sallyj

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I have been so overweight for so long--and on so many diets--it is difficult to have "WOW" moments anymore.  Or at least this early in the game.  But this morning I did have a fun thing happen.  I have two pairs of the same style pant but in different sizes.  I knew I was now wearing the smaller size but had not put away the larger pair.  So this morning as I got dressed, I pulled on the slacks, and they were too big.  I assumed I had grabbed the larger pair.  I started to change and checked the pant size, and they were the smaller pair!  Now they are too loose.  What a great way to start the morning.

I had my two month check up yesterday and have lost 52 lbs.  My surgery and healing has gone smoothly with no complications.  I am at a point right now that even compliance is easy.  I'm even exercising--something I've never been good about before. 

 

My greatest struggle has been my own expectations (unrealistic?) and fears.  I have had several "stalls" where I don't lose anything.  But they are never followed up with a -10 lb. loss like I read elsewhere.  Two pounds is closer to it.  It can be discouraging especially this early one when quick weight loss is supposed to be "inevitable."

 

So I have been focusing my goals on doing what I am supposed to do--vitamins and supplements, protein, and exercise--instead of weight numbers.  I found a good food diary, Diet Minder, and like to both plan what I will eat and track what I do eat.  There's a spot for water consumption, medication, and exercise as well as food. 

 

I am determined to change my habits and thinking before this "honeymoon" is over. 

 

Some of the things I look forward to include:

sitting in a lawn chair on my deck (fitting into a regular lawn chair)

taking a long bubble bath (fitting into the tub)

not needing the seat belt extension when flying

not being the fattest person in the room

not having to shop in the plus size stores/departments

not having to decide on participating in something based on the parking distance (being able to walk that far!)

And so many other daily activities I forget about

 

I have now had my first meeting with the Mercy Bariatric Program people and one of the two behavioral group meetings.  I have to say, no one can go into this surgery uninformed!  Delusional maybe, but not clueless.  I keep hearing the same things over and over and over.  Sandi made a good point though when she reminded me of how studies continually show that people need repetition to actually learn/understand something.  And not everyone surfs the web like I do.  So, while I wish I was hearing more new and detailed information, I understand why it is so much of a rerun of what I had read before I even made my first phone call.

            I was disappointed in the Mercy program; their “experts” did not build my confidence in their understanding of the clients they were actually dealing with.  I wonder if they have even received training specific to obese and/or bariatric patients.  When the physical therapist gave us a handout of exercises that had the same exercises and illustrations that you see in generic materials, I knew she didn’t have any specialized understanding.  Telling us to make adjustments to the exercises or just not doing ones that we “can’t” is absolutely worthless.  She’s the one who should know how to modify exercises for specific physical needs.  She’s the one who had the training, not us.  While I am frustrated by them, I know it is the profession and its training that is the real cause.  Fat people don’t go into nutrition and physical therapy as professions.  So no one actually learns about working with fat clients.  Same old story. 

            The program also is not client centered—typical of Sioux City .  Maybe it is just because I am so obese and have bad knees that I see this, but why have meetings in a place where there is no convenient parking?  Or have us meet in one place and walk several blocks to a new location?  Inconveniencing the client is “proof” of their commitment.  No it’s not; it’s proof that people don’t want to work other than 9 to 5.  It’s the lack of commitment to their patients on the part of the professionals.  But I just don’t expect any better of them.  It is the medical profession after all and it’s Sioux City .

            So I realize that I am the one who is going to have to learn what I need to learn on my own.  Maybe there are some people I can contact who are at research 1 institutions doing something in these areas.  You’d think with all the talk about the obesity epidemic, people in the health professions would be looking into how to work with fat people not just thin people.

            I did buy the recumbent exercise bike.  I’ve been doing well with it.  I have exercised twice daily (just 10 min.) every day since I’ve gotten it except yesterday.  But yesterday I had to climb three flights of stairs.  I’m pleasantly surprised that it does not seem to bother my knees.  Actually, I feel better about walking.  It could be that it helps prevent stiffness, but I think that by strengthening the muscles, that must help.  I am concerned about coming off the Celebrex, so this is encouraging.  I am trying to build in exercise as just a part of my day.  I’m not pushing myself, although if my feet didn’t hurt I could probably go longer than 10 minutes.  I was pretty tense at first, so had to work at relaxing my shoulders and feet.  I still tend to clench my toes! 

            I’ve been doing pretty well with the eating except for the pizza order Monday!  But I think I was under-eating.  I didn’t feel hungry so much as like I just didn’t have any energy.  It wasn’t like being tired from being worn out, but literally like my body lacked the wattage, so to speak!  This makes me wonder what it is going to be like when I am eating so few calories.  If I have to come off caffeine, exercise, and eat next to nothing, where I am going to get any energy?  Will my body be able to draw from the fat stores enough?  Will exercising now help this?  I hope so. 

            I told Pastor Brenda about considering the surgery.  She was kind of supportive, but still a bit hesitant.  That’s okay.  I just wanted her to know.  Sandi is still willing to come out for a week.  I need to see about setting the surgery date tomorrow (since I will have my second mandatory meeting) so I can get that to her.  I know they want me to complete four meeting now, and I have the additional two scheduled, but I need to make plans.  I also need to have a back-up plan for work if I can’t come back in two weeks.

Well, I went for my next meeting.  This time we were in a small group of six.  We watched the video—same information (and inaccurate due to using bad CDC data on obesity deaths) as I can find on the internet.  Then we met as a group with Dr. Rizk and again a review of pretty much the same information.  All very general.  After that, we had individual, brief, meetings with Dr. Rizk.  I guess I have lost an inch in height because the predicted weight loss and BMI is more in line with being 5’ 4” than 5’ 5”.  My blood pressure was a bit high but not problematic.  I was, of course, nagged about not having a regular doctor.  So now I have to go to another doctor on Monday for a general physical. 

 

 I have to admit I was a bit disappointed.  I really thought that someone who made his living working with obese patients would be more personable and less “doctor-ish.”  Maybe I just expect something that is unrealistic.  After all, it was clear that this guy is a surgeon.  That is his end of the process.  Mercy really deals with the personal, holistic stuff.  He does the cutting and pasting!  So I need to remember that and not expect him to be more than that. 

 

 I will fax a request for my limited medical records from BGSU and Dr. Briewa this afternoon after work.  I will also have to contact Dr. Strittholt’s office. 

 

 My not having a documented history might cause some problems in the insurance approval, so I will need to write a letter of explanation.  I need to go back through what I have and “de-bitter” it.  When I explained to Dr. Rizk about bad experiences, he said I sounded bitter.  I should have said, “Not bitter, but angry.”  So much for his understanding of how obese people are treated by the medical profession.  I will take that in to Sandi next week.  Then it will all be a matter of waiting.  I hope this will just be done in time for the term break. 

 

 I have been looking into a recumbent exercise bike, but most are made for 300 lbs.  I can’t really afford one right now anyway, so maybe that can be my after New Year gift. 

 

 I am trying to lose some weight now but find I get tired, so I need to make sure I eat enough.  I am concerned about that when it comes to building exercise into my life.  I want to lose the high end of the range, so I will have to exercise daily.  But it is tough for me to get my head around that and develop a “doable” plan.  I need to work on that as much if not more than the food.  That I am an old hand at!

I had my pre-surgery psychiatric evaluation this morning.  It was pretty straight forward: am I informed and understanding of the risks; are my expectations realistic; do I have any addictions, etc.; do I have an eating disorder that would make the surgery unwise.  Nothing very detailed or too probative.  I wonder if by being so verbal, I am not “working” the system.  I did mention the childhood situation, but didn’t go into the depression because it was never clinically diagnosed.  I also hedged a bit with the definition of bulimic binge eating.  Because I eat a lot all through the evening, I didn’t really fit the clinical definition.  Also, that behavior has changed a lot in the last couple of years.  I do take longer to eat a lot, and even my “a lot” is less than it used to be.  Now ice cream might actually last several days instead of being gone in one night!  And I was thinking about how I used to eat at least some of anything I bought right away.  So I’d heat the pizza while I was fixing the ice cream.  And have some cookies with the ice cream.  And then have a sandwich and chips after the pizza! 

            I did buy and eat a Godiva chocolate bar at Barnes and Nobles.  That 220 calories will be my breakfast and my last chocolate for some time.  It was good, but not that “oh my God, this is what makes life good” kind of good.  I need to remember that when I get something in my head about having to have something.  But I figure that if I can still keep the calories down and the carbs more low-glycemic, then I should be in pretty good shape. 

            Tomorrow I go for the more important of the doctor appointments—the one with Dr. Rizk.  I will start gathering my medical information to submit my first attempt at insurance.  In my mind, it is kind of a done deal if the insurance approves it.  But it is also still a mental thing rather than a real event. 

I attended the general seminar on the bariatric surgery on Monday the 18^th.  There wasn’t much new information but a confirmation of what I had read elsewhere on the web.  But I didn’t realize that the stomach was literally cut off and not merely divided by a staple “border.”  It is weird to think of the rest of the stomach just sitting there doing nothing.  Doesn’t it degrade?

            The surgeon, Dr. Rizk, seems nice enough.  I don’t know just what kind of relationship I want with him. I don’t want it to be paternalistic or knight in shining armor.  I guess I want it to be professional but considerate, like he sees this “market” as more than just a niche to make good money from.   I would like to know his reason for specializing in this type of surgery.

            He did address the ability to take pills after the surgery.  There should not be a problem, except for aspirin based pills or others that can cause stomach ulcers—such as Celebrex!  That was not good to hear as I have just started enjoying the benefit of it.  But I also know the weight has to come off for any future hope of treatment (ie. knee replacement surgery).  So it goes back to trade-offs:  hurt more now to get the weight off and benefit from the reduced weight or stay on Celebrex and try dieting again.

            One thing that did dawn on me as to why the surgery is more successful than even following the same diet without the surgery. (A huge thing is the ability to stay on such a restrictive diet without the physically smaller stomach to feel full and the psychological support of that.)  It’s the malabsorption part—with the reduction in the length of intestines, there are fewer calories absorbed as well as fewer calories consumed.  That is a reason why the lap band procedure has slower and less weight loss; it reduces the size of the stomach but doesn’t change absorption.  This of course depends on the assumption that calories are absorbed through the intestines! 

            At the seminar, I got the sense that most people were already pretty sold on the idea of the surgery, especially those of us on the heavier end of the scale.  Few people had any questions—versus my three!  Most questions were really about insurance coverage and cost.  I have been functioning as if my insurance will cover it—even if it takes them some time.  I might have a problem or delay because I don’t have a documented history of medically supervised weight loss attempts.  I wrote up an “essay” to address that, so maybe that will help.

            I have decided to keep taking the steps towards doing this.  I have the psychological evaluation on Monday and then the first meeting with Dr. Rizk on Tuesday.  I will give him my medical history then and have more opportunities for questions on a one-to-one.  The next step would be to start the two pre-operative meetings with the Mercy program.  I do want to make sure to ask the psychologist if he also does individual counseling.  That way if there are emotional/psychological issues to address that group meeting don’t seem to resolve I will at least have the name of someone who works with obese patients and should have some specialization or expertise. I also want to ask Dr. Rizk about a GP who is experienced in working with WLS patients. 

            I am trying to prepare myself and be realistic about what post-WLS will be like.  How will I spend my time that I used to fill with eating?  What will I really look like?  What is a realistic goal?  What kind of exercise program can I really do, both physically and motivationally?  I will be the same person with the same fears and foibles, so how will I address them?  Will I be even harder on myself out of fear of failure or can I learn to be moderate and balanced!  This seems to be about so much more than just weight loss. 

            I was thinking (in preparation for the psychological evaluation) about how I started overeating for the physical comfort and sensations provided by food in a stressful and emotionally unsafe world.  But I am still doing the same behaviors in a different environment.  I’m not saying that the world is wonderfully supportive, but it is not the threat it was in large part because I am not vulnerable or even needy in the same way.  I have resources that a small child does not have.  So the behavior is not needed in the same way, but it has become habit. 

            So, I need to develop strategies and resources to address key eating triggers: stress, boredom, emotional threats.  I do know that exercise is supposed to be good for stress reduction, and I have friends to call for emotional support (and as the weight comes off and I can return to church, that network should enlarge).  So I need to create some special exercise or physical treats (massages? facial or manicure at a beauty college?) to address stress. 

            But the boredom is more of a problem.  I can’t just go window shopping or such with my knees being what they are even with weight loss.  I can start knitting or needlepoint projects—although I need to keep the cost down.  I have the information on the dog/cat blankets.  Maybe I can do some of those.  Until I have a better sense of what I will weigh eventually, I don’t want to knit sweaters using my good yarn.  Although, I could develop my skills using cheaper yarn and knit the large size. 

            I can also develop a cleaning schedule to use my time.  If I can build up some strength and energy, that should help even if I only do thirty minutes at a time. 

            And there is always reading and the DISSERTATION! 

            Man, this is a lot of lifestyle changes.  But I have to be committed to this and those changes or I have no business having the surgery.  I like my life in some ways—the people I know, my job, the things I like to do, my “boys,” my mind.  But I don’t like how small it has become.  I don’t like not being able to go to events, movies, travel, church, etc. because I am ashamed of my weight or because I hurt.  So I need to think of the life changes as tools to enhance what I already like about my life and enable me to add the things that I can’t do.

            I keep thinking of the surgery as something that will give me a fighting chance for success.  But I still have to fight the fight.  I really think the emotional/psychological support will be as key as the surgery for me. 

            So why do I think I can make these life changes now when I haven’t been able to before?  Part of it goes back to how the surgery works and the psychological impact of the rapid weight loss.  The physical limitation of food intake and caloric absorption is one key thing.  Feeling lousy after surgery and the reported lack of interest in eating also seems to provide a window for “de-fooding” my life in terms of coping strategies.  Also, there is just the sense of obligation to be successful after undergoing such a drastic measure.  And the rapid weight loss is almost like getting a head start on the real weight loss work after the first twelve months.  So there are quick successes that provide encouragement. 

            The fact that this will require permanent changes in terms of food—I can’t go back to eating a whole pizza after six months.  I guess I need to ask about food cravings and if the physical changes due to the surgery helps in terms of those. 

            For me, having the ten post-op behavior sessions is a great thing in providing support to make and stick with the life changes.  And the support group. 

            Finally, I need to decide what to do about pre-operative weight loss.  Should I try to do Atkins since it emphasizes protein like the post-op diet will?  I know it is always good to lose weight and will help in terms of the surgery, but how will it impact the post-op weight loss?  I’m thinking in terms of metabolism, starvation mode, etc.  

I went to the orthopedic surgeon today and came away very discouraged.  There is next to no cartilage in my knees—he actually took x-rays—and there isn’t much to be done about it.  I was hoping to learn of some exercises or physical therapy I could do to improve it—and get some aerobic exercise in.  He said anything I do in that way would just make it worse.  And that even if I were to weigh 120 lbs. I would still be in pain.  I think that was the most discouraging thing.  I always thought, “If I just weighed less…” and imagined being able to go and do when I got thin.  I still think I might hurt less (hope springs eternal)! 

 

So it is on to medication—celebrex—if they approve it.  That could be up to 72 hours.  And then it takes three weeks to tell if it is helping.  And, of course, I am too young for the surgery even if I lost weight.  So now I need to find a form of aerobic exercise that I can do sitting down and not involving the knees in any way.  Not a happy camper.  I hope taking celebrex won’t interfere with the bariatric surgery.

I have continued to research and think about the bariatric surgery.  I am trying to be honest about both the risks and the problems of both the surgery and the following lifestyle.  I have been reading a lot of chat/bulletin board posts, but very few of them go past one to two years.  I want to learn about the maintenance lifestyle.  Will I essentially be on a high protein diet the rest of my life?  I do read how people come to tolerate some sugar.  So if I were to eat at a restaurant, I could eat some of an entrée even if it were not low fat and low carb?  What would my daily diet be?  Yogurt for breakfast, tuna salad for lunch, and a chicken thigh for supper?  A part of me sees this as a logical outcome for the process of devaluing food that I have tried to start. 

 

 

 

And what will I do with the extra time!  Eating has been a big part of my daily structure when at home.  If I spend nights at meetings or exercising, what becomes of Spenser?  In the spring and fall, I can walk him—which he wouldn’t mind, but I don’t see that happening in winter or summer.  If I commit 10 hours to work (including drive time) and 8 hours to sleep, that only leaves 6 hours to fill.  And take at least 2 hours in the morning, so that just gives me 4 hours daily to plan during the week.  Now the weekends will be another challenge.  But if I get to where I feel good and can move, then there are more options.  Right now I can barely work on my feet for 15 minutes at a time.  (Although today I did put away all the piled up laundry, changed out the litter box, and finished the rest of the laundry.  Even a little bit of weight loss off seems to help.)

 

 

 

As I think about all this, I think that why don’t I just start dieting again?  Why do the surgery when you can just imitate the diet none surgically?  But right now I am in the “flush” of anticipation and feel confident.  But what happens in six months when I am bored or craving food again?  And even if I were able to stick with it, would I have either the support system in place or the ability to keep it off?  That is one area where the statistics are on the side of the surgery.  The studies clearly show that diet and exercise alone are not likely to produce long term success for most morbidly obese people whereas the surgery has a significant percentage (and therefore more likely to include me) in long-term weight loss and maintenance. 

 

 

 

Also, I know that even if I were to lose the weight, I would still be hippy and “shoulderless.”  I would definitely do the plastic surgery—I’ll take mean ugly scars over drapes of skin any day.  If nothing else, people might assume I was in a car accident!  And it’s not like any would be seen except maybe the upper arm and inner thighs in summer or when swimming. 

 

 

 

But I am also trying to think in terms of the psychological effects.  I think about the stages of development and where I lack.  What challenges would becoming a “new” body present in terms of identity development?  If/when I move again, if the weight were off by then, what assumptions about social skills would people make?  When fat, no one expects me to socialize or understand much about interpersonal dynamics.  I guess in some ways not having a family or large support group helps in that there are not that many relationships I have to worry about.  I do worry about Sandi though.  Right now she is the healthier one—the one who pays attention to vegetarianism and exercise.  Would she struggle with her feelings and stay my friend or would she “dump” me because it is easier? 

 

 

 

This long weekend I am trying to eat just a normal serving size of food and stick with soup.  I did eat an egg McMuffin for breakfast (but gave about a third to Spenser).  Fareway will be closed Sunday and Monday, so I intentionally did not go there today.  This way I have to stick with just what I have in the house. 

 

 

 

I haven’t exercised today and I should.  I tried watching a seated exercise show this morning, but the lady had that “soft, gentle” (i.e. condescending) voice.  I need to watch my tape, but I think I will wind up getting some “seated dancing” DVDs I saw on Amazon.  Maybe that will improve my sense of rhythm as well as provide a workout!  I try to do some leg exercises as I sit every so often.  But I don’t want to push the legs and wind up paying big time.  I have discovered it is more difficult than I thought to “dance” to my own music for even 15 min.  I don’t know what to do that is actually exercise.  But at least I am moving for 15 minutes.  Every bit of increased movement should be of some benefit.

 

 

 

I have also thought about the need to learn how to breathe better.  I have always been a pretty shallow breather. I need to pull out my Andrew Weil book and read what he has.  If I remember correctly, he does have a chapter on breathing.  I should gather up all my diet/health books and create little library space for them!  If doing were as easy as reading! 

I spoke with Sandi last night about the surgery.  I know she has some substantial doubts about it both in terms of “theory” and real risks.  She questions whether the surgery does something physically necessary or if it is a “psychological surgery.”  Does the surgery provide some kind of psychology motivation that could be gained in a non-surgical way?  Also, is the growing popularity of a surgical solution to morbid obesity just an expression of our cultural hatred of fat people?  I think she is probably on to something in both of those concerns, but are they reason enough not to avail myself of the tool?  Clearly dieting on my own or even with Weight Watchers has not proven successful.  Maybe I do need a fear of throwing up or a belief that I “can’t” not follow the diet. 

            She raised the good point of asking if, in a worse case scenario, the problems I could gain would be better or worse than the problems I have now.  So if I feel nauseous all the time, is that better or worse than physically hurting all the time?  I guess the risks I am most concerned about (after spending the day researching on the internet) are 1) blood clot, 2) leak, 3) stricture, and 4) gallstones.  I already worry about blood clots in my legs, so I will definitely discuss that with the doctor.  Two and three have more to do with the doctor’s skill than me (but at least I don’t have a previous surgery to make things worse).  And from what I read, there is something I can take to help prevent gallstones.

            The other major risk related specifically to this surgery is malnutrition, but I don’t understand why if people get their protein and take their vitamins as instructed.  I will have to ask about this. 

            Sandi also asked why they make the pouch 2 oz. instead of, say, 6 oz.?  I would guess it has something to do with restricting the amount of food to a level that is severely low—which is what really causes the weight loss.

           

I am also concerned that because I have so much to lose, that I wouldn’t lose as much as I want.  I really want to be below 200 lbs. and below 50 lbs. overweight—so I can be simply overweight and not obese!  If the average weight loss is 70% of excess weight, that doesn’t meet either of those goals. I found on one site the breakdown of what to expect weight loss-wise:

 

 

I just want to make sure I wind up at the high end of the range!  So I am thinking that I need to start dieting and exercising now.  I am doing “okay” on the eating but still using fast food primarily and have started drinking more liquids.  But I think my real turn about needs to be in the area of movement.  I need to start exercising/moving.  This morning I did do about 20 minutes of stretching.  I figure I can talk to the orthopedist about exercise or even physical therapy.  If I can get approved for the surgery and then have it during the term break, maybe I can lose weight before then to improve my results. 

 

One behavior that I think I might have trouble with is slowing down and chewing everything to death!  And how do I get the protein in if I don’t feel hungry?  Are protein drinks supplemental to meals or instead of? 

 

I have to admit, I am getting excited about the possibility and do hope that I am approved without much delay.  I can’t see being able to do the surgery before school starts, so the first term break would be the next option. But I don’t want to get ahead of myself (oh yes I do!)

 

Sandi was so sweet to say she would come and be with me during the surgery if this is something I do.  I wonder how me losing a significant amount of weight would affect our friendship? 

I received information from the bariatric surgeon in Omaha yesterday and was a bit put off by it. It just seemed very cold and impersonal. It didn’t encourage me or make me think they would be sensitive to my fears. But while looking for an orthopedist in the yellow pages, I discovered that there is a local bariatric surgeon after all over in the Dunes. So this morning I called there about their seminar, which meets on the 18th. The woman I spoke with was actually friendly and had information. So I think I will go to that one instead. One major concern I have has to do the “open” surgery rather than the laparoscopic. I am nervous enough without having to think about a huge scar and six weeks of recovery. I guess I want to keep the surgery private and I can get away with two weeks off work during the break but can’t see a time for six weeks off. Also, having to take care of myself seems a lot easier with the laparoscopic. I have a BMI of 66.4 which is at the high end of the eligibility, but she said that since I carry my weight all over, I could still be a candidate. Also, maybe I can lose some weight before surgery. The fact that I’ve never had surgery is also a factor in my favor. She also had some good news about the insurance. It seems that mine is pretty good about paying for the surgery, but I will need to document that I have been overweight for more than three years. I need to find out the contact information on BGSU’s clinic where they would have my weight, and maybe even dig up the information on the doctor I went to in Bowling Green. I have some pictures—but I tend to not keep pictures of me! I did call about my insurance total out-of-pocket and it is $950 ($200 of which is the deductible). I would need to pay them $500 up front and Mercy $300. But $950 isn’t bad for a surgery that the internet says can run $25,000. After the first seminar in July, I would find out if I could do the laparoscopic. Then I would make an appointment for a small group session and evaluation. There are two pre-op meetings with a physical therapist and someone else. Then there are twelve sessions, again two pre-op, with I think a nutritionist. Somewhere in there I think there is a behaviorist. But there is also a support group that meets twice a month. I guess what made me start thinking more seriously about doing the surgery is when I checked out the TOPS website about a support group and saw that all four of their top winners for weight loss had weight loss surgery. I guess it is difficult for me to face the fact that I cannot do this on my own—and my fears that I will “blow” this as well. But in thinking about it, I’ve come to the realization that I tend to do well when I have a good support system—when I think people care about me. I’ve been pretty good at following advice when I’ve asked for it and I’ve always been responsive to counseling. So if this procedure can start me on that path and give me access to support personnel, then that is a positive thing. I think about whether I will be able to say no to myself—and to make it through the weeks of not eating. But I have become more and more disenchanted with food—even though I still overeat. I don’t want to shop or cook, so the idea of eating/drinking easily prepared (eggs) or prepared liquids seems okay. I figure I will always need to be in some type of support group though. In considering why I want to do this, I guess it comes down to a couple of things. First, I am so tired of hurting! I am becoming physically disabled because of my weight. I avoid too many things because of even short walking or standing time. And I hurt just sitting! I can’t sleep the night through because of my knees hurting. I want to be able to ride a bike, go out in public without shame, to play with my dog, even walk around the block. I am old enough that I am starting to be afraid about dying alone in my bed. I am unable to do even basic things like cleaning and for once not because I don’t want to! I have also made an appointment with an orthopedic surgeon even though I don’t think there is anything he will do for me. I know my weight will play a huge roll in that, but maybe it can support my need for the surgery and/or provide me with some temporary relief while I am losing weight. So I am checking out online support sites and reading up on things. I have to say that after talking with Sandi this morning, I am more hopeful than I have been. I guess I can see how I am slowly making my way to this decision. I wonder if I can get the surgery done between 1st and 2nd term?