Jacqueline H.

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I finally feel just about ready!  I devoted my day to preparation for my surgery in a nice, leisurely way.  I started with my shower, really taking my time to wash and condition my hair and shave my legs and all those things you do for a special occasion, because this is what this is!  It was very much a sense of ritual preparation, and I felt very much at peace. 

Before I dressed, I took all my measurements, which is something I hadn’t done in some time.  I was actually surprised at some of the numbers.  I am apparently mostly a 50-inch-around sausage, except for my “middle” waist, the one between my upper and lower tummy rolls!  After my lunch of chicken broth, I took my first dose of antibiotics, which made me only very slightly queasy for a bit, but nothing too bad.  I then asked Dan to take a couple of pictures of me as my official “Before” shots.  I think they turned out pretty well, although it was kind of a shock to see myself from a side view.  I hadn’t realized quite how apple-shaped I still am.

I spent some time this afternoon working on my scrapbook, then, just before 3 p.m., the hospital called to tell me I needed to report to the hospital at 7 a.m. for my surgery!  I must be the first patient of the day, which makes me feel good – Dr. Fares et al should be all fresh and rested up to tackle my surgery.

At 4 p.m., I took my magnesium citrate over ice.  I had a choice in the pharmacy of the traditional lemon or grape, and I went for the grape.  I’m glad I did – it really didn’t taste too bad, although I found that it appeared to work before I even finished the glass! At 7 p.m. and again at 8 p.m., I will need to take my last two rounds of antibiotics.  Once I finish my usual bedtime meds, I’ll be all set! 

My bag is mostly packed, except for the things I’m still working with, like my WLS scrapbook and my thumb drive, which has my journal on it.  My plan is to take the laptop with me to the hospital so I can journal there.

Dan did a very sweet thing tonight, too.  Danny wanted desperately to order in because it is rainy tonight, but Dan convinced him it would be better if they went out to eat.  So they went to Piccolo’s, which made Danny happy, and also spared me from the torture of food I can’t have.  Not that I would necessarily want it at the moment after that magnesium citrate, frankly! But I’m glad not to have to test it out!

 

I had my final visit before surgery with the surgeon’s office Monday.  My weight was down 8 lbs from the last time, giving me a total of 23 lbs lost and for once, John looked genuinely pleased with how I am doing.  I got a chance to ask some last questions about my surgery, too, so now I know what to expect.  A lot of my final instructions will come from my PAT, which is now scheduled for July 9.  The anesthesiologist at that point will tell me what I need to do with my various medications and vitamins before surgery. 

 John said I can expect to have a ventilator, but only while on the operating table, and not to expect many tubes such as NG or any drains.  I also will not have a Demerol pump, but will be taking Toradol and Dilaudid as needed for pain, with darvocet at home.  He said I could expect to spend about an hour and a half in recovery and then they will expect me to be tired and groggy, but able to get up and move around, which is the goal.

 I can take my fan to the hospital to keep cool, but John said that there is no wireless access, so I don’t know that I will bother with the laptop.  He did say I could bring it to play DVDs on, but I don’t have a DVD player in it yet.  (It’s an older Dell, newly remodeled, but still not entirely up-to-date.)

 Two big things did come up, though.  First, my cardiac clearance was originally written in May for the previous surgery date, so now I have to make sure I get a new one ASAP.  The other thing was that I told John I hadn’t been taking my glyburide-metformin very often because my sugars have been running so well, and he said I should continue taking the metformin post-surgery because of my PCOS. 

 Later in the afternoon, I had to see my PCP as well.  He is happy with this month’s blood work.  I was especially excited by my Hemoglobin A1C, which was 6.0, just a tenth of a point from “normal,” which is outstanding for a diabetic.  I told him about the glyburide-metformin issue, and he said he wants me to take ONLY the glyburide until my surgery date is passed, then we will start ironing out the kinks in the metformin.  I was confused by this until I read a section on both medications in Diabetes for Dummies.  I understand now that I should stop the Metformin a couple of days before surgery, but I decided that I might as well take my combined pill at bedtime up until that point.  I hadn’t realized that the metformin is especially helpful with high morning sugars, and while my sugars are only in the 120s when I wake up, I would feel better if I got them down just a teeny bit more.

 I am just tremendously excited about my surgery!  I have a confession to make, though.  Monday was the fourth day of my liquid diet, and I did fine up until dinner time.  I had gotten my hair cut and we were going to stop at the local pizzeria, which has a grilled Portobello that I knew I could eat without being too far over any dietary lines.  But instead of eating on the pizzeria side, Dan suggested we go in and sit in the restaurant.  I planned to just order a salad, but ended up ordering chicken and shrimp in champagne sauce.  It ended up coming with a light serving of pasta – which I ate.  And they had this incredible bread and dipping oil.  Before I knew it, I had totally caved on my diet plan and eating the kind of thing that made me fat to start with.  Or rather, TOO MUCH of this good thing.  Because I do believe that I will be able to eat “good” food, but just not as much.  And these servings were huge!  I only ate half, but that was too much and it triggered a binge urge.  I ended up begging Dan to stop at Dunkin Donuts on the way home, ostensibly for a sugar-free iced coffee, but I ended up getting a doughnut, too.

 I planned to start over this morning on the liquid diet and did do fine until lunch.  I got really hungry while we were at court waiting to find out whether I was serving on the murder trial (the defendant ended up pleading guilty to manslaughter instead), so I was starving when we were finally dismissed and I came home for lunch.  Instead of eating veggies and a shake, I ate the left-over chicken with about a half a cup of the remaining pasta.  That was all it took for me to lose it again – I also ended up eating a donut and some candy out of the candy jar at work.   Why?  I was sleepy and while I know it could have been the new antihistamine I took last night making me sleepy, I also suspect having any carbs at all contributed. I totally set myself up. 

 And of course, tomorrow is my birthday, so I am already thinking, “Well, if I don’t start the liquid diet again until Thursday, I could have dinner out and maybe a cupcake or something to celebrate one last time the way I am used to!”  I feel guilty thinking it, but it’s the reality of what I am feeling.

I can either beat myself up for this failure or look at it as a sign of how completely addicted I am to food.  I totally lost control as soon as I had a carb.  I’m just hoping that when I start over again, it won’t take me days to recover my lack of hunger and cravings.  And I hope this slip up doesn’t make me regain anything, at least not for long. 

Since May, I've been stressing over the work commitments I need to complete before I go for my surgery date.  First there was the revised Preservation Survery my boss wanted for the trustees, which I finished last week.  Second has been the feature article on coeducation that I finally finished TODAY! And the final thing yet to be done is my diaster plan for Preservation Management Institute, which I need to finish before July 17.  I feel so much more relaxed knowing I only have one more major task to get completed before I am off!  I'm rewarding myself with some downtime tonight to just read and either tomorrow or Monday I will start on the disaster plan.  Wheeeee!

I finally saw my PCP about my "personal problem," and I am sort of pleased to report that the only thing he suggested that I hadn't already come up with on my own was to use Anusol. He assures me that this should take care of my bottom in just a couple of days.  If it doesn't, I'm to call him and come back.  His other suggestions, such as drinking plenty of fluids (check) and eating as much soft, mushy food as possible to give my backside some "light duty" for a few days (check), I had come up with on my own over the weekend.  Between those two things and using some knock-off Tucks with witch hazel, I've actually seen a dramatic improvement.  Hopefully the Anusol will do the final trick.

Skip this entry if you're not someone who can read about bathroom issues, because it is otherwise definitely Too Much Information! 

When I was on water restriction due to the sodium issue, I developed some constipation and, worse, hard, dry stools.  Every time I would go to the bathroom, I would end up bleeding because the stools were so dry, I must have injured myself in passing them.  (I swear, it felt like passing ground glass, so I am not surprised.)

Well, my doctors have now let me have more water, but I'm still having the same problem.  The stools aren't quite as dry, but I'm still sore as can be every time I go.  I don't know if I am reinjuring myself or what, but today is so bad that I did schedule an appointment for the doctor on Monday just to deal with the pain. 

I am also thinking that this may be an inspiration for me to give the liquid diet (or at least a modified version) another try before my next visit on July 2.  Dan was asking me what I wanted for dinner, and my honest reaction was that I think I want a protein shake because at least I know that liquid is not going to add any more bulk to what I had at lunch (a chef salad.) Maybe if I just give my poor behind a rest for a few days, whatever I've done with it will get a chance to heal up.  :-( 

Any suggestions?

Yesterday I had my final pre-surgical meeting with my surgeon, Dr. Fares, and with John the bariatric coordinator.  This was my chance to get (all) my questions answered about the technical nitty-gritty stuff, like how long my common channel will be.  (15 feet, so obviously I'm having a proximal bypass!) I also got to ask Dr. Fares if they could film my operation because, yes, I'm weird and want to know what my guts look like.  He said that he had no problem with it, but that the DVD recorder has been having problems, and he can't guarantee it will be fixed by then.  (Given that I'm six weeks from surgery, I think I have at least some chance of it.)  

Would I actually watch it?  I think so, even though I'm a little nervous about it.  But I'm also incredibly curious to see what actually happens.  I'm just going to go with the flow, though. (John says he could give me a demo tape and I would never know since I wouldn't be able to tell if they were my guts or someone elses.) 

Biggest news out of the appointment: they approved lifting my water restriction and instead want me to try the 64 oz a day and see how I do.  I'm to report if I start to show symptoms of sodium depletion, but otherwise, t hey will wait and do a new blood work test when I get my PATs done next month. 

I'm getting more and more excited!!  And it was kind of cool yesterday that for the first time in the waiting room, I ended up talking with other bariatric patients.  One of them was a woman who is a year out and looked fabulous after losing 90 lbs.  Her advice to me:  walk, walk, walk and eat slowly in small bites.  I'm up for it.  :-)

There were two wonderful letters in my mailbox yesterday -- the official notification from Aetna that my surgery had been approved, and the official letter from the doctor's office surgery instructions and scheduled post-surgical office visits.  I was SO thrilled! 

The pre-op diet of two liquid meals and a regular meal, however, is not working out as well as the paperwork.  In trying to follow the plan, my blood sugar kept plummeting between meals, leaving me forced to eat either something with carbs that I really hadn't planned on, or using my glucose tablets.  I e-mail John for suggestions and he said that he wants me to switch to three small meals a day with a calorie count of no more than 1,000, so that is the next step. 

This was the first morning since last week that I didn't walk in the morning. I actually woke up at the usual time and felt ready to go, but I promised myself that I would let my blisters on my left heel and on the ball of my right foot heal before I went out again.  I might not have done it if my Lifemasters nurse hadn't called yesterday on her twice-monthly contact about my diabetes and reminded me that I need to take especially good care of my feet.  And I did dance around the living room for a while this morning to make up ever so slightly for not walking. 

One of the things that I have struggled with for month is exercise.  I really think that now that I am doing it, it is making the biggest difference, though!  I started out with 15 minutes a day in March and then moved up to 30 minutes a day in late April.  Now I am up to 40 minutes every morning and am thinking that I really find it easy enough that maybe I should try to add one more lap of my apartment complex to bring it up to almost an hour.  The biggest change is that I actually look forward to that time every morning where I am just quiet and walking.  It wakes me up!

I saw John this morning and he not only had Valerie join our consult, he brought in two interns because I am evidently a freak of nature which makes me the perfect learning experience.  

John, after looking at my labs, reassured me that it is clearly a question of my medication being out of whack and not my kidneys, which is a huge relief.  He also said he had actually seen this happen previously with people who take another anticonvulsant, Tegretol.  He explained what was happening to me biologically and said that the liquid restriction is definitely the way to go until the medications are entirely out of my system. He also wants me to see the neurologist and get off the Trileptal.  (No problem; I'm already weaning myself off of it because I don't WANT to take it if that's what it does to me.) 

Given all that went on, he said that while I had been approved by my insurance company (YAY!!!!!), they wanted to delay my surgery until they had seen how my body reacts off the medication and until I am definitely stable.  "Anybody who would want to continue without taking a step back at this point would be crazy."  Okay, so I had a brief thought of wanting to take my chances since the date was soooooooo close, but I fully expected to be told I was nuts to even think about it.  So I pretended I hadn't even had the slightest thought.  ;-) 

So, new surgery date is now July 19, which actually should work out well.  Focusing on the positives of this: 1. I should be stable by then, which is good.  (As Dan says, "seizure, coma and possible death are something to take seriously.") 2. I'm finally losing weight, so if I lose even more weight before the surgery, I will be that much further along when I actually have the RNY!  More weight loss, yay!  3. Now, instead of having to get a bunch of stuff done in the next four days, I have nearly two months.  What a RELIEF.  4.  If I go in mid-July, then I'll only have two weeks of short-term disability before my normal vacation period starts, and since I wasn't planning on going anywhere, that's fine with me.  It will be an okay period for me to be out of the office, too.  

So, I'm happy, despite the temporary snag in things.  And, hey, I'm down 9 lbs from last week!

I started my liquid (high protein, low carb) diet on Monday, May 14.  I noticed the first day that I felt a little spacey, and by the second day, I was finding it very hard to concentrate and also began to feel weak.  I also noticed that evening that I had gained 6 pounds just in the time since I had gotten up!  So I decided to go to the doctor the next morning. 

By morning, I felt worse than ever:  no appetite at all, kind of headachey, total inability to concentrate.  AND I gained another pound, putting me back over 300 for the first time in months.  At my PCP's office, he acted as if he suspected I was not being honest about following the liquid diet.  (He is not the doctor who put me on it.)  His advice?  Cut the number of protein drinks in half and drink more water to flush my system.   (I was appalled, honestly; the only calories I was getting were from the protein drinks, and we were only talking 600 to start with.  And he wants me to cut them to 300 cal?  Forget it, doctor or no doctor.) 

I did follow his advice in trying to drink water.  I found I couldn't do it, however; I started to vomit and couldn't even hold the water down.  By 7 p.m. that night, I was vomiting so much nothing up that I thought I should go to ER in case I was dehydrated. So, we drove off through a torrential thunderstorm, with me in my PJs and with a basin to vomit in and that was all.  

Four hours later in the ER, they had determined that I WAS sick, and that the problem was low sodium.  This is usually caused by having too much water.  I didn't think I had too much water to drink prior to getting so sick, but apparently the water I tried to drink afterwards definitely made it worse.  Thank you, my soon-to-be-ex PCP, for advising me to do the EXACTLY WRONG THING for what was wrong with me.  

They admitted me into the hospital and it took me two days to build up my sodium levels again with a sodium chloride IV.  They also took me off the liquid diet and put me on a low-cal, carb-controlled diabetic diet.  I was finally released on Friday at noon.  

I have appointments on Monday with both my surgeon and my PCP to discuss what happened and work out what we need to do next. I'm afraid to go entirely back on the liquid diet because, although they didn't find a direct connection with it and what happened, I am not satisfied that what happened was completely unrelated.  I'm also worried by a bigger question:  if the liquid diet, which I can change and control, could have done that, what would permanently changing my body do?  What if there is something wrong with my sodium or my kidney function already?  Could it be worse?  We'll talk it all through tomorrow.  I WANT to go through with the surgery, but only if it is medically safe for me. 

The good news to come out of this:  when I got home from the hospital, not only had I lost the 7 lbs I had gained as I was getting sick, but I had lost an additional 8 lbs.  Somehow over the course of the hospitalization, I had dropped a total of 15 lbs.  This is the lowest I have been in years.  Now if I only knew WHY.