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This morning I spent three hours at the cariologist's office getting a nuclear stress test, so I can get cleared for surgery.  I seem to have done ok, but no results yet.  The tech's were surprised at how long I could go on the treadmill without my heart rate gettting up to where they wanted it. 

You have to lay on a table for 20 minutes while some sort of xray machine scans your heart.  That was the hardest part.  My shoulders were killing me.

The second hardest part was that when I tell people I'm going for weight loss surgery, they seem surprised, because I am not morbidly obese.  Then when I tell them I have to take 5 medications for diabetes and have been unable to stop eating on my own, they pretend to understand.  Somewhat confidence shattering.

This morning I had my meeting with the surgeon Dr. Boorse at Lehigh Valley Hospital.  Naturally I was 20 minutes early and they were just turning on lights in the waiting room when I arrived.  I was pleased that my weight was down a few pounds and my blood pressure was good.  He came in and looked deeply tanned from a vacation.  He was slightly (only slightly) taken aback by my suggestion that I might prefer the VSG.  We spent some time going over my medical history. I showed him the endoscopy reports that I had with me.  He was of the opinion that I may never have had Crohn’s because a biopsy was never taken.   

He told me that he is qualified to do the VSG, but that he has not done any at Lehigh Valley because insurance will not pay.  He thought that the band was good for me, because I had shown that with some extra help I can follow a diet, but he did say that if he were in my situation, he’d prefer the VSG for himself and he thinks that over time it will probably turn out to be verified as a very good procedure.  He said that it was quite easy to do, and while in there he’d fix my hiatel hernia.  I think that I interrupted his normal flow of things by being fairly well educated about a procedure which he is not accustomed to reviewing with patients.  (He had lots of flip charts for lap band and RNY which he uses to educate patients.)  We agreed that we would try with insurance for the VSG.  If that is turned down, we’ll reapply for a lap band.  I signed two release forms. 

I finish my six months pre op program on September 23.  The Bariatric review board meets on September 25, after which materials are sent to insurance companies.  A staff person will be calling me in the next week or two to schedule a tentative surgery date.  I am scheduled for a cardiology evaluation this Friday at my regular doctor’s office.   

I left feeling elated, relieved, and mildly scared.  I think I ought to be concerned that he has not done more VSGs but I don’t worry one bit about it given the feeling he gave me.  After all he’s done thousands (OMG) of RNYs and hundreds of Lap Bands. 

Now maybe, for a while I can focus on my life and work and let this obsession fall a bit into the background.

Today I had my fith month meeting at Lehigh Valley.  I gained 6 pounds from last month.  That is bad/good.  It is good in that if I can get back on track and start losing again, I'll be at the right place next month 35.5 BMI.  An interesting and encouraging finding was that though my weight went up, my percentage of fat went down.  So, I've lost fat and gained some muscle.  That's not so terrible.

I had been wondering if Dr. Boorse, who I have not yet met, will actually do a VSG.  I was told today that he will soon be starting them.  That was good news.

The group irritated the heck out of me.  The presentor was ill prepared and I could not wait to get the heck out of there. 

Wednesday night is my second support group meeting.

Ate too much for dinner.  Ate after dinner.  Feel very full and it feels very good to feel this full for the first time in some while.

What I will feel after WLS, I don't know.  But this is sick sick sick.

My wife promised that she would have her school HR person contact AmeriHealth to see if they pay for VSG.  It turns out that they do.  Now I just have to sustain weight.  I've been doing some good exercise, 60 minutes on the treadmill today, walking at an average of 3.5 3.6 mph.  It feels good. 

I have my 5 month bariatric group check in on Tuesday the 19th and meet with Dr. Boorse on Sept 2.

Today I went to LVH to meet with Jerry the Clinical Social Worker (therapist).  I needed to talk out some of the confusion in my head, get some clarity on “facts,” and devise a better plan that I can live with.  I asked my wife to come in with me because she is the one who has had to put up with listening to me as I obsess about my bad behavior, decisions, and on and on. 

It was a good meeting.  We focused a bit more on my control issues than felt comfortable to me, but it seemed right, that is where my issues are.  A number of things were clarified and something of a strategy was devised.  I’m going to try to maintain my weight at 260 – 262.  I’m going to exercise a great deal, as that makes me feel better.  I’m going to add some protein shakes or snacks to what I’ve been doing.  I’m going to stop eating off of the plan I’ve set for myself.   My wife offered to call the HR person at the school where she teaches (our insurance is through them) and have them call the insurance to find out if they will reimburse for VSG, which I now think is the best course for me. 

Oddly enough this evening I’ve been thinking that if it turns out that I lose more weight or for some other reason the insurance rejects me, that will be ok.  I think that I can lose more weight on my own and master this diabetes monster.  I’d rather do it with help from surgery, but if that is not what is out there for me, it’ll be ok. 

The other thing that is lurking in the back of my head from this meeting and from my thoughts of the past few days, is that I believe I ought to turn this whole matter over to “God” or the spirit or whatever, and I’ve been unable/ unwilling to do that.  More of my need for control.  How can I find the control I seem to think that I need and the faith to let things be healthy, comfortable, and consistent with “the universe?”

If I ever needed proof that I need some external control via surgery, this week has been the proof.  I have gotten off track, off plan, binged, eaten things I have not eaten in months, and generally over done it in a chaotic manner.

Lack of structure is death for my diet.  i don't know if I can/ should want to lose more weight.  But I do know that I don't want to put it back on again.

I've decided to try to get back on structure tomoroww and stay that way until I see Gerry, the clinical social worker on Tuesday the 12th.  i need to talk this whole thing out with someone.

On the brighter side, I'm actually not putting on too much weight because I am still exercising pretty well.  I gave myself a break today because I had to do lawn mowing in the heat and I didn't think it good to do 90 minutes of exercise and then mow.

Today I called I spoke to the bariatric coordinator at Dr. Boorse's office about my BMI issues.  If I continue to lose weight at the rate which I have been losing, I'll get below 258 lbs before September 2, when I see him and I'll be below a BMI of 35.

She told me that they submit all of the weights which they have for me, which would include my initial weight of 291.  None the less she said that it is quite possible that if my weight goes below a BMI of 35 that my insurance might reject me for surgery.  For the past two days I've continued my exercise, but I've been eating more and I've put on a pound or two.  I plan to try to keep my weight around 262 until I see Dr. Boorse and get weighted.  That is still over four weeks away. 

This all feels crazy and wrong.  I actually don't feel as good being able to eat more. I was proud of myself losing weight, now I just feel confused and crazy again.  I'm sure I'll get over it, but it doesn't feel good. 

I sent an email to the progam asking to have an appointment with the Clinical Social Worker so I can talk about how this is effecting me. 

On the bright side, at this weight my blood pressure and diabetes are both under good control.  Probably the exercise is helping with that.

Today I had my meeting and evaluation by the exercise physiologist.  I have been doing cardio most days for 50 - 70 minutes.  She told me that I was in better cardio health than most of the presurgical WLS patients whom she sees.  She gave me the impression that if I kept up my exercise progam and increased it with some of the additonal exercises that she gave me, that I could lose the weight without surgery.  Of course I know that in part because I've done it before.  What makes me crazy is that I don't know why I've been able to be relatively good with my diet and exercise for the past several months, and why I was not able to do it before.  That is why I want something, like the band or VSG to reign me in when Iget off track. 

This evening my wife really wanted to go out to our favorite Mexican Restaurant for dinner.  I didn't want to refuse her because she has been working so hard on our house the past few days.  I ate much more than I have been eating lately, though I did leave most of the rice and most of the tortillas.

Yesterday I saw my PCP and my blood  pressure medication was reduced.  I've lost 25 lbs since the last time that I saw her and I've been disturbed by low blood pressure.

Today was the four  month meeting of the bariatric group.  At weigh in I was down 26 lbs over all and 17 lbs for this month.  Potential problem.  My BMI is now 36.  If I continue to lose weight, and I think that I can, and if I get below 35 before surgery, will my insurance still approve?

Then the nurse threw in another wrench.  She said that one of the surgeons is starting to do the Gastric Sleeve, and she thinks that is the proceedure which is best for me, especially because of the diabetes.  I've started trying to learn about it. 

Today's theme in the class was exercise and we were encouraged to make an appointment with the exercise physiologist, who will set out a program for us.  Apparently she meets with us once now, once after surgery, and once six months after surgery.  You can also have supervised exercise at the hospital, but I live too far away for that.

I'm wondering if I can/should/ will have to, do it without surgery at all.  I've been good forthe past three months.  As if to prove to myself what an idiot I can be about food, I ate cake, and chiken that were in the frig at the office, brought by a drug rep, in addition to my regular dinner.  I feel full for the first time in a while and actually I like it, though I'm also ashamed of myself.  I'll get over it.

Friday I go for the exercise evaluation/assessment/ plan.

I need to call to meet with the surgeon and the M.D. Bariatrician.

Very tired and confused.

PS Blood sugars are the best they have been since I've been diabetic, primarily I think because I've lost some weight and because I've been doing cardio for 45-60 minutes per day.