pizzicato66

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So, I just crossed the 15 month mark, and have been holding steady at 165 - just under 140 lbs from my high weight.  I've been holding steady since about May, and not worrying about logging my food, but still on the scale daily.

 

I have more "normal" food (aka carbs and a bit more fat) and eating a bit larger portions but far less than I had before.  I find myself experimenting to see what "works" with my rny and learning the hard way at times (too much fat/carb or too large a portion).  That said, I'm not gaining and hopefully can keep maintaining this time around.  I do worry that I'm not getting enough protein now that other foods are getting onto my plate, and I notice some hair loss recently, so I'm going back to "protein first" as much as possible.

 

That said, I've started conversations with plastic surgeons for a panniculectomy! It's time to take that "FUPA" off the front, after 30+ years of a belly.  

 

My surgeon assures me that I will qualify for the panniculectomy, but lipo on my upper abdomen won't be included, so I'm talking to a cash-pay surgeon she recommended to potentially have lipo on that area a few months before the panni (doing it after would just make me baggy again).

 

I'm also considering going back to my post-op eating style to see if I can whittle a bit more off in the next few months, but that would delay the surgery, since you need to maintain weight for 6 months before going in.  That wouldn't necessarily be a bad thing.

 

I definitely have a LOT more anxiety about this surgery, as I've heard how painful the first few weeks are.  I really didn't have a lot of pain with the RNY, although the band removal was worse the first few days.  I probably should stop watching the panniculectomy vlogs on youtube as it doesn't really help my anxiety, and I know from my own experience with my bariatric surgeries that there's a wide variety of experiences with pain/healing and there are a good amount of people who love the drama and attention.  Not discounting their experience in the least, but I need to temper my anxiety somehow.

 

Much to consider. For now, I'm sticking with my plan and meeting with the lipo surgeon in a few weeks to see what she thinks about my 2-step approach, and whether it really would leave me with a lot of pudge on my upper abs if I didn't do the lipo.

 

Long term, I'll consider whether I want cash pay surgery for my thighs and arms (they're pretty saggy too).

 

Much to think about...

Looking back at this year, and it's been interesting!

This time last year, I had to cancel my revision surgery due to Covid.  On one hand, I was able to enjoy holiday festivities, but it did mean switching insurance providers and re-qualifying for surgery.

 

Feb 19, I had my band removed but had to recover before getting my bypass.

April 20, I had my RNY!

 

Since then, I've lost 104 lbs, am down from size 22/24 to 14/16, and have alost a total of 48 inches across all measures.  It feels GREAT to move comfortably without getting winded on walks, aching joints and muscles etc. and fitting into "normal" clothes.  I'm within 10 lbs of my lowest weight after my lap band in 2007 and about 2 lbs / week come off easily. 

 

I was worried that weight loss would be harder with a revision, but it's actually been easier!  Best decision I've ever made.

Well, after almost 3 years, a pandemic, a covid postponal and cancellation, band removal surgery and my RNY (and a total of 7 weeks' pre-op fasts over the 3 surgeries), I'm HERE!  4 weeks gone since my RNY as of today.

Surgery Happened!

Happy to say that the RNY surgery was MUCH easier than the removal. One night in the hospital, but I was up and walking by the first evening (my surgery was at 7am), sipping water and broth the first day, and I was headed home just after noon the next day.  No heavy pain meds (just tylenol), far less incision pain, and a lot less gas pain!

The Recovery Process

I took 2 weeks of sick leave for recovery, but was already lurking on meetings and reading work email and messages the day after I got home.  Did my best to relax and be as useless as possible those 2 weeks, but I was pretty self-reliant within a day or so, compared to the band removal recovery.

Week 2 I had 2 days of onsite meetings for work that lasted into the evening, which was pretty tiring, but I took extra rest time the following days (esp after my doctor scolded me).

Activity

I've started a few walks and puttering in the garden without any heavy lifting, so my energy is gradually returning. I really need to commit to regular walks (I haven't been good about that).

Diet and Food Tolerance

I'm still on soft foods for another week, but have started introducing a bit of tender meats/proteins and cooked veggies. 

Protein shakes tend to make me queasy these days (even when I mix with my morning decaf), so I'm trying to get as much of my protein and fluids in with real food, rather than the shakes, and I am doing well getting 60-80g of protein in every day.

I'm still getting accustomed to my food tolerances, which I'm sure will continue as I introduce more foods.  I definitely do NOT have a lot of tolerance for fat and have to be really careful (e.g. an egg salad with fat free yogurt is fine, but an egg with a little smoked salmon makes me queasy).

I have to be careful not to overestimate how much I can eat. I definitely have restriction, but really have to use the tiny bowls and spoon and slow myself down so I know when I'm done!  Had a bit too much soft chicken breast last night and it HURT!!  I didn't throw up but it was a good hour of feeling uncomfortable.

The Results

As for my weight, counting the pre-op diet, I'm down 26 lbs as of today. The scale did NOT move for the first few weeks post-op but is now starting to kick in.... I think!

Mental state - Revision Anxiety and Trusting the Process

One nice thing about revision surgery is that you already know what to expect from the pre-op and post-op eating phases, tiny portions, the surgery process and recovery, etc.  It's a little different with the procedures, but the key things are the same.

As a revision patient, I'm worried that I won't be able to lose as much, that all those years with the lap-band slowed my metabolism down enough to kill the "honeymoon period" this time around, but I'm reminding myself it's VERY early and my body's healing. I think my "3 week stall" kicked in almost immediately.  My clothes definitely are getting looser and I can see a change in my face, and I'm solidly in ketosis, so it has to happen eventually, right?

In any case, I'm here, and there's no going back! 

Revisions - One Surgery or Two

For those having revisions and worried about having to have 2 surgeries to remove and do the RNY, sleeve or whatever your choice, I can honestly say I'm glad my doctor chose to split the procedures and let me heal in between.  My scar tissue was extensive and healing from the removal surgery was more challenging. I don't think I would have done as well if he'd continued with the whole surgery at once. 

It was also a welcome break to have a "normal stomach" for 2 months. I treated it as a bit of a vacation and enjoyed some foods that were strictly off-limits or 14 years! Let's just say i had a LOT of Diet Dr Pepper and even a BEER!  I was able to go into the RNY surgery feeling like I was honestly and truly ready to start over.

I see others in support groups who had both procedures at the same time, and there's an overwhelming amount of patients that are really miserable (nausea, pain, vomiting, drainage tubes, etc). Yikes!

All in all, I feel lucky that my process went pretty easily, even if it took a while.  It's worth the wait!

Well, it turned out that I had a lot of scar tissue when they removed my band (not surprising after 14 years), so I was only able to have the removal.  

On the bright side, they sent me home the same night and I was back to work a week later. I had terrible vertigo (I've had positional vertigo for almost 10 years), and I'm thinking it might have been the angle they tipped my head during surgery, but it's much better now, and I'm just being careful with fast movement.  The incisions are healing well and I'm still restricted for lifting things for another week, but otherwise, I feel pretty good!

Follow-up appointment with the surgeon and dietician later this week (the ones originally intended for post-RNY). Hoping we can get back to it with the RNY sooner rather than later (but it's usually 2 or 3 months).

I still feel some restriction, so my stomach is probably still expanding now that the band is out. But, I'm having no trouble eating "normal" food at this point (had some gas if I overdid it for the first couple of weeks - like my stomach was still "angry"). 

 

It's a bummer that I need 2 operations instead of 1, but I'd rather not take chances or have a tougher recovery period, so it's worth taking my time.

I'm rescheduled for the 15th - hooray!!  

United Healthcare accepted my paperwork from my previous approval in a week, no less, and I was able to schedule right away (which is great, since the surgeons are all busy rescheduling cancellations from January due to the Omicron spike).

 

Happily fasting away and getting my home and garden tidied up before I have some lifting / energy limitations for 6 weeks.  It's amazing how much easier the pre-op fast is when you can have some solid food, and there's a band to help with hunger.  It's also a lot easier when I'm not fighting off Omicron!

The extra month was a blessing too because it gave me a bit more time to process and accept the upcoming changes and healing process, so my jitters have pretty much subsided now.

Everything has fallen into place nicely!

Welp, it turned out that my pre-op covid test was positive, so what I thought was the sniffles was a breakthrough omicron case.  Even though I was already recovered, my test was positive, so surgery was cancelled.

Now it's the new year and I have a new insurance carrier (United Health Group), and I'm talking with them about whether we can file for approval using documentation from my other approval (since it was pretty extensive and should cover all the steps they'll want me to take before surgery).

But because our plan is just getting set up, the bariatric support team at UHG doesn't have the requirements yet, so I'm waiting for them to call back when it is available (3 to 5 days).  

 

Hopefully I won't have to start all over again with all the same appointments, months of supervised medical weight loss, etc. since I've done all of that already. Stay tuned...

Ah, life. You do know how to make things interesting!

I was plugging away at my pre-op diet and isolating to stay healthy before surgery, but my niece returned from a work conference in Miami, and brought all the fun things an indoor conference in a pandemic can bring.  

She spent the weekend before heading back to her home for a few days, so she could get life in order and come back for a dogsitting and helping me out when I got home from the hospital. While here, we isolated and masked when in the same living space. Before she left, she got a covid test, so we could be extra careful.

on Monday, she called me. She tested positive for Covid AND Influenza B. DAMMIT! She was just starting to feel tired and early Covid symptoms so she started isolating at her place as the viruses kicked in. She was miserable, and I started worrying.

I was furious with her employer and the organization who decided we're ready for in-person events, in Miami, no less! More anger with J & J for making such a crummy vaccine, and for the booster guidelines that prevented her from getting a booster to go with that crappy vaccine.

Next morning, I noticed my tonsils were getting sore. DOUBLE DAMMIT! I ordered home tests and zinc losenges on instacart and started drinking a lot of chicken broth I had in the freezer.  It morphed into a head cold, and the home Covid tests came up negative on 2 consecutive days. My Flu and Covid shots did their job!

The rest of the week, I went into hardcore contingency planning mode. Who would watch my dogs while I was in the hospital? Who would be around to help out when I got home? Who could drive me to/from the hospital.  Could other family fly out and help? Zoom calls, requests to friends, neighbors, coworkers.... I had a few good options ready to go, but it was still stressful AF.

Complicating matters was the fact that my insurance is changing Jan 1, which would mean starting over if we didn't get this done by Dec 31. 

Finally, I had a second call with the nurse from the bariatrician's office and we agreed, postponing made the most sense, and they had an opening on Dec 28th. Just in time for me to have surgery, 2 nights' stay in the hospital and everything wrapped up before the insurance change. PHEW!

I got good news today, because my niece tested negative for Covid, and she's on her way to recovery too!  So, we now can be in the same house and not worry about contagion, and she'll be here to care for the dogs and help out when I get home.

So, here I am, one week out (again), and feeling a lot healthier and calmer.  Another week to get things done at work and then I can stay away for 2 weeks healing and relaxing.

 

Fingers crossed it all goes as planned from here on out!

So, here I am again.  14 years after my first bariatric surgery, 40 years since my mom put me on my first diet as a teenager.

 

I realized 2 years ago (pre-pandemic) that I wasn't able to make progress and maintain without more help.  I had exhausted every option I could try using my lap band and different eating plans, fitness plans, etc.

- fitness challenges and personal trainer workouts

- post-op diet (basically low-cal, low-carb)

- tracking on this app

- keto

- paleo

- moderate cardio and resistance training

- "bio-hacking" with a coach -  keto with moderate cardio and resistance training, an asthma med and a steroid (which I had to buy using shady payment processes and receive by mail).  I wound up with mild palpatations during cardio and very little improvements to show for it. I love the trainer and consider him a dear friend, but the approach wasn't for me.

- medical weight loss - contrave and phentermine with low cal/carb diet and vitamin injections. I lost weight quickly (similar to immediate post-op), but had severe memory loss, anxiety and turned into a stressed-out idiot. My mental state cost me a contract job I was working. I was a cloudy-headed freak!

- noom - cheesy silliness and no new knowledge or health improvement to show for the money  

Every time, I burned out, and my setpoint came back with a vengeance and I turned into an unholy bitch/unruly mental teenager. 

Meanwhile, perimenopause kicked in and made me even crazier, and now my metabolism has slowed down even further than all the dieting had triggered already. 

Eventually I just threw in the towel and realized I needed a serious break from the madness.  I spent a few years having whatever I want and just gave myself a break from worrying about it. It just wasn't worth the stress and unhappiness.

While it was really good for me mentally to have a break from worrying about everything and driving myself constantly, I regained all that I had lost, plus about 20 lbs.  I'm now at my heighest weight, but I'm mentally in a MUCH better place.

I got a referral and scheduled an appointment with a Bariatrician. He reassured me that I'm far from alone with my experience.  By choosing a gastric band instead of a malabsorptive surgery option, I had not chosen a powerful enough tool (as he said, I was "using a ball peen hammer but needed a sledgehammer").  I needed that extra edge of malabsorption to help me with maintenance. 

In the 14 years since my surgery, weight loss science has progressed, and bariatricians have almost entirely stopped using gastric banding. It also turns out that up to 50% of patients with bands wind up having a revision to remove the band entirely or replace it with another technique, either because the device had physically failed, they had complications, or they couldn't lose the weight.

That's FIFTY, yes FIFTY percent! I also found out that it usually happens before 10 years, and I was at 14 years. It was a real relief to hear I wasn't alone in this.

So, I started my journey of preapprovals for surgery, following the same steps first timers have to take.  Aetna has the most complicated requirements of all insurers, so it would take a minimum of 10 months to get through it all. i started scheduling my appointments.

I went to orientation and started monthly appointments with a medical weight loss doctor who had me try Ozempic.  Weekly injections into my belly that caused gas, stomach cramps and left me generally crappy feeling, with no impact to my weight or appetite.  I stopped taking it. 

.... and then Covid happened. 

The offices closed indefinitely, so  appointments paused. Turned out they had reopened but nobody notified me (another several months' delay) until I  contacted them to see what's up and they sounded surprised I didn't know. Whoops on their part...

I ramped back up, got the remaining appointments out of the way via zoom, and FINALLY got to submit my insurance preapproval, and it came back in 2 weeks! Imagine that! I started talking with the coordinator about scheduling my surgery in the new year (post-holidays, refreshed FSA, etc).

... and then my employer announced we were switching insurance providers Jan 1 to UHG. $%^&**!!!!

I immediately started plan research and contacted their help line to find out if I even had coverage (turned out ONE of the 3 offered does cover it).

That said, after all the hoops Aetna had me jump, I thought it made the most sense to go forward with surgery before the end of the year, especially since I was already approved.  I got everything scheduled for surgery Dec 21. 

There's a 50% chance I'll need a second surgery for the RNY, depending on scar tissue or any complications he finds. If that happens, I'll use the new insurance and the approval steps I already took should cover the requirements for submission.  Let's just hope it's a once and done surgery this time!

SO, now I'm 2 weeks out from surgery. I had one last wild meal last night with Sacha (which wasn't THAT wild, in hindsight) and started my pre-op diet this morning (basically low-carb, under 1000 cal/day) so I can shrink my liver.  I  have my pre-op physical Friday, covid test 2 days before a liquid fast the day before, and then I head to the hospital.

I begin today, and hope for the best, trusting that the changes will happen for me again, and that my confidence in the process will come with it.  I'll have a different tool, one that shows much more promise for success, and will learn what life will be like with it (my food tolerances and reactions will change with it).I'll go in a little wiser than last time too.

I'll take Dory's advice and "just keep swimming..."  Wish me luck!

Well, I'm still plugging away, although it's been slow-going.  Looking back at my earlier posts and goals, it gets a little disheartening, but I'm going to focus on good things I'm doing right now and the tools I've added to my collection:
- podcasts.  I LOVE LOVE LOOOOVE the "Inside out Weight Loss" podcast with Renee Stevens!  As soon as I hop in the car in the morning, I pop the ipod in and squeeze in an episode on the drive to work.  She's got a great way of reframing how you think and helping to change the attitude.
- I joined the gym!  I even meet periodically with a trainer to see how things are progressing.  There are 2 classes I love (pilates and S.E.T - strength endurance training) and I have been using the weight circuit on the other days, followed by a nice 3 mile walk with the pooch (I feel guilty doing cardio without him).  Plus lots of trips to dog beach on the weekend.  I live in a great hilly neighborhood, so even when I don't get to the gym I still get a good workout (and so does Dearest Poochie).
- I've nearly eliminated the junk out of my diet. The fill I got this Spring really helped, because a lot of the naughty stuff just doesn't sit well for me now.  Now, I think it's just a matter of trimming back fat calories and nipping the portions down just a tad more.
- I got a bodybugg :-)  It's great having a toy that tells me burn vs. input on my calories, although I do question if it's really as accurate as they say.  Either something is funky, or my food measure/estimation is way off.  Time will tell!
- I'm back to the support sites and reading up again. 
- I scheduled with a new doctor who is in the same network as my bariatric doc, so referrals should be easier when I need them.  I have an appt with the new doc coming up and will get bloodwork, so I can make sure everything is on track.  Plus, he might have some suggestions on what to do to speed things up a bit more.

So, I've re-lost about 6 lbs, with 14 more to go before I'm caught up to last Summer.  Hopefully, things will kick in again soon.  One of my bigger goals is a weird one.  I want to lose enough to see just how badly I need Plastic Surgery.  At this point, I know I have skin, but there's enough fat hanging yet that it's hard seeing just how saggy things will be.  I'm trying to be as realistically optimistic as a 42 year old former fattie can be - ha!

Wow- has it been that long since I've posted to my blog?  To be honest, I forgot all about this site, which is a symptom of where I am right now.  Let's see.... I guess a catchup is in order!

my band is still there, no complications but I'm WAY overdue for a fill and a good brain-adjustment.  Why?  Because I made a BIG change in my life in 2008.  I moved to California!  I decided by the end of last year that I really wanted a new start someplace, and always loved Southern Cali, so I dug in on a job search that would bring me here.  I wound up finding a job in San Diego, and relocated at the end of March. 

On one hand, it's been a great adventure and I'm having fun exploring and enjoying a snowless winter (I even made a couple road-trips to the mountains to see the snow).  On the other hand, I really miss my family.  If only some of them had come along!  I don't necessarily see this as a permanent thing (I feel relatively sure I'll move back eventually).

The one big drawback to all this excitement is that it took me away from my bariatric program, and I think it was too soon to go it alone, like taking the training wheels off too early.  Initially, I did great, and lost another 10 lbs (got down to 197 and bought my first pair of Gap jeans).  I took looooooooong walks with the pooch exploring the area and grilled nice meals for myself.  But, the snacks and carbs gradually started sneaking in, and I found myself fighting the band and eating till I was uncomfortable.  My loss stalled for months, and then in the Fall started creeping up, so I've now regained about 15 lbs and I'm at 213 lbs.  Now, even though portions are still smaller than they would have been preop, I'm grazing a LOT, getting into the candy and chips and making really bad food choices. 

It's not that I didn't try to get help.  As soon as I arrived, I planned ahead to see my new PCP for a referral and tried to get into UCSD.  I was as proactive as I could be, going to the pre-op seminar as they required, filling out the paperwork, ordering up my file from my bariatric doc in MN.  When I finally got to meet with the coordinator for their program, I found out that they wanted a big up front fee AND they wanted me to pay cash for fills, even though my insurance would cover it.  So, I requested my file, switched primary care docs, got a new referral, and contacted the program at Sharp Community.

They *said* I'd just need to drop off my file with a letter from me requesting admittance to the program, and that I'd be able to schedule as soon as the doc reviewed my file and approved me.  That was August 9.  BUT, after weekly phone calls, I didn't get anywhere (apparently the nurses didn't feel they could work with him to read my file).  So, I filed a complaint, picked up my records AGAIN, and started calling around.

This time I picked Pomerado and Dr. Callery.  Turns out, they only needed a referral from my PCP, no up front fees, and they'd schedule me.  So, I got my referral (finally came through on Friday), and called to schedule.  I couldn't believe it... they said I could get an appointment next week, WITH the SURGEON!!!  I was in shock, and totally happy.  What a relief!!

Lessons learned
- get all the right questions, ask them up front and call around - a LOT! 
- Don't choose a program just because it's a famous hospital or conveniently located
- Try not to relocate in the first few years after your surgery, so you can stay with the same program as long as possible.
- Bariatric docs can be really arrogant and difficult with post-ops!  I came from a larger and more experienced program and still had a terrible time finding a place that would take me, even with no complications!!

Most of all...

- DON'T use hitches in life as an excuse to lose your focus.  I totally played mind games and made excuses for my eating because I'd "start over when I got into the new program"  In the end, I lost out on the deal, and I'm going to have to make up for the regained weight and retrain my eating habits.

So, it's time for a change. 
- I'm using that appointment next week as my fresh start, and am already putting more thought into my eating habits. 
- I'm trying to get out to the support websites more often. 
- I'm paying attention to how my tummy feels before it's overfull. 
- I'm being introspective and trying to figure out how my head works, so I can do better this time.
- I'm forgiving myself for acting up, and choosing to make my life better

Nuff said.  Here's to new beginnings!