery ~ Possible risks of surgery~ How the operation is performed ~ Why the operation is performed ~ alternatives to surgery ~ postoperative diet changes ~ possible depression after surgery ~ need for long term followup ~ need for lifelong nutritional supplements
So here's my letter sorry it's really long ( turned into a research paper)
Dear Dr. …,
I am writing this letter to you per your request. I have been researching Gastric Bypass Surgery for a long time, and more intensely these past months. Researching this for a long time has left me well informed on the many issues steaming from this procedure i.e., benefits, risks and also the alternatives too.
I know that there are risks associated with this surgery just as there are many risks associated with any surgery. Some of the risks / complications are, but not limited to, death, bleeding, dehiscence (the separation of areas that have been stitched or stapled together), infection, leakage , pulmonary problems, stenosis (narrowing of the passage, i.e. the valve). These are only a select few risks that could occur during surgery or after surgery, both immediate and/or long-term complications. Are these complications scary yes they are but so is being morbidly obese!
Morbid Obesity is a condition that many overweight people have. Obese people who have a BMI of 30% or greater are considered Morbidly Obese. Many morbidly obese people also suffer from co-morbid conditions. Co-morbid conditions are disabling conditions related to clinically severe obesity, or obesity related conditions i.e., high blood pressure, sleep apnea, high cholesterol, diabetes, etc. Other health conditions related to being morbidly obese could be G.E.R.D.’s, stress incontinence, sleep disturbances, etc. As well has health conditions related to being obese there is also other issues that occur with obesity. Many obese persons suffer from the inability to qualify for many types of employment, and are discriminated against in the workplace. Obese persons are more likely to be unemployed and often suffer from low socioeconomic status. There are many other obstacles that face obese people.
Gastric Bypass Surgery is a tool that is offered to those who are morbidly obese whether they have preexisting co-morbidities, or not.
The Roux- en-y gastric bypass surgery (a restrictive and mal-absorptive procedure) would give me the tool I feel I need to help me become healthier. Although I don not suffer from many co-morbid conditions, I know that if I do not loose weight and keep the weight off my co-morbid conditions will increase. In the past year and a half my blood pressure has increased, I have lower back problems due to the excess weight I am carrying in my upper body. I am starting to have joint aches and pains and I know that is only the beginning. I am unable to join my family in activities due to being out of breath and tired. In the past I have avoided social events due to the fear of embarrassment, anything from a snicker form and individual, a comment from a child, or the possibility that I wouldn’t “fit” whether it be in a seat, or a space on a bleacher where there was room but not enough for me. This tool would allow me to continue with a healthy diet and the ability to loose weight and keep the weight off. I have started an exercise regime, currently moderate walking, and plan to continue to walk and do other various exercises after surgery. I know that after some of my access weight is gone I will feel better about attending a gym (which I have available to me for free) to start weight training.
The roux –en –y procedure can be done open or laparoscopic. When the procedure is done laparoscopic there is a few (approx. 3) small incisions made into the abdomen. Small devices, including a camera, are then inserted into these incisions. Many patients who receive laparoscopic procedures are able to recover quicker than those who have open surgeries performed. Also laparoscopic procedures leave very small scars which many would consider added benefit.
During this procedure the surgeon creates a small stomach pouch and then constructs a bypass for the food. This newly constructed bypass allows food to skip many parts of the small intestine. Due to skipping much of the small intestine it makes it impossible for the body to absorb many calories and most nutrients.
After the procedure has been completed all patients have to eat a special diet that will be worked out between the patient and a nutritionist. This new diet at first is very restrictive. Initially the diet consists of clear liquids in very small amounts (tablespoon at a time) and then on to a full liquid diet for approx the first 2 weeks after surgery. This liquid diet is so the new pouch and construction system can heal correctly. After the liquid diet you are then on a pureed diet, on this diet you can consume purred high protein, low sugar, and low fat foods. After those stages are completed you are ready to start the “regular” food diet. This new diet is also a high protein, low sugar, and low fat diet. At this point in time your stomach should be able to hold ½ to 1 cup of food per meal. Meals need to be eaten slowly, and all foods eaten need to be chewed completely before swallowing. Hydration is also very important, making sure you drink plenty of fluids each day is extremely necessary. Before bariatric surgery many people could eat fatty foods or foods containing a high amount of sugar and have no problems. Those who have had roux-en-y surgery will more than likely experience the “dumping syndrome” if these foods are consumed.
Another requirement after surgery is the consumption of nutritional supplements. Due to the new construction of the small intestine many nutrients will not be absorbed from the foods eaten, therefore supplements will need to be taken. Calcium supplements, vitamin B12, a multi- vitamin, and iron are the main supplements that need to be taken. These supplements will need to be lifelong supplements. Of course Protein! Protein is a main component to proper nutrition for bariatric surgery patients. These new diet changes will be in effect for the remainder of your life. Through out time you will learn what foods, the different types and how they are cooked, will affect you and your new construction. Also life long follow ups with the surgeon will be necessary. Your nutritionist will also play a life long roll in your future.
After surgery many patients have the possibility of becoming depressed. There are many reasons depression can set in, some reasons depression may occur are not seeing immediate results, and the question of whether you made the right choice (seems more frequent when side effects occur after surgery). There are many reasons patients may become depressed and that is why continued follow up with your surgeon, nutritionist and your PCP are important. There is treatment for depression, there are medications can that be prescribed and also psychological treatment can be done. These two treatments can go hand in hand or be done separately.
Although there are alternatives to having Gastric Bypass surgery; for example: diet programs, self help programs, exercise, acupuncture, nutritional supplements, diet/ weight loss powders or pills, hypnosis, and probably many others. Many people have had great success loosing excess weight using these alternatives. Those who are obese find that after having a successful weight loss using one of these alternatives the weight loss is regained and usually more weight is gained on top of the weight that was lost.
Weight loss surgeries have been proven to provide patients with a long/ longer of weight loss stability. Although WLS allows patients to loose weight and be able to keep it off it requires a lifelong commitment. WLS is a tool. It is a tool to help an obese person obtain the ability to regain their life. Some of the added benefits to weight loss surgery of course ~ the loss of excess body weight/fat, the improvement or resolution of other co-morbid conditions, including: diabetes, hypertension, sleep apnea, etc.
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Gastric Bypass is the tool for me to gain the life I have always thought I could achieve on my own. I am 27 year old single mother of a very busy 7 year old son. Being overweight has been an emotional rollercoaster for me. I have been over weight ever since I can remember. In grade school I played on sports teams, enjoyed every minute of the sport, but couldn’t stand the thought of some one looking at me in a pair of shorts. The fear of being the last one down the court or being the lead base runner and having people waiting behind me to get to my next base and continue on to home. In High School I remember trying out for the basketball team and not making the team and the comments from other team mates were negative like “you are a good ball player, just not quick enough”, and so and so can run faster so…Of course there was always the scare that if I did make a team would there be a uniform large enough for me. Finally these comments and the thoughts finally overcame me and I decided that enough was enough and I wasn’t going to play any more sports in school or any where for that matter.
During High School many of my peers were on this diet or that diet or trying this “eating disorder or that one”. I never really talked to them about what I was doing. I think I tried every diet that they were doing the only difference was they really didn’t need to be dieting in my eyes; I would continue doing the diet after all my friends stopped. I remember learning about eating disorders in health class, Gee that sounded like a great idea. The easy way to loose weight! Gee was I wrong. After many years battling bulimia I decided to change my life. Throughout the years of purging, especially when I was on another diet and “cheated”, I would have to say that the bulimia really only showed his nasty face occasionally. He appeared when my diet wasn’t working any more, or I decided to eat something I shouldn’t have eaten, quick way to have “a moment on the lips and never on the hips”. In May of 2005 I decided to regain my life and take control. I did extensive research on eating disorders was I really a bulimic? Read tons of books, very few books actually on bulimia, and articles. This reading made me realize that things would only get worse and what I was feeling needed someone or a group of individuals to help me recover. In July I moved into my parents house with my son, I was buying my first home and need someplace to stay while the new home was put on the property, I decided there was no way to hide my eating disorder form my family so I had to tell someone so I could get help. I actually told my OBGYN and that got everything rolling. I called a nutritionist who deals with these issues and a psychotherapist. After a few months of working with these two life saving individuals I contacted my PCP for some additional help, I needed to be put on an anti-depressant to try to help me overcome the bulimia. After many months of treatment I am doing awesome, and brought me to where I am today; in control of my life, and ready to achieve the life I have really always wanted. I want the life I have dreamed of having to come true. And weight Loss Surgery will help me achieve that dream. I want to be able to loose weight and keep the weight off. I want to race my child up a flight of stairs and not be exhausted, I want to be able to run the bases with him and go swimming with him, enjoy every day. I am tired of not wanting to do stuff do to the fear of not fitting in or the lack of energy .And although this surgery is not to be used for cosmetic purposes what obese person wouldn’t dream of being healthy with the possibility of wearing a smaller dress size and wear trendy clothes rather than old obese persons clothes. Loosing weight and having the tool to keep it off will benefit me greatly. I have currently started walking longer distances when I park my vehicle at work to get the added exercise and am doing a dance exercise video in the evenings. I need this surgery to help me, although I don’t show many co-morbidities currently, they run heavily in my family. And now is the time to change my life so that I don not live a life of disappointment, pain and severe health issues.
I have many people supporting me through this journey of weight loss surgery. These individuals are family members, friends, co-workers and acquaintances. These special people in my life will be there for me both pre op and with your approval post op as well.
Dr. ... I would like to thank you in advance for providing the opportunity for many obese persons the chance to become healthy and happy for either the first time in many years or for the first time that they can ever remember. The success and happiness I have heard from those in the group support meeting or through inline chats and messages is hart warming. You and many other surgeons have “saved” many lives.
