Jacqueline H.

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If I want to succeed with this long-term, three things I need to do are:

1. Find alternative ways to deal with physical pain. The last week with my ear ache reminded me that I tend to use food as the anesthesia when I'm sick or otherwise physically uncomfortable. What am I going to do when the ability to use food like that is taken away?

2.  Quit rewarding myself with food when I succeed in losing weight.  Because how illogical and self-sabotaging is that?

3. Practice, practice, practice with mental rehearsal for predictably difficult situations.  If I totally lost control after one day of going to an out-ot-town conference, what am I going to do when I go to the five-day one in mid-November?

This is one time I am grateful for the six month diet period so that I have some time to work on these things before the surgery.  Especially the pain thing, because I expect that to be problem #1 post-surgery.

The last week or so, I've started to have reservations about the surgery off and on, mostly because I have a couple of friends who had friends or relatives who did not have good outcomes after THEIR surgeries.  They keep trying to tell me that if I just work hard enough and long enough at the dieting, they're "sure" I'll get good results with the weight loss.

This weekend, I went to a work-related conference and had to do the whole hotel/conference thing, which is always a challenge for me, dietwise.  I learned two really, really important things, though.

First, I saw myself naked in a nearly full-length mirror with that horrible fluorescent lighting that hotel bathrooms have.  I knew I had a fat top part of my belly.  I knew I had a pendulous lower part of my belly that I used to call "my third breast" when the rest of my abdomen was slimmer.  (Now I'd have to claim to something like four more of 'em if I was really counting.) But what I didn't know until I saw it in the mirror was that beneath  both of those fat parts, something ELSE had gotten fat enough to start drooping!  A part I didn't even know could GET fat!

I know now that the reason I never noticed how fat I was getting in that area is that a) I can't see it past my bell(ies) and b) when I sit down, it actually lies differently so that it is sort of resting on my pubic bone and is kind of tucked under the rest of my belly fat.  But when I stand up...yikes!  There it was, sticking out and down like ANOTHER lower belly! I'm sure not going to notice this in my clothes, but nekkid, it was realllly noticeable.

There is no reality check like seeing that "even that" is getting fat.

Second, I fell completely off my food plan and not only ate the wrong things, but flat out binged until my stomach was literally sore from being full.  I do this, not every day, not even every week any more, but waaaaaaaay too often for my body to be anything but it is.  It always has been the "thing" that ends up derailing me, this "urge to splurge" every now and again.

Putting the two things together --the reality of what my body currently looks like and my inability to stop eating until overfull, -- I acknowledged that just following a weight plan has not worked and does not show much sign of every working without some major change.  I can't help but think that if my stomach is smaller, at least if I do try to binge, I'll be forced to stop much, much sooner due to the physical constraints.  And for all the fact that other people may have lost 120 lbs just by diet and exercise alone, I'm not convinced that I can do the same without some kind of external help.

I also thought more about the idea of getting therapy through this process.  I don't have some kind of major eating disorder, but I DO have "issues" that lead me to binge and to want on some level to hide behind my weight.  Those will HAVE to be dealt with if I am to be successful.

Strategies to adopt: 1. Find out exactly what kind of mental health coverage I have.  2. At my next visit with John, ask if there is a therapist he can recommend for this kind of thing.

After looking at all of last night's reports and checking me out himself, my PCP thinks the fainting may have been caused by an ear infection I didn't realize I had in my left ear.  Just in case, though, he is sending me for a cardiology workup to the doctor who is supposed to do my bariatric surgery clearance.  I was told by John at Dr. Fares' office that the cardiology clearance should be my last consulatation, but my PCP figures that since I need to be seen by someone anyhow, might as well be him.

I called to reschedule my psych eval and the doctor's office said they are not sure I will have to do so, but will let me know after they talk to Dr. B. I also asked what kind of symptoms they saw when I blacked out and whether it could have been a seizure.  The person who talked to me hadn't seen me herself, but she said that because Dr. B. couldn't tell for sure if it was a seizure or not, they called in the neurologist while I was unconscious and the neurologist said it didn't look like one.  VERY reassuring!  So, apparently I just passed out from low blood pressure.  The big question now is why that happened, but I will be seeing my PCP after lunch today.

While I was lying around in the ER, I remembered that Oprah was doing "the aftermath of WLS" on her show that day.  I didn't remember until nearly half way through, but I got to watch at least the last half of it.  Dan remembered to tape it for me, but my son apparently goofed it up halfway through, so I'll only have the first half to watch later. It prompted quite a discussion about whether or not I was an addictive personality by nature and whether I should have ongoing psychological support while undergoing this process.  I don't think I would ever become an alcoholic since I only drink a couple of drinks a year, but I can see turning my addictive nature to something else like shopping or more spending more money on books (which is already a problem!) I did agree after watching what I saw of it that I would probably do better if I had ongoing counseling to help me through the process.  When I would lose weight before, I would get anxious because I was no longer "invisible."  It's going to take support to help me through that.  And while I believe friends can be great help for many things, sometimes the help you need requires a professional.

I had my pre-operative psych evaluation yesterday -- or at least half of it.  Around 2 p.m., Dr. Bresch was just beginning to talk to me about the risks of my comorbidities vs. the risks of the surgery when my ears started to ring.  I paused the conversation to check my blood sugar, which was perfectly fine 96.  He asked if I wanted him to get someone and I said, "No, but a glass of water would be helpful."  I remember taking one sip of the water while the ringing in my ears got so loud that I couldn't really hear very well, and then the next thing I knew, I was staring at ice cubes all over the floor and wondered how they had "magically" gotten there.

Then I noticed that I also had shards of ice all over my sweater and a huge wet spot from my top all the way down to my lap.  There were two or three nurses in addition to the doctor all trying to ask me questions about how I felt and whether I had a history of seizures. (Err, no!)  I was still kind of deaf, but apparently this was an improvement because they told me I hadn't been able to talk for a while.  Given that I had totally missed my dropping the glass of water or them asking questions before that moment, it was obvious I had some kind of black out.  

They took my blood pressure, which was 90/53, which is very low for me, and then took me off to the ER (I was in a hospital for the visit) to be checked out.  Nearly seven hours later after bloodwork, a chest x-ray, an EKG and a CAT scan, they still didn't know what caused my blood pressure to drop so suddenly. 

I'm just grateful that this happened in the office and in a  hospital, because god only knows what would have happened if I had blacked out while driving on Route 1!!!  

Because I had the car and the checkbook, Dan and Danny had to call around to find someone who could drive them to the hospital.  They didn't arrive until after 6 p.m. This turned out be a good thing, as the two and a half hours Danny was in the ER was about the end of his tolerance.  

Meanwhile, I'm now afraid to drive the car by myself until I have a better idea of why I blacked out.  I haven't been sick, my blood pressure is normally 130/86, and I had had lunch just an hour before, so I have no explanation for what happened.  

The visit before that had been interesting.  Dr. Bresch was asking some challenging questions, which I hadn't expected, which appeared to be tests of how much research I had done.  Did I know what procedures the hospital offered? Did I know which procedure was the most risky? When do I have to exercise -- before or after the surgery? (Both!) He also asked which issues led to my weight gain, and then rattled off about 8 options very quickly.  I grabbed onto a couple of them, but said it was too fast for me to remember the others and he said that was deliberate!  So I guess the point of it was to see which I pcked up on in that barrage. 

I'll have to reschedule; since we only got through half the visit, I wasn't quite done.  And next time, I'm BRINGING SOMEONE WITH ME!

Recently my mom came up from Arkansas to visit for a week or so.  She's been diabetic for several years but has never been good about keeping her blood sugars in check, and now she's really paying the price.  She had a painful-looking unhealed sore on her leg, she told me she'd recently lost two toenails because she hadn't been to the podiatrist as recommended, and her kidneys are getting close to shutdown from neuropathy.  The worst thing is that she just can't feel any of these problems any more because her neuropathy is so bad that her brain doesn't process the distress signals her body sends out.  She can't feel when she hurts herself, she can't tell if some internal organ is causing her discomfort, and she especially can't tell if her blood sugar is low until she actually passes out.

It's the worst case scenario of where diabetes leads, and as a newly diagnosed diabetic, it scares me half to death that I could end up that way!  So I'm working hard to keep my diabetes in check, and so far, I'm doing okay at it.  But what I would dearly love is to have it gone so I am not haunted by the image of myself at 75 with no toenails and unhealed sources, having a heart attack I can't feel. 

Last night in the middle of the night, I woke up having to go to the bathroom.  This is unusual these days because normally my CPAP machine keeps me sleeping comfortably and doesn't put my body into the distress that can be one of the causes of middle-of-the-night bathroom visits.  Apparently, I had been sleeping on my tube, which explained at least in part why I had woken up the way I did because I had been cutting off my air flow.

When I got back to bed and went to put my mask on, I heard the sound of water gurgling in the tube, heading my way.  This meant that while my tube had been kinked up, condensation from the vaporizer had gotten into the tube. 

So, there I sat in the middle of the night, draining my tube and trying to get my mask dry enough to put against my skin again, even though more moisture was obviously still working it's way through the backed-up tubing system. 

Of course, I spilled water on my nightie while doing this, so I had to arrange my clothes to avoid that wet spot, and when I did finally get my still-slightly-damp mask on, it was whistling from something I couldn't track down. It was very annoying and prevented me from going right back to sleep (as if having a damp gel thing on my face wasn't enough.)

While I was untangling, draining and drying everything and getting frustrated because I was tired and wanted to just go back to sleep, I just hated the whole thing.  Not the CPAP, which is a godsend in helping me sleep, but in NEEDING the CPAP.  I found myself thinking, "Other people don't need to do this just to sleep!  And if I weren't so fat, I wouldn't either! This completely sucks." 

This morning I woke up thinking about that incident and promising myself to use it to continue to work on changing things.   

I started scheduling from the required consultation list
that John gave me, beginning with the psychological evaluation.  I don't
know why I hadn't thought of it before I called, but I discovered very quickly that his first selection was NOT covered by my insurance! In
fact, the fee was going to be my $500 deductible and then insurance would
pay 70% of whatever was left.  Holy smokes! Fortunately, the other
person who was an option was in-network, so I scheduled with him instead. 
It made me go through the entire list and find out who was in and out
of my network before I went a step further, though.  Let the insured
beware!

After a long, hard summer of trying to find a surgeon in a
reasonable travel distance who my insurance company would pay for, I'm
finally seeing Dr. Fares.

I visited Dr. Fares's office for the first time last week (10/3) and
met John, the nutritionist.  We talked about my weight yo-yoing patterns
from the past and my current eating patterns, and he recommended I get
an RNY surgery.  I had originally been considering a Lap surgery
because I wanted something reversible, but even before the visit, I had
started to question why I wanted to be able to undo it.  Do I really think
that in some magical future when I've lost enough weight, I can undo
what I did to my body and miraculously not gain weight? Errr, no. To have
a professional give me a firm reason to give up the Lap-band thought
was helpful.

My insurance requires that I follow six months of a
physician-supervised diet plan before they will even consider the surgery.  He set me an
attainable goal of 15 lbs, although he told me he'd really like to see
something like 40. I asked about what would happen if I lost too much
weight, thus "proving" to the insurance company that I was "capable of
losing weight."  He reassured me that even if I lost the 40 lbs, I'd
still be in a category where I'd be eligible for the surgery, so not to
worry.

John also said that a good, attainable weight for me ultimately would
be 180 lbs to alleviate my health issues -- hypertension, sleep apnea,
GERD and, as of February this year, diabetes.  I've always had a
different dream weight, but I'll take whatever will make me healthier.  180 is
still 125 lbs away, and that's more weight than I truly believe I can
lose and keep off with what I've been doing.

The very next day I buckled down on a diet plan and so far, so good.  I
haven't been doing perfectly, but I am writing everything down so that
the insurance company will be happy.  I'm doing well enough that my
blood sugar readings, after being too high for the last two months, are
*great*. 

So, I'm starting.  I still have some resistance at home -- D. doesn't
really want me to have the RNY and is hoping that if I lose weight on
the diet, I will change my mind, but he still doesn't get that losing it
and keeping it off are two very different things.  Time to try
something new. My health and my son's future security rest on it.