maxs_mom

Send Message

Block

Add Friend

I started to take weight loss / weight loss surgery seriously around the first of October.  In the six weeks that have passed since then, I went from attending Dr. Srikanth’s seminar to now being less than one week pre-op (being on the fast-track is one of the only perks of being self-pay).  As a result of following first my own version of a modified Atkins diet and then my surgeon’s “sandwich diet” (not nearly as yummy as it sounds), I have lost 33 pounds!  I am confident that my VSG will ensure continued success.  However, I also know that diet is only one part of the program; I am going to have to get active.  Right now, exercise is my true albatross. 

 

Issues of shame and embarrassment aside, one of the main things about which I've fretted is my actual ability to exercise.  I am super morbidly obese and mobility and stamina are real factors.  Additionally I suffer from chronic pain due to fibromyalgia, osteoarthritis, and migraines.  I attended a support group on Tuesday night that was actually a presentation by two mental health workers on managing holiday stress.  One of the tools discussed was exercise generally and water aerobics and yoga specifically.  Hey!  I like to swim and there were other ladies there that were only too happy to tell me where they went and one even gave me her phone number so that when Dr. Srikanth clears me for swimming pools (usually 6-8 weeks post-op) I am set to go. Additionally, I already do my own self-styled deep breathing exercises and stretching to help alleviate my pain.  I discovered that there’s a Yoga studio near me that has a reputation for working with bariatric patients and that they’re having a special workshop on 12/07/2008 called “Exploring Gentle Yoga”.  Yesterday I registered online for the class and paid in advance. 

 

Also at the support group, we were asked to write out our goals in the areas of eating, exercise, and stress management.  Each area had three questions:

1)  What has stopped me in the past from reaching my goal,

2)   What are my triggers, and

3)   What is my plan?

I wrote, “Shame and embarrassment have previously kept me from exercising.  I am discouraged that I cannot physically do a wide variety of exercises right now and feel uncomfortable at a gym watching the skinny people work out.  I commit to exercising because it is good for me and an essential piece of the puzzle when it comes to successful long term weight loss.  I am going to exercise for me and find a place that I can do it comfortably.”

 

So now I’ve put it out there and that makes me feel that not only am I accountable to myself but also to others.  I've decided that my rewards from now on are going to be physical fitness related.  My first major goal is to become a passing visitor to terrific twosville and as soon as I drop under 300 lbs my husband knows what to get me: Wii Fit!

Amy

Dr. Srikanth's dietary guidelines are the best.  Here's the information from his own 33 page Patient Handbook for Weight Loss Surgery that is given to all of his patients regardless of procedure (some supplements may be increased if bypass performed):

Pre-Op: 10 day clear liquid diet plus 3 30 gram protein shakes daily plus 4 children's' chewable mulit-vitamins, 1500 mg chewable calcium citrate, 30 mg Prevacid Solutab plus any additional nutritional supplements based on extensive lab work tailored to a individual's needs (i.e. additional OTC and/or vitamin/mineral supplements like A, D, B-12, and iron).  At the final pre-op appointment he also goes over any additional maintenance medications you may have (e.g. OTC pain relievers, Rx pain relievers, Metformin, Crestor, Atenolol, etc.)

Pre-Op 2 Days Before Surgery: 4 packets Neutra-Phos-K (nutritional supplement with electrolytes) is added to the above

Post-Op Week 1: Clear liquids plus 4 mulit-vitamins, 3500 mg calcium citrate, 60 mg Prevacid Solutab plus the additional supplements listed above (Neutra-Phos-K is only taken 2 days post-op)

Post-Op Weeks 2-4: Clear liquids, 3 30 gram protein shakes daily, and 4 mulit-vitamins, 3500 mg calcium citrate, 60 mg Prevacid Solutab plus the additional supplements listed above (Neutra-Phos-K is only taken 2 days post-op)

Post-Op Weeks 5-6: Add "mushy" (consistency of baby food) to above, adding only one new food item a day.  Do not drink any liquids 30 minutes before meals or 60 minutes after eating.

Post-Op Weeks 7-8: Add soft foods to above

Post-Op Week 9: Introduce regular solid foods as tolerated.

It is because of his strict dietary guidelines that he can boast the best excess weight loss percentage of any surgeon in WA. 
Dr. Srikanth gives you a tool with WLS, tells you in-detail how to work with it most effectively, expects compliance (and checks on it through monthly follow-ups for the first year and then regularly scheduled for life) but doesn't bend when it comes to eating things that will sabotage general health and maximum weight loss. 

I am including my personal lists of the pre-op labs/exams/consults that Dr. Srikanth required as well as my list of my surgery specific medication that he requires as evidence that he is very thorough and that his requirements are tailor-made to an individual's needs, both to decrease surgical risk and ensure a successful outcome:

 

Labs: Comprehensive Metabolic Profile, Uric Acid, Phosphorous-Inorganic, LDH, ALT (SGPT), GGT, Magnesium, Lipid Profile, Iron-TIBC, CBC Differential with Platelet Count, TSH, HGB A1C, B12, Serum Folate, Vitamin A, Vitamin D (25 Hydroxy), Zinc (Serum), Serum Impact PTH, 24 Hour Urine Calcium, Serum Feritin, Urine N Peptide, Serum Osteocalcin, Urinalysis, Prothrombin Time, Partial Thrombone Time.

 

Exams: Abdominal Ultrasound, Pelvic Ultrasound, Chest X-Ray, Upper GI Swallow, Bone Densitometry, EKG, Sprirometry, EDG, Myocardial Perfusion Scan, Pulmonary

Function Tests

 

Consults: Cardiologist, Pulmonologist, Psychologist, Internist, Nutritionist

 

Children’s Chewable Multi-Vitamin (OTC)	1 x 4 daily
Calcium Citrate (OTC)	1500 mg Pre-Op (Will increase to 3500 mg daily post-op)
Vitamin D (OTC)	2000 iu daily for deficiency
Prevacid Solutab (RX)	30 mg x 1 day Pre-op for gastritis/hiatal hernia - will increase to 2 x day post-op)
Vitamin D (RX)	5000 iu x 3 weekly for deficiency
Cyancobal Inj (B-12) (RX)	1000 mg x 1 weekly for deficiency
Multigen Plus (Iron) (RX)	5000 iu x day for anemia
Neutra-Phos-K (Nutrition/Electrolyte Balance) (RX)	4 x day two days pre-op and post-op
Lortab Elx (RX)	7.5/500/15 as needed for pain post-op
Zofran Solutab (RX)	8 mg as needed for nausea and vomiting post-op due to narcotics sensitivity
Phenergan Sup	50 mg as needed for nausea and vomiting post-op
Intravenous Venofur Solution (Iron) (RX)	20 mg/ml IV to start with surgery and 4 scheduled post-op for anemia

 

 

Dr. Srikanth is anything but lackadaisical when it comes to all aspect of his patients' health and long term weight loss success.  I am having VSG with Dr. Srikanth on 11/19/2008.  I chose him because he’s the best in WA…period.  The Center for Weight Loss Surgery, which he was instrumental in establishing, has been recognized by more surgical organizations and insurance companies than any other in the state.

Amy

When I decided to get WLS, in the first week of Oct 2008, I started a modified Atkins diet with some meal replacement shakes thrown in.  I had my consult on 10/18/08 and scheduled my surgery for 11/19/08 (the process is moving quickly because I am self pay).  I have followed my surgeon's recommendations (I'm human, there were some bad choices made and still to make I am sure) for rapid weight loss prior to surgery.  As of today, I have lost 25 pounds and I still have 15 days to go until surgery; the last ten of which will be clear liquids and three 30 gram protein shakes daily.  I am confident that I will meet my 10% excess weight loss goal by surgery day.

Today I posted a message to a new member of the VSG forum.  We have the same surgery date (11/19/2008) and roughly the same amount of weight to lose.  She sent me a PM and I responded.  While I was writing, it struck me that a variation of my message to her would make a decent blog entry.  So here it is....

Once I made the decision to get the surgery, my mind was made up and the sooner I could schedule, the better! From consult to surgery I have 32 days total to get all of my pre-op labs/testing/consults complete as well as to start changing food habits that had been years in the making.  I'm almost to the end of my pre-op requirements and am now struggling with the issue of losing sufficient weight pre-op to shrink my liver so that Dr. Srikanth has room in my abdomen to maneuver during surgery. 

My official clear liquids/protein shakes starts 10 days pre-op so Saturday, Nov 8th is my last food that has to be chewed day (and I am having a big juicy steak for my food funeral) for many weeks.  I already did 10 days of clear liquids/protein shakes at my surgeon's suggestion in an effort to lose weight rapidly pre-op.  Right now I am on proteins, low-carb and low-fat.  I would hate to have to have my surgery cancelled because my liver was too big!  Additionally, in the past two weeks I have given up caffeine and carbonated beverages and am trying to quit smoking.   I know it may sound like I’m giving up a lot…and I am.  I am giving up having to shop by catalog if I want well made fashionable clothes.  I am giving up getting winded just walking slowly around the grocery store.  I am giving up having to ask for a table at restaurants for fear that I won’t fit in a booth.  I am giving up doing everything possible not to be photographed.  In short, I am giving up my inability to lead the life I want to lead because of obesity.  When I think about it in those terms it helps me to make better choices and to do the things my surgeon recommends. 

I’m more anxious than scared right now.  Though, if I think about it for too long I can make myself scared.  I have never had surgery (save having my tonsils out when I was in grade school thirty years ago), never broken any bones, never given birth.  My fear is centered around the possibility of not waking up from general anesthesia.  I am sure that the day of and perhaps a few days before I may get more frightened.  However, I am trying my best to keep a positive attitude In all honesty, having it all happen so quickly is probably a good thing because I don’t have months and months to worry about the what-if’s.   

By no means am I a little ray of freaking sunshine or a Pollyanna.  Staying positive is what works best for me to cope with the fear and deal with all of the changes I’m making.  I know this is hard even now and I've not yet had surgery.  There are thoughts that this won’t work for me, much like the fear that I would be the only adolescent unable to get a license because I just wasn’t capable of learning how to drive (that notion was disproven and I got my license on my 16^th birthday).  I know in both my head and my heart that the likelihood of surgical complications or inability to lose weight after surgery is slim.  That doesn’t make the fear go away, but it acknowledging it makes me feel better.  

 

Amy

Today is the maxi-poopers 1st birthday!!!!!  We're going to Neenie's house in Aberdeen this afternoon so that Max can celebrate with his grandparents and doggy cousins.  We'll have a birthday party tonight!

I need a life!

Amy

I'm still in the middle of getting pre-op requirements done.  I have my appointment with the internst this morning.  Yesterday I found out that Dr. Srkanth wanted to add a cardio stress test after reviewing the report from the cardiologist.  I really hope that nothing else gets added; I'd like to have all pre-op labs/procedures/consults done by the time I see Dr. Srikanth agan on 11/08.  I'm also anxious to see if I "passed" my pre-ops.  I have eleven days after I next see Dr. Srikanth to take c are of anything if I have to; I just hope I don;t have to.

AMY M WLS EVENTS SCHEDULE           VSG SCHEDULED FOR 11/19/2008
Date	Event	Provider	Complete
10/06/08	WLS Seminar	Dr. Srikanth	X
10/18/08	Surgeon Consultation	Dr. Srikanth	X
10/20/08	Schedule Surgery	Dr. Srikanth	X
10/20/08	Family Doctor Visit	Dr. Flores	X
10/21/08	Nutrition Class	Joanne	X
10/23/08	Psychological Evaluation	Dr. Petek	X
10/24/08	Pre-Op Labs, Abdominal & Pelvic Ultrasounds, Chest X-ray and Upper GI Swallow	St. Francis Hospital	X
10/27/08	EGD	Dr, Srikanth	X
10/29/08	EKG & Spirometry	St. Francis Hospital	X
10/30/08	Cardiologist Consultation	Dr. Wagner	X
11/01/08	Internist Consultation	Dr. Fajardo
11/05/08	Bone Densitometry	St. Francis Women's Health and Breast Center
11/05/08	Myocardial Perfusion Scan	Auburn Regional Medical Center
11/06/08	Pulmonologist Consult	Dr. Baylor
11/08/08	Final Pre-op Surgeon Consultation	Dr. Srikanth
TBD	St. Francis Pre-Op Visit	St. Francis
11/19/08	Surgery Day	Dr. Srikanth
12/01/08	Two Week Post-op Visit	Dr. Srikanth

My endoscopy was yesterday afternoon.  It was uneventful as I was “asleep” for the entire procedure.  The worst part of the day was that I had to check in two hours early and then wait.  Dr. Srikanth found a small hiatal hernia, antral gastritis, and some evidence of antral scarring.  He prescribed 30 mg Prevacid Solutabs once a day for 45 days.  Obviously years of overuse of OTC NSAIDS to treat headaches and various aches and pains (which were later used to diagnose Fibromyalgia) as well as my prescription for Relafen (a prescription NSAID) were causing damage to my stomach.  As I already knew that I might have to switch from Relafen to something else due to VSG, I emailed my family doctor this morning and she switched me to Tramadol for my chronic pain.  

 

I know that losing weight is not going to resolve all of my various medical issues, but I certainly hope that it will help to alleviate some of the symptoms like joint pain, shortness of breath, etc.  As of right now, I am taking seven (14 pills daily) prescriptions plus my multivitamin and calcium citrate.  This doesn’t include the medications I take on an as needed basis for migraines, anxiety and itching.  I just know that Dr. Srikanth is going to add more vitamin supplements after he reviews my labs.

 

I am still very excited about my decision to have WLS.  I’m a list maker and the only con on my list is the possibility of complications during or from surgery.  The pro’s are simply to numerous to list but certainly just the possibility of better mobility and greater self esteem are significant.  Those two things alone would positively impact the quality of my life, from personal relationships to professional ones, and everything in between.

I had my psych consult on Thursday, 10/23/2008.  It went well (I think).  It consisted of an hour interview and then "evaluation".  The best part was the "evaluation"; 1 hour and twenty minutes taking tests, almost 500 questions total, to determine whether I was a good candidate for WLS.  There were 3 tests total, the MMPI-2, one designed to evaluate how well you work as a patient in the healthcare system (who knew such specific tests existed?) and one on eating habits.  Unless I completely bombed the testing portion, I am confident that I will be determined psychologically fit for surgery and the long road to long-term weight loss success.

After a delightful 4 hours at the hospital yesterday, Friday 10/24/2008,  my labs are now drawn (10 vials of vampire food), abdominal and pelvic ultrasounds complete, chest x-ray and upper GI swallow complete (the radiologist said everything looked good - no problems).  Next up, endoscopy Monday afternoon.  Things just seem to be moving so quickly.

Also, I decided Tuesday night to follow my surgeon's advice and do what he calls "the sandwich" for my pre-op diet routine.  Basically that's 10 days of clear liquids/protein shakes, followed by ten days of a modified Atkins diet, and then his standard 10 day pre-op diet of 10 days clear liquids/protein shakes again.  I also have given up all carbonated beverages and caffeine (which was almost as big a decision as opting for the additional 10 days without solid food since I live in the Seattle area - coffee anyone? - and drank diet coke like water).  So far so good.  I was a little tired after all the testing yesterday and took a nap when I got home.  I also felt a little under the weather last night but I think that had more to do with the barium, leaving my system, than anything else.

I was not looking forward to having my blood drawn for the 24 blood tests (I also had a UA and have brought home a lovely kit to do a 24 hour urine catch - I better label the container properly lest DH think I made lemonade - ~Ha~).  I am what they call "a bad stick", a term that which I am sure many of you are familiar since it's relatively common with obesity.  It's been an issue for about ten years.  My family doctor's office usually has to try about 4 spots because not only is a good vein hard to find but my blood is sluggish and it would take several sites to obtain the necessary amount of blood just to fill one small vial.  I became used to it and always give any phlebotomist at any lab a warning just so they wouldn't think it was them.  I thought for sure that I would be a pin cushion after yesterday because I couldn't imagine how they were going to get all that blood from me.  I'm used to several techs trying as well as infusion nurses being called for just 3 - 4 tests or to start IV's.  Well, guess what!  Yesterday the tech easily found a good vein within seconds and 10 vials of blood was drawn from that one spot rather quickly.  Moral of this story - diet coke and coffee/tea are not replacements for the need to drink at least 64 oz water daily in order to maintain good hydration. 

Date	Event
10/06/08	WLS Seminar
10/18/08	Surgeon Consultation
10/20/08	Scheduled Surgery
10/20/08	Family Doctor Visit
10/21/08	Nutrition Class
10/23/08	Psychological Evaluation
10/24/08	Pre-Op Labs and Studies (except Bone Density and EGD)
10/26/08	EGD
10/30/08	Cardiologist Consultation
11/01/08	Internist Consultation
11/05/08	Bone Densitometry
TBD	Pulmonologist Consult
11/08/08	Final Pre-op Surgeon Consultation
TBD	St. Francis Pre-Op Visit
11/19/08	Surgery Day
12/01/08	Two Week Post-op Visit

I'm going to write a real entry tomorrow, but for now wanted to post some VSG research links:

ASMBS VSG Position Statement 06/2007 http://www.asbs.org/Newsite07/resources/sleeve_statement.pdf

 

LAPSF 2 Year VSG Study 10/2007 http://www.ncbi.nlm.nih.gov/pubmed/17356932?dopt=AbstractPlus

 

LAPSF 5 Year VSG Study 05/2008

http://www.ssat.com/cgi-bin/abstracts/08ddw/O4.cgi

 

LAPSF 5 Year VSG Study  Presentation to SSAT 05/2008 (Video)

http://www.ssat.com/video/2008/SSAT%2049th%20Annual%20Meeting(3)-Cirangle.htm

 

LAPSF VSG  Educational Presentation to FACS 10/2004

http://www.facs.org/education/gs2004/gs33lee.pdf

 

ANSURG RNY vs. VSG on appetite suppression and EWL 03/2008

http://www.ncbi.nlm.nih.gov/pubmed/18376181?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 

SURGTODAY VSG and the role of Gherlin 05/2008

http://www.ncbi.nlm.nih.gov/pubmed/18516524?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 

OBESSURG VSG for morbid obesity 07/2007

http://www.ncbi.nlm.nih.gov/pubmed/17894158?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

 

SURGTODAY VSG vs. LAGB for BMI > 60 04/2008

http://www.ncbi.nlm.nih.gov/pubmed/18560961?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 

OBESSURG VSG vs. LAGB on Gherlin 05/2005

http://www.bernhard-ludvik.at/download/pub/2005_ref61.pdf

 

WORLD OF GASTROENTEROLOGY VSG for morbid obesity 02/2008

http://www.wjgnet.com/1007-9327/14/821.asp

 

OBESESURG VSG sleeve size and results 10/2007

http://www.ncbi.nlm.nih.gov/pubmed/18098398?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel