Jacqueline H.

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I was very nervous about telling D about having my tentative surgery date because he blew up at me last week when I told him I was going through with it, but when I finally mentioned it this Wednesday, he didn't say anything much at all.  It wasn't one of those nasty, "giving you the silent treatment" silences, just a "I'm going to hold my tongue" kind of silence, which was, as far as I am concerned, a more than acceptable response. 

Then yesterday, he insisted on giving me my Mother's Day gift early because, he said,"If I don't, you're going to go out and buy yourself one!"  Guess what it was?  A really nifty personal blender that has a portable cup feature!  MUCH nicer than what I would have purchased for myself, honestly.  I was so happy, I just hugged the box for a few minutes and then hugged him, too.  He also said, "Well, I figured if you're really going to do this, might was well have the right tools to do it." That sounded great coming from him.  So, this was defnitely the best Mother's Day gift in a while (at least from him.)  

Liquid diet starts Monday and I'm almost looking forward to it. 

I haven't been posting much because I've been tremendously discouraged by my constant failure to lose weight the way I have needed to.  I relapsed after my mom was diagnosed back into binging when stressed -- and boy, have I been stressed the last few months.  Between Mom and what is being planned for our department at work, I wasn't even sleeping well, much less eating properly.  When I told my assistant I was trying to lose weight, she laughed because she thought I was kidding, given my current stress load.  No, sorry to say, not kidding.  

The good things the last few months are that at least I am walking 30 minutes several days a week.  Some weeks it has only been three times, but others it has been six.  I haven't actually lose any weight since going up to that amount of walking last month, but I think I am actually carrying more muscle than I was, and losing fat.  

I saw my surgical team last week and rather than tell me, which is what I feared, that I was going to be denied the surgery because of failure to lose weight, they said that we would shoot for the first week of June.  I am tremendously relieved and excited and afraid I will still not lose enough for it to happen.  I don't think I'll believe it until I'm actually lying on the surgery gurney at this point. 

I told Dan after the appointment that they wanted to go forward and his REAL feelings came out.  He is still vehementaly against it, and he had been secretly hoping that the practice would deny me.  He's very upset, but my mind is made up.  When we talk about it again (and we will have to, although I've been avoiding it for the last week), I'm going to tell him he can keep acting like an ass about it and I will just shut him out of the process because my mind is made up; or he can go through the motions of supporting me to decrease my stress, because his disagreement has been registered.  But it isn't going to change anything!

I saw the cardiologist last week for a follow-up on the med changes he made and he says that as far as he is concerned, I'm ready to go for my surgery.  He'll write a report when I get him the surgery date, as it needs to be within 30 days of the surgery.  Yay!

I also saw John at the surgery office today for my monthly follow-up, and he says that basically, I am ready to submit my request to insurance and have the surgery.  We talked at length about when to have the surgery because something major came up over the holidays.  My mom, who is 1200 miles away from me in Arkansas, was diagnosed with leukemia.  I asked him how soon after surgery I would be able to travel, since, if I had the surgery in eary March, I would ideally like to see her sometime this spring.  Normally we would try to go in the summer, but I'm honestly concerned that it might be too late if we wait that long.  Might not be, either; my dad lingered "at death's door" for two years, and she might be around for a long while yet if she responds to treatment. 

I was truly blown away by John's and Dr. Fares's responses and God bless them both. John told me that he thought I should absolutely not have the surgery until I have seen my mother and am at peace with my having done whatever I need to do towards her.  He gave me lots of good reasons for this: Worst case scenario, do I want to see her before something happens to ME? (Yes.)  He also pointed out that if I have complications or some other problem that prevents me from traveling around, he doesn't want my surgery to be preventing me from doing something that important.  Finally, he feels that trying to split my energy two major ways by taking care of Mom and taking care of myself after surgery is too much to ask.  I need to be able to feel Mom has been safely addressed and be able to focus on myself afterwards without worrying about other people. 

All of that made a lot of sense.  I was concerned about the issue of what if I have to delay my surgery for MONTHS until I feel I am really ready not to worry about my mom's situation? He said it should be no worry; "This is an elective surgery.  It shouldn't interfere with what you NEED to do."  

Dr. Fares said the same things, which made me feel that if they are both in agreement spontaneously, they really do have my best interests at heart and are making good suggestions based on their experience. 

So, I'm trying to make plans to see Mom in March on our spring break.  That way, I will at least have seen her when I feel I need to and can then begin to think further about when to have the surgery.  

I feel so much more relieved now that the pressure to have the surgery at the end of February or early March is off.  Not that I don't want the surgery, because, OH, do I, do I, do I!!! But now I don't have to feel like I have to cram it in between other major things as if it is an afterthought. 

I saw Dr. DeStefano Monday afternoon and he said that my test results all looked fine.  I'm out of shape and I do have slight leaking of the mitral valve, which he said is to be expected at my age, but nothing else is wrong with me.  He even tested the arteries in my neck after I told him that I had been turning my head while talking to Dr. Fares yesterday when I nearly passed out.  They are fine, too, which is good news. 

On the other hand, there is no explanation for why I have now fainted twice.  He said it is normally caused by pain or emotional distress, neither of which I felt I was experiencing, so I'm baffled.  Especially because I seem to be doing this consistently in doctor's offices!  I don't have a fear of doctors or the subject of bariatric surgery, so I just don't get it.  But I do seem to have become someone who just faints at weird times.  :-(  It's amazing how many people have come forward with their own anecdotes about people they know who abruptly faint.  Who knew it was that common?

I was scheduled to see John at the doctor's office today, but also met Dr. Fares.  I was up three pounds from last month, which was discouraging, but some of it may be water weight, since I was retaining at least 3-4 lbs. when I weighed myself this morning.  I had also had blood work done before I came in after fasting, so I don't know if that had anything to do with it. 

We went through the surgical informed consent and John and then Dr. Fares answered the questions I had, mostly about malnutrition post-operatively.  John also said none of my reports have been sent, so I'm going to check to see if they are getting stalled out in my PCP's office or what. 

I don't remember what we were talking about, but suddenly I started to feel overheated and my ears started to ring, just like they had when I was seeing Dr. Bresch.  This time I was smart enough to say what was happening and ask to lie down.  They took my pulse, which they said was bradychardic (heartbeat too slow) and took my blood pressure, which was 112/67, too low for me.  I also checked my sugar, which was (again) a perfectly fine 144 (typical a couple hours afte a meal.)  I rested until I felt better.  It's a good thing I'm seeing Dr. DeStefano (the cardiologist) this afternoon, but I'm getting kind of discouraged that this happened again with no reasonable explanation.  What is going on with me???

Also feeling stressed out because they are checking my mom for leukemia.  We won't know for a few days, and she is in a positive frame of mind even if the news is bad (she feels that at 76, she's lived a good, long life anyhow), but having Mom possibly be sick and so far away is emotionally trying for me.

Another two for one day.  It was almost a three for one, but because my doctor wants me to have a microalbumin test the same day I get my blood work done and I decided not to start the urine collection yesterday, I've put the blood tests off until next week.  Of course, now NEXT week will be a three-for-one, but then I'll be within kissing distance of completing my clearances, all before Christmas! 

Started off with my endoscopy this morning.  Somehow, the hospital didn't have me on their schedule, but since I had all my paperwork from the office in hand, they got me in anyhow.  The only problematic part at all was the usual difficulty getting my IV started.  The nurse suggested that if she didn't get my vein on the third stick, we might want to consider my doing it without sedation.  Uh, no, not if I can help it, thank you for your thoughtfulness!! I prayed and on the last attempt, the needle went where it was supposed to go. Yay!

They had explained that I was going to be lightly sedated and that they would be asking my cooperation through the procedure, asking me to breathe certain ways, swallow at certain times, etc.  I remember them giving me the sedation and then my waiting for them to start telling me what to do while I listened to them chatter.  They were still chattering (at least from my perspective) when someone said, "You're all done, honey."  I couldn't believe that it had been over without my actually knowing a thing, and being so comfortable throughout.  I was just snuggled up on my side the whole time and believeing I was listening to them talking.  I guess the drug was one of those sedatives that make you forget what happened. 

I just got a short summary report from the doctor, which I was still pretty spaced out to follow, but I do know that he did clear me for surgery and recommended I continue taking my Nexium.  I do have a mild hiatial hernia and something called "esophagitis esophagus" that I will have to look up, but apparently is nothing to prevent me from having surgery.  Since my biggest worry was that I would flunk the gastro clearance, I am thrilled!

We had just enough time (Dan was driving me all around for this) to grab a quick lunch before I went to see the pulmonologist, Dr. Seelagy.  HIs office started out with a breathing test, which I passed.  I then talked briefly with the doctor about my sleep apnea and my allergies, and he said he would recommend against another sleep study at this point.  Instead, he just wrote me an order to bump my CPAP pressure up to 14 for now.  He felt that since I will absolutely have to have another sleep study after I've lost weight and this was a temporary setting, we might as well do the simplest thing now.  As for my allergies, he suggested another spray for my nose for the time being, and said I could certainly come back to the practice to his partner, who is an allergist, if I want to tackly my (ridiculous) allergy situation more aggressively.

The only downer of the whole day was that while we were waiting in the pulmonologist's office, Dan said something about "my band." I said, "I'm not getting the band.  I'm getting the bypass.  I thought you knew that!?" He blew his top and said, "I will absolutely not support that!!!" We then dropped the subject because we were in a public place, but we have apparently been talking at cross purposes for the last month.  I thought he was coming around to the surgery -- but he is only coming around to a reversable surgery.  I don't know what to do now.  I know that I feel the permanent surgery is the best choice for me, but how do I convince him of that? And what will happen if I can't?  How stressful is my homelife going to be?

Last night I went to my first support group for Dr. Fares' group.  I could not believe what a huge group it was!  But the huge volume of people does explain why they are thinking of splitting the group into separate Lap and gastric groups.  

Valerie, John and Dr. Fares all spoke on different topics, and one of the psychologists who does clearances for them explained how their practice does that.  The assessment she puts people through was nothing like what I experienced, but I can see why her consultation (which is apparently not covered by anyone's insurance) costs as much as it does.  Even though I couldn't have afforded to see her, it was reassuring to me that at least this was someone that the office wanted you to see, if at all possible, because it was obviously a very high-quality program.  My only other consolation that way is that I think I can get some good counseling through benefits at school, so not all is lost. 

I learned a lot about some of the finer details of living post-surgery, such as some of the rules for taking supplements and how to tell whether you are having a problem with your surgery or are just sick with something else.  These are all things that were new concepts to me, and I usually think of myself as well-informed. 

The only disappointment was to find that there will be no December meeting.  Not only am I disappointed because I enjoyed this meeting and hate to wait two months, but it also means I won't meet my basic support group requirements for my insurance until the end of January instead.  This may work out, though; I have a huge work project due Feb. 16, and I was trying to figure out how to schedule surgery so that I can get that done before I'm out for any length of time.  This will make putting off the surgery until later in February or early March more logical. 

This is slightly OT, but my mom is in the hospital with cellulitis, which can result in gangrene or even death because she hasn't been handling her diabetes well.  Once again, I' m reminded that doing this surgery may help save me from a lot of those kinds of complications.

Tuesday was a double-header for me, with my gastroenterology consult at 10 a.m. and the testing my cardiologist wanted done at 1:15 p.m.  I had just enough time to pop into my office and set my voicemail for the Thanksgiving holiday and turn on my e-mail autoreply before I had to take off to the first appointment.

For some reason, I was expecting the gastroenterologist to be kind of formal and stuffy, but I found, just as I have with all the consultants I've seen so far in this process, that he was down-to-earth, if business-like, and that the office was small and the staff informal and friendly.  While I had to sit for a while in the waiting room due to some paperwork confusion, the visit itself was very short and to the point.

Dr. Rubin looked at my history, particularly my very lengthy med list and asked me to explain several things: why I was there, why I had chosen WLS, which kind I was looking at, what the differences were between surgeries, and how I made that decision to pick the surgery I had chosen. 

Given that he is a bright man and must do a lot of these consults for Dr. Fares, I realized at some point that he wasn't asking for his own benefit, but trying to subtly find out how well informed I was about what I wsa getting into.  I'm beginning to grasp that a lot of my consults will probably be along the same lines: "Tell me about this surgery? Why do you want it? What's involved?" Fortunately, I have done my research, so I wasn't caught off guard.

He did comment on my many meds I take, which I agreed was extreme -- but not my idea!  I pointed out that part of the reason for me to get the WLS was to hopefully cut down on the ridiculous number of medications I'm taking every month by eliminating some of the problems, such as the high blood pressure, the GERD and the diabetes.   Hopefully the pulmonologist I see in December will have some ideas even before the surgery how to cut my ludicrous 4 allergy meds a day down to one. 

Dr. Rubin scheduled me for an endoscopy on December 4, which is the same day I will see Dr. Seelagy for the pulmonology consult.  I'm trying not to worry about the endocscopy too much, not because I'm concerned about what they're going to do (because, hey, I'm going to be sedated!) but because one of my paranoias is that my esophagus may be too damaged for them to operate because of the GERD.  I'm keeping my fingers crossed.

When I was done with Dr. Rubin, I had to go to the cardiology testing, which requested I not having anything mrore than a light meal or snack no later than 4 hours before the test.  Since the test was at 1:15, this meant I had to finish all foods by 9:30, and since I had breakfast at 8 a.m., I was already starving by the time I had to have the test.

First they gave me an echocardiogram, which seemed to go well, although I won't know the results until I go back to the doctor on Dec. 11.  Afterwards, they set me up for an exercise stress test, which I was dreading.  I had had one about two or three years ago and had thought then the test was going to kill me!  But this one was much easier.  Dr. DeStefano only put me through 3 levels before he let me quit, which is a good 2 or 3 levels less than what I had done in Princeton.  I was huffing and puffing like a steam engine and had a hard time getting enough air by the time I was at that final level, but the doctor still said I did well.  The highest my BP ever spiked was to 160/90, which was actually when I was sitting down trying to catch my breath after the test.  I don't know yet what it all means, but Dr. DeStefano was encouraging.

On next week's agenda: my first support group meeting!

I just got back from a week-long professional workshop that required that I stay in a hotel while I was attending, so once again, I got the "hotel mirror treatment"!  This time, I was better prepared for the experience of regularly (and unavoidably) seeing my entire body in a mirror, getting a really good look at how others see me. 

Dude, I have gotten SO FAT over the past five years! I honestly hadn't really grasped exactly how round my body had gotten, especially how apple-shaped my stomach had become.  

I'm not moaning about this, but instead looking at it as necessary reminder of what the reality is.  I'm waaaaay too heavy, and it shows, not just in how my body is shaped, but in my health. 

Another positive thought I took from the experience was that since the group of people I was with all week are people I will be with twice more throughout the next year, they will be people who should notice a difference if I succeed in having the surgery.  So, no need to beat myself up about how uncomfortable I am with my body now; I know that they will (hopefully) be able to see the changes by the next time I see them all.

This morning at 4:45 a.m., I woke up completely freaking out about whether I had screwed up in my understanding of Aetna's Clinical Policy Bulletin 157.  I kept looking at it before bed last night, wondering if instead of following option A, the physician-supervised plan, I should really be looking at the requirements of option B, the multidisciplinary team approach, which would require me to add in regular consults with a behavior management specialist and a "professionally trained" excercise expert.  I was so stressed by trying to figure out what I needed to do, that I ended up unable to go back to sleep until almost 6:30.  Thank goodness this was my late day, so that I didn't have to be anywhere before 10! 

It also turned out to be my day to compare different doctors' scales. When I went for my tri-monthly depoprovera shot at the ob-gyn's, their scale showed me at 290, which was a nice surprise.  After that visit, I had some time to call Aetna to ask for clarification on the PB, and the woman I talked to said that she cannot interpret the policy bulletin for me, only my doctor can.  The good news out of that was that she said the doctor is the one who determines whether or not you are meeting the criteria for the bulletin, and consequently determines who is an "expert."  So, I went off to my 2nd bariatric consult, determined to find out who I needed to start seeing if I was adding behavioral management and exercise training. 

At the bariatric office, I weighed 291.8 on what I consider my "official" scale.  The office, since they round down to the whole number, considered this a 10-lb loss, putting me at about half what John had asked me to lose, so we were all happy.  This time I worked with Valerie, the nurse-practitioner, and we had a long talk about what I had done this month and whether I needed to change my understanding of the clinical policy bulletin.  According to her, I don't need the six-months-diet; only three!  And as for all the exercise training and behavioral modification exprts, she says that so long as she is documenting everything thoroughly and so long as I attend two of the required bariatric support groups, I should be fine.  By her calulations, I could have the surgery as early as January, not in April or May, which is what I had assumed!  

While this means I really have to commit soon to whether or not I am really going through with this, I'm happy to have it coming sooner rather than later.  I'm also still thinking about going to someone for the behavioral mod aspects of my eating, simply because I find it hard to stay on plan on the days I do things like binge because of discomfort. 

After the bariatric appointment, Dan and I grabbed a quick lunch at Subway (where both John and Valerie were having lunch, which was an amusing coincidence) and then dashed off to the cardiology office. 

After an EKG and filling in the doctor about last week's fainting episode, he decided I should follow up with an echocardiogram and a stress test.  I didn't think to ask if that was actually the normal pre-bariatric screening or something special for the fainting, but I guess it doesn't really matter.  He said that depending on what the tests show, he may put me on a betablocker, which he also felt might help with my migraines.  (Just what I need -- another med. :-( ) On his scale, I weighed in at 294 or so, which puts his scale in line with what I think I can expect from the WW scale on Wednesday.  If that's what I'll actually weigh there, I'll be pleased because it will confirm that I've lost 10 lbs so far!