Caryl Mauk
Update 3/11/05
I just joined my fiance's gym at St David's Hospital. I had an evaluation by an exercise physiologist today who helped me plan my exercise program.
I sent my paperwork to the surgeon's office and I'm waiting for them to call me to set up an appointment. I'm excited!
3/29/05
I have an appointment with Dr. Faulkenberry April 12th.
4/12/2005
Met Dr. Faulkenberry today. We will be trying for approval, but it will probably take a while as my policy has an exclusion. Dr. Faulkenberry says I am a good candidate for either Lap-Band or RNY. I lean toward RNY but have not completely made up my mind which to do. Now we wrangle with the insurance company.
5/26/05
I received my denial letter a couple of weeks ago. My attorney is preparing my appeal.
6/26/05
My first appeal was denied. I have a meeting scheduled with the benefits review committee next Wednesday, 6/29/05. If I am approved, I hope to have surgery by the end of the summer. If not, I hope to have a new job by the end of the summer. St. David's hospital system's insurance covers bariatric surgery.
7/1/05
Final appeal denied. My attorney was not allowed to speak for me at the appeal meeting. Looks like I'm job hunting after I get back from my honeymoon. Phil and I are getting married July 4th!
7/12/05
Got a job offer at St. David's. I start August 8th. I'm sorry to leave my old job, but I have to do what's best for my health.
10/13/05
I've been working at St. David's Medical Center since early August. My insurance starts November 1st. I'm going for a checkup with my PCP in a couple weeks. She's going to refer me to a multi-disciplinary weight loss program. We both know people tend to gain back weight lost in these programs, but we are preparing to prove medical necessity for my next attempt to gain coverage for lap RNY.
11/30/05
I had my check up a couple of weeks ago (yeah, I procrastinated!). I haven't heard how my labs are yet, but only had them drawn a couple days ago. I've got appointments December 5th for a mammogram (welcome to middle age!) and with an endocrinologist. I'm nervous about seeing a doctor for weight loss, mostly because it makes me accountable. The upside is the opportunity for better support. I'd really like to see a dietician again. I've found it helpful in the past. I'm working on getting an appointment with the bariatric surgeon again. They have to check my insurance again and won't make an appointment until that's done. I'm nervous and excited about that. Nervous that we'll have more hitches getting insurance approval and excited that surgery may finally become a reality.
I have been planning on RNY since I went to the first bariatric surgery seminar with my husband (then my fiance). Recently I began reconsidering having the Lap-Band instead after reading a profile of someone who had severe complications following RNY and eventually died. I know the surgery is risky, but acceptably so. I'm a nurse and am well aware of what is involved. It scares me to think of the possible complications, but it scares me more to think of the certain complications of my weight. As for the lap-band, I'll talk to Dr. Faulkenberry about it again. With my esophageal dysmotility, it's probably not a good idea as the band can worsen this condition. Honestly, RNY is probably a better option for me anyway because my willpower is not so great. In the last year I've become much more aware of my compulsive eating. Well, it's all academic until I find out my insurance will cover me.
12/6/05
Talked to Elizabeth at Dr. Faulkenberry's office today. Got the official word that I need the 6 months supervised diet and exercise program. Called FirstHealth and talked to Betty, a nurse who reviews claims. She says she will mail out the requirements. I saw the endocrinologist yesterday. I've gained more weight and now weigh 322. It's really depressing.
1/11/06
I've been back to the endocrinologist a couple of times. I maintained a weight of 318 over the holidays. I've been keeping a food diary on MyFoodDiary.com which helps with accountability. I started Glucophage for glucose intolerance (precursor of diabetes). I've also been researching surgery in Mexico. I may do this if I can't get approved after the 6 month diet.
1/17/06
The food diary has been helpful. My calorie intake has been gradually descending and in the last 13 days I've had more days below 2000 than above. I know that sounds like a lot to post-ops and petite people, but that is actually low enough for gradual weight loss for me. I like being able to watch the percent of fat, carb, and protein during the day. I can base my food choices on my running totals and adjust the percentages. I need to increase my exercise also, but have been meeting some resistance there. At least I have been more active the last couple of months.
1/24/06
I saw Dr. Faulkenberry again today. I got good news! My company changed to Humana January 1st. Jenna (at the doc's office) thinks we don't need the supervised diet now. We won't know for sure unil we submit the claim. She said they should be able to get it to Humana in about 3 weeks. I'm getting excited now. I didn't expect to be submitting for approval until May. I don't want to get too excited, but I'm hoping. I'm also down 2 lbs! I'm still working on my diet.
3/8/06
I thought I'd updated more recently, but I guess I didn't. After my appointment with Dr. Faulkenberry, I started a low carb diet to help lose some weight before surgery. I've done pretty well with it, but the first 3 weeks were hard. I was exhausted, felt sick and had migraines. I lost 9 lbs the first 2 weeks. I haven't weighed again, but I can feel the difference in my clothes. I'm still waiting to hear from Humana. I'm going to check in with the doctor's office tomorrow.
3/9/06
Well, let's try again. Called the doctor's office. They said they sent a letter to insurance 2/13/06. They recommended I call my insurance. I called Humana, they had nothing. I called the doctor's office again and Megan looked into it. Ends up they requested preauthorization from the wrong insurance. My insurance changed 1/1/06 and they sent a letter to the old one. Good news is Megan started the process with Humana. She said we haven't been set back much because Humana is fast with claims. We expect Humana to contact the doctor's office in 3 days to collect the rest of the info they need for the claim. So, I wait some more. Hopefully it won't take too long.
3/22/06
I spoke to a nurse at Humana today. My preauthorization is pending. They are working on getting more info from the doctor's office and should have a decision by the end of the week. I don't know whether to get excited yet. Meanwhile, my diet is going well. I have lost a little more weight. I'm down to 301. That's 17 lbs since the beginning of the year. I'm feeling more confident that I can handle the post-op diet. Hopefully I'll have some good news soon.
4/5/06
I was told a couple weeks ago that Humana requires the 6 month supervised diet and exercise, plus psych eval, nutrition eval, and five year history of morbid obesity before I can be approved. I've gotten a letter from my psychologist and have seen the dietician. I've requested my records from my last doctor's office so I'll have info from 9 years ago when I was almost as big as I am now. After my May appointment with my endocrinologist I'll get records from there for the 6 month diet. I've continued to lose weight. I was down to 294 at my appointment this week!
4/18/06
I went to see my PCP this week. She was so excited about my weight loss and said I really was looking good. My anemia has resolved with the iron supplement and my cholesterol is better. My triglycerides are still high and HDL low, so she wants me to try niacin. I'm hoping the time-released type will not cause flushing for me. I tried non-time-released niacin before and the flushing was bad enough I quit taking it. The last couple of days I haven't been eating as well. I've eaten too much and too much "bad" stuff. Yesterday I ate a cheeseburger from Sonic and it totally blew my budget (calorie-wise). I'm trying to do better today. I still need to find some records from over 5 years ago showing my history of morbid obesity. The doctor I went to in 1997 had already destroyed my records. I'm going to try the student health center at the University of Texas next.
5/1/06
I've been having a harder time with my eating lately. It seems like some days I'm just really hungry and eat too much. I'm still keeping my carbohydrate intake down below the amount my endocrinologist said I should shoot for, significantly lower most days. I went for another "diet" visit today at the endocrinologist and have lost 4 more lbs since last visit. In the next couple weeks I'll be getting together the info to deliver to Elizabeth at the surgeons office. Then we can resubmit to the insurance.
This has been a long, often frustrating process, but I am definitely healthier than when I started trying to get approved for this surgery. I think I will recover better now than I would have last year. My finances are better too. Still, I'd like to have surgery by the end of the summer; if not here, then in Monterrey with Dr. Rumbaut.
I just realized my husband and I will probably have surgery around the same time. We had a car accident last fall and his right upper arm was badly broken. He had surgery and the bone has been held together with a plate while it healed. In July he will most likely have surgery to remove the plate. Hopefully I can have my surgery and be somewhat recovered but still off work when he has his surgery. We'll see.
5/15/06
Today is a big day. I picked up my medical records from Dr. Scumpia's office documenting my supervised diet. I took that plus a letter from my psychologist and documentation of my weight over the past several years. Now we should be able to resubmit to Humana. I expect the process will take a couple weeks. I've got my fingers crossed for approval this time.
I also went for my exercise consult at St. David's Health and Fitness Center. Basically, that was just reviewing why exercise is necessary and how to progress after surgery. I am a member there already and know the exercise physiologists that work there. They all know my husband too. In fact, my husband modeled for the handout they gave me illustrating weight training and stretching. He's so cute! I could see the weight he has lost since those pictures were taken. I'm so proud of him! While I was there, I went ahead and worked out on the elliptical for 15 minutes. I haven't been to the gym much since our accident last fall. I need to start going again.
5/16/06
I'm approved! Just got word today. Yay!
5/18/06
It's becoming more real to me each day that I am really going to have this surgery. After all the waiting and frustration, this is really happening! I am scheduled for an EKG and echocardiogram next week at St. David's. The following week I have my pre-op appointment with Dr. Faulkenberry. Then we'll schedule and I'll have a date. I've started the pre-op diet so I'll be ready whatever date they offer me. It's a super low carb diet, 30 grams of carb a day. I've also made a commitment that I will take a 15 minute walk with the dogs daily. It doesn't sound like much, but keep in mind my dogs weigh 100 lbs and 50 lbs and the small one is a puppy.
5/23/06
I had my pre-op testing yesterday. It didn't take long at all. Then I went grocery shopping and stocked up on soups and such for the time I'm on liquids post-op. Today I weigh 286. Down 36 lbs since I started my supervised diet. I usually don't weigh at home, but couldn't wait until my doctor's appointment next week.
6/5/06
I have a date! My surgery will be June 26th. I'm excited and nervous. I had my pre-op visit with Dr. Faulkenberry last week. He went over the surgical risks in detail and we went over the consent form together. He was very friendly and caring. I'm glad I chose him for my surgeon.
6/12/06
I'm starting my 2 week pre-op 30 gram carb diet today. When I saw Dr. Faulkenberry a couple weeks ago, he advised me to loosen up on my diet a bit until 2 weeks before surgery to help me do a better job this last 2 weeks. He says it's real important to be very strict 2 weeks before surgery to shrink the liver. I've been having a few "last suppers" lately. I'm nervous, but I'm looking forward to the surgery. I want to get full eating just a few bites like my husband does.
6/20/06
Less than a week until my surgery. I went to the hospital and met with the anesthesiologist today. I'm getting a little nervous. That made it all feel real. I'm looking forward to getting the surgery done. My pre-op diet is going ok. I feel like I'm ready for all the changes this surgery will entail. I've been preparing for a year and a half. I'm still losing weight. I'm down to 284 now. I've lost almost 40 lbs since last December.
6/25/06
Well, surgery is tomorrow. I weigh 282 lbs, down 40 lbs since last December. Today I'm on clear liquids. After surgery I'll be on liquids for 2-4 weeks. My husband is out buying me some more sugar-free jello right now. He's taking this week off work so he can help me out. I'm a little nervous, but I know things will turn out ok. People at work have been supportive. I think I'm looking forward to being taken care of by them. I'll be a patient on my own unit for a night. See you all on the losing side!
6/29/06
I came home from the hospital yesterday. Everything went well. My surgeon says he's pleased with how surgery went. I had a lot of pain the first couple days, but once I was able to start oral pain meds the relief lasted longer. I only had nausea the first day and I think that was mainly due to all the pain medicine. I got nausea medicine that worked fine. I haven't needed any of that since the first night. I was NPO (nothing by mouth) the day of surgery and that night. My mouth was super dry, but I was able to use the little sponges to moisten my mouth and I brushed my teeth. I had my leak test the next morning early. That was easy. I had to stand in front of the xray machine and drink gastrografin. It tasted like they disolved 15 packets of sweet and low in a couple tablespoons of water. Not tasty, but tolerable. My doctor called the nurs in less than an hour and gave orders for me to start clear liquids. I was so excited by the chicken broth and sugar-free jello.
I had my surgery at the hospital where I work and stayed the first night on my own unit. My nurse in recovery was a nurse I worked with several years ago. There were no beds available on the unit I needed to go to so I stayed in recovery for 7 hours. I was relatively comfortable in a regular bed. Then I went to the Intermediate Care Unit. I got up and took a walk about 6pm. I walked a couple more times that night for longer distances. The next morning my doctor had me transferred to a regular med-surg floor. I stayed there another day. All the nurses were cool. I got a lot of compliments from people I work with for my walking and how "good" I looked. In a relative sense, I'm sure.
Since I've been home, I've been resting and walking a bit. My husband and I went to Target today. I'm tolerating liquids fine. I had some broccoli cheese soup run through a blender today, but it was a little much for me and caused diarrhea. I'm doing better on water and broth.
7/6/06
I am doing well so far. I'm still mostly on liquids, though I can manage some thin purees. I had some refried beans with cheese yesterday. Other than that it has been a lot of blended soups. I'm tolerating most things fine. I've had no nausea. I've been having one or two protein shakes a day from my stash of samples. Most of them have been pretty good. I did have a blue, fruit-flavor Nectar that I didn't care for. I'm looking forward to having more regular food. I'm getting my vitamins in, except sometimes I don't get all 1200 mg of calcium. I'm working on getting my routine down. I've been getting in 60-70 grams of protein in and that should improve as I heal.
7/10/06
It's been 2 weeks since surgery and I've lost 14 lbs! I'm feeling pretty good. Not really taking any pain medicine any more. I'm managing liquids and purees well. I've been walking and will be increasing that now. I'm starting to get a few things done that I've been putting off. I see my surgeon to follow up next week.
7/19/06
I went for my post-op doctor visit yesterday. I got my prescription for B-12 shots. Today I went to do my first injection and I wimped out! I've given hundreds of shots and I had the hardest time bringing myself to stick myself. My husband was a medic in the Air Force and knows how to give shots, so he did it for me. He's been great since my surgery. Today I was really constipated and my appetite hasn't been great. I started a stool softener and I'm trying to get my fluids up.
7/31/06
So far, everything has been going very smoothly. I'm tolerating most foods now. I have to be careful with high carb foods like mashed potatoes. They make me feel just wiped out. Some of the things other people say they can't eat go down fine, like chicken or scambled eggs. Today I picked up some jerky. I've never eaten jerky before, but I needed something filling for snack attacks in the late evening. I tried a couple flavors of Jack Links and it's pretty decent. One thing I'm working on is exercising more. I have been feeling super lazy. My goal is to exercise 30 minutes a day. Today I took my dogs to a park and walked for 30 minutes. I want to get in some good habits before I go back to work.
8/4/06
I am officially in the 250's now!!! Today I am 257. I was losing very slowly the last 3 weeks or so, but now it's picking up again. This week I've been doing a good job with my exercise, walking 30 to 45 minutes per day with my dogs. Eating is pretty easy now and I'm having to be careful. My calorie intake is up, approaching a more normal intake, but definitely low enough to promote steady weight loss. I'm going back to work next week and I'm as ready as I can be (keeping in mind I would actually prefer not to work at all). On the down side, my cat Azriel has been gone for a few days and I'm afraid something might have happened to him. I put some signs out in my neighborhood yesterday and talked with some of my neighbors. My husband is also having some trouble. He's very depressed and having a lot of anxiety. We're working on getting him some treatment. I want to support him like he's supported me with my health issues.
8/16/06
I tried cereal for breakfastt today. Just about 1/2 cup of frosted mini wheat type cereal with soy milk and a few blueberries. The time has not yet come for cereal. I had some mild dumping, feeling shaky like my blood sugar dropped. I'll be holding off on that for a while. I still feel tired and that was 5 hours ago.
I went back to work last week. It wasn't hard to get back in the swing of things. I did feel very tired and had a lot of back pain. It'll take a few weeks to get used to the 12 hour shifts again. In the mean time there's Tylenol (and plenty of it!).
I saw my primary care doctor today. She was very excited by my weight loss. I've lost 30 lbs since surgery. I'm feeling good.
8/23/06
I haven't been exercising as much this week. My husband had surgery Monday and I've been worn out. He's doing quite well. He had the hardware removed from his arm that was put in when he broke his right humerus 11 months ago. He's feeling pretty good and he pain has been quite managable. That has been a huge relief for me.
Other than the stress associated with my husband's surgery, I've been doing well. I'm starting to have my little wow moments. I can wear my size 24 capri pants from Eddie Bauer that I bought before my surgery! I've gone from a size 30 to 24. My Utilikilt that I got back into 2 weeks after surgery is getting loose. If you are wondering what a Utilikilt is, check out www.utilikilts.com. At work, people are noticing my weight loss. My charge nurse says I walk different than I did. The other night at work I was thinking about that and noticed I do feel lighter when I walk. It's exciting.
I'm in the 240's now. It has been several years since I was here.
8/28/06
I took a good 45 minute walk with my dogs today. I was lazy the last week and didn't exercise much at all. My husband is recovering well from his surgery. Despite not exercising, I did still lose a couple pounds which makes me feel better. I ordered some new clothes on sale at JJill a few days ago. Some things that should fit now and some others that will fit in the next couple months. I can't wait for that package!
8/31/06
I woke up early today. I worked last night and work tonight. I usually try to sleep until 4PM. I woke up today before 2PM. I'm getting a lot of complements at work on my weight loss. I heard someone else at work is considering WLS. It's a big decision. If she decides to go this route I hope all goes well. My angelette, Kim, is having surgery today at the hospital where we both work. I hope I get to go visit wih her tonight on a break.
9/11/06
I went to my endocrinologist's office today. I weighed in at 242! That's 40 lbs down since surgery and 80 lbs total since the beginning of the year. Tomorrow I go back to see my surgeon. I'm feeling good. I worry I am eating too much sometimes, but in general I'm making reasonable choices. My husband is feeling good, too. I'm delighted with his progress since his arm surgery.
9/27/06
I'm still feeling good. I'm down to 238 (actually fluctuating between 237 and 240, so I figured I'd give myself credit for 238). I saw my surgeon last week and had my labs drawn. I don't anticipate any problem since I had had a CMP and CBC the week before and already got the all clear on those. My surgeon did iron studies and the B vitamins (folate, thiamine, and B-12). I'm wondering if I need to up my iron, so we'll see what they say. I had a nice moment this evening. I was working in the kitchen, cleaning up after dinner and talking to my husband. I turned and said something to him and he told me my face really looks slimmer. That's a nice feeling! I'm really feeling the difference in my weight. I feel lighter when I move. I just feel smaller.
10/1/06
234 today, wow! Here's a picture of me wearing one of my new slim blouses.
10/11/06
I'm not sure what to say today, just felt like it was time to update. My husband found a new job which he'll be starting at the beginning of November. I'm feeling good. I feel like my eating is stable. I'm really greatful for my tool. We ate at TGI Friday's last night. I ordered a pecan crusted chicken salad. It was gigantic, even by my old standards. It was ok, but not great, but I was in a mood where I just wanted to taste lots of stuff. I could eat less than a quarter of it, plus a couple bites from my husband's plate. I was stuffed. In the old days, I might have polished off most of my salad plus had some dessert. I was disappointed to have to stop eating, but knew I didn't need any more food.
I just got a pair of jeans from eBay. They were less than $12 including shipping, which is good because I should have gone a size smaller. No biggie. I knew this would be a transitional pair of pants anyway. They got here just in time for the first chilly day!
