sl1pp1nghalo
PHASE #8
Mar 23, 2009
OK ITS BEEN A FEW WEEKS SINCE I HAVE POSTED MEANING IVE HAD 2 MORE SESSIONS WITH MY PSHY FOR DIETARY
LAST WEEKS WAS PRETTY MOUCH A RUTINE VIST DIDNT REALLY GO OVER ANYTHING NEW BUT A POUCH TEST FOR DUMMIES ARTICAL I FOUND ON THE WEB THAT I TOK N TO HER WE BOTH FOUND IT VERY INTERESTING AND I WILL POST IT AT THE END OF THE BLOG FOR ALL THAT ARE INTERESTED REALLY IS A GOOD READ
UMMM OK LAST WEEK I HAD MY #4 VISIT OF THE 6 IM REQUIRED TO DO ALL WENT SAME OH SAME OH TILL THE END OF THE SESSION SHE GAVE ME SOME HOMEWORK TO DO IM THINKING OMG I HAD THIS STUFF I ALWAYS FEEL THAT WITH HER BEING A SHRINK AND ALL THAT WHATEVER I WRIGHT IS GOING TO BE PICKED TO DEATH TO FIND SOME DARK SECRETS I HAVE HIDDEN INSIDE ME LOL BUT ANYWAYS THE FIRST THING ON THE PAPER WAS I HAD TO GIVE 4 ANSWERS TO THE QUESTION WITHOUT MY CONFLICTS ABOUT MY BODY AND FOOD, MY LIFE WOULD BE ????
MY FIRST THOUGHT WAS MY LIFE WILL NEVER BE WITHOUT THESE CONFLICTS WE ALL HAVE BODYS THAT NEED TO EAT TO LIVE AND HAVE TO ON A DAILY BASES THINK OF WHAT WE ARE PUTTING IN OUR MOUTHS TO LIVE HEALTHY RIGHT? SO I THOUGHT SHE WANTS HONEST ANSWERS HERE SO I WROTE THAT OFF TO THE SIDE THEN ANSWERED THE 4 AS FOLLOWS
1) MY LIFE WOULD BE IN BETTER HEALTH
2) MY LIFE WOULD MORE ACTIVE WITH MY FAMILY
3) MY LIFE WOULD BE EASIER TO EXERCISE HAVING MORE MOBILITY
4) MY LIFE WOULD BE EAISER TO ENJOY WITH LESS WORRYS ABOUT FITTING IN OR ON THINGS.
THE SECOUND QUESTION ON IT WAS WHOM DID YOU GET THE MESSAGE THE IT WAS UNACCEPTABLE TO BE YOURSELF?
AND ASKED ME TO CHECK EITHER MY MOTHER MY FATHER MY BROTHER SISTER GRANDPARENT FRIEND LOVER ECT. BUT IN ALL THE ONES TO CHOOSE MINE WAS NOT THERE SOCIETY SO I WROTE A BOX FOR IT AND CHECKED IT THE NEXT PART OF THE QUESTION ASKED TO LIST THE MESSAGES I HAD RECEIVED AND THIS IS HOW I ANSWERED IT
I DONT REALLY GET MESSAGES FROM ONE PERSON OR EVEN A FEW PEOPLE ID HAVE TO SAY SOCIETY AS A WHOLE WE ARE RAISED IN A SOCIETY WERE OVER WEIGHT PEOPLE ARE NOT ACCEPTED FOR WHOM THEY ARE BUT FROWNED ON FOR THERE SIZE. WE GET ALL KINDS OF MESSAGES FROM TV COMMERCIALS ADVERTISMENTS, MAGAZINES, EVEN CHILDHOOD TOYS SUCH AS BARBI AND KEN DOLLS WHO HAVE UNREALISTIC SIZE PREPORTIONS IF THEY WERE REAL PEOPLE THE OBVIOUS MESSAGE THEY SEND US IS SKINNY IS BEAUTIFUL AND FAT IS UGLY
I GO TO SEE HER FOR MY #5 VISIT TOMORROW AND IM WONDERING WHAT SHE WILL SAY ABOUT MY ANSWERS BUT I GUESS TIME WILL TELL LOL WELL THATS IT FOR NOW ILL TRY TO WRITE MORE TOMORROW AND POST WHAT SHE HAD TO SAY TILL THEN ......
Pouch Rules for Dummies
INTRODUCTION:
A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren’t really trying to lose weight. The truth is it may be because they haven’t learned how to get the satisfied feeling of being full to last long enough.
HYPOTHESIS OF POUCH FUNCTION:
We have four educated guesses as to how the pouch works:
1. Weight loss occurs by actually slightly stretching the pouch with food at each meal or;
2. Weight loss occurs by keeping the pouch tiny through never ever overstuffing or;
3. Weight loss occurs until the pouch gets worn out and regular eating begins or;
4 Weight loss occurs with education on the use of the pouch.
PUBLISHED DATA:
How does the pouch make you feel full?
The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness.
What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal?
For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs.
We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible.
OBSERVATIONAL BASED MEDICINE:
The information here is taken from surgeon’s “observations” as opposed to “blind” or “double blind” studies, but it IS based on 33 years of physician observation.
Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage as I was able to follow my patients closely. The following are what I found to effect how the pouch works:
1. Getting a sense of fullness is the basis of successful WLS.
2. Success requires that a small pouch is created with a small outlet.
3. Regular meals larger than 1 ½ cups will result in eventual weight gain.
4. Using the thick, hard to stretch part of the stomach in making the pouch is important.
5. By lightly stretching the pouch with each meal, the pouch send signals to the brain that you need no more food.
6. Maintaining that feeling of fullness requires keeping the pouch stretched for awhile.
7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears.
8. Incredible hunger will develop if there is no food or drink for eight hours.
9. After 1 year, heavier food makes the feeling of fullness last longer.
10. By drinking water as much as possible as fast as possible (“water loading”), the patient will get a feeling of fullness that lasts 15-25 minutes.
11. By eating “soft foods” patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain.
12. The patients that follow “the rules of the pouch” lose their extra weight and keep it off.
13. The patients that lose too much weight can maintain their weight by doing the reverse of the “rules of the pouch.”
HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE:
By following the “rules of the pouch”, it doesn’t matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved.
OUTLET SIZE:
Regardless of the outlet size, liquidy foods empty faster than solid foods. High calorie liquids will create weight gain.
EARLY PROFOUND SATIETY:
Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full.
After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time.
OPTIMUM MATURE POUCH:
The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 ½ cups at a time.
IDEAL MEAL PROCESS (rules of the pouch):
1. The patient must time meals five hours apart or the patient will get too hungry in between.
2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal.
3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure.
4. No liquids for 1 ½ hours to 2 hours after each meal.
5. After 1 ½ to 2 hours, begin sipping water and over the next three hours slowly increase water intake.
6. 3 hours after last meal, begin drinking LOTS of water/fluids.
7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called “water loading.” IF YOU HAVEN’T BEEN DRINKING OVER THE LAST FEW HOURS, THIS ‘WATER LOADING’ WILL NOT WORK.
8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
THE MANAGEMENT OF PATIENT TEACHING AND TRAINING:
You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective.
NECESSITY FOR LONG TERM FOLLOW-UP:
Trying to practice the “rules of the pouch” before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn’t work. The real work of learning the “rules of the pouch” begins after healing has caused hunger to return.
PREVENTION OF VOMITING:
Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick.
It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient’s mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth.
In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting.
Vomiting will occur only after eating of solid foods begins. Rice, pasta, granola, etc. will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when “comfortably satisfied,” until the patient learns the size of his/her pouch.
SIX WEEKS
After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 ½ hours after meals.
REASSURANCE OF ADEQUATE NUTRITION
By taking vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on proteins and vegetables at each meal.
MEAL SKIPPING
Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two oz of protein at each meal.
ARTIFICIAL SWEETENERS
In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets.
AVOIDING ABSOLUTES
Rules are made to be broken. No biggie if the patient drinks with one meal – as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party – that’s OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up.
THREE MONTHS
At three months, the patient needs to become aware of the calories per gram of different foods to be aware of “the cost” of each gram. (cheddar cheese is 16 cal/gram; peanut butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures.
THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY
1. Fill pouch full quickly at each meal.
2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 ½ hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours.
3. Protein, protein, protein. Three meals a day. No high calorie liquids.
FLUID LOADING
Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz.
Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time.
POST PRANDIAL THIRST
It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won’t make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow.
URGENCY
The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time.
SIX MONTHS
Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat.
INTAKE INFORMATION SHEET AS A TEACHING TOOL
I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them “back on track.” Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to “get it”, and a small percentage never quite understand these rules, even though they are quite intelligent people.
HONEYMOON SYNDROME
The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don’t need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the “honeymoon syndrome” and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient’s weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track.
EXERCISE
In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down.
THE IDEAL MEAL FOR WEIGHT LOSS
The ideal meal is one that is made up of the following: ½ of your meal to be low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health.
VOLUME VS. CALORIES
The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don’t worry about calories. This is the easiest way to “count your calories.” For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings – it would stuff them way too much.
ISSUES FOR LONG TERM WEIGHT MAINTENANCE
Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off.
COUNTER-INTUITIVENESS OF FLUID MANAGEMENT
I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a “soup” in the stomach that is easily digested.
SUPPORT GROUPS
It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others “get it” and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a “peer pressure” to stick to the rules that the staff at the physician’s office simply can’t create.
TEETER TOTTER EFFECT
Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left.
Now if you don’t concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh.
TOO MUCH WEIGHT LOSS
I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially “break the rules” of the pouch. Drink with meals so they can eat snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories.
A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don’t “get” that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger.
BARIATRIC MEDICINE
A much more common problem is patients who after a year or two plateau at a level above their goal weight and don’t lose as much weight as they want. Be careful that they are not given the “regular” advice given to any average overweight individual. Several small meals or skipping a meal with a liquid protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets.
SUMMARY
1. The patient needs to understand how the new pouch physically works.
2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes.
3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch.
The goal is for the patient to become an expert on how to use the pouch.
EVALUATION FOR WEIGHT LOSS FAILURE
The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up.
1. the staple line needs to be intact;
2. same with the outlet and;
3. the pouch is reasonably small.
1) Use thick barium to confirm the staple line is intact. If it isn’t, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut.
2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call “soft calorie syndrome.” This
causes frequent hunger and grazing, which leads to weight regain.
3) To assess pouch volume, an upper GI doesn’t work as it is a liquid. The cottage cheese test is useful – eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn’t be able to hold more than 1 ½ cups in 5 – 15 minutes of quick eating.
If everything is intact then there are four problems that it may be:
1) The patient has never been taught the rules;
2) The patient is depressed;
3) The patient has a loss of peer support and eventual forgetting of rules, or
4) The patient simply refuses to follow the rules.
LACK OF TEACHING
An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago.
DEPRESSION
Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for awhile only to return having gained a lot of
weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression.
A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly.
If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry.
EROSION OF THE USE OF PRINCIPLES:
Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their “new” life surrounded by those who have not had bariatric surgery. Everything around them encourages them to live life “normal” like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician’s office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer “refresher courses” for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again.
TRUE NON-COMPLIANCE:
The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no ‘connection’ between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude.
A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven’t figured out how to do that yet… Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.
0 comments
LAST WEEKS WAS PRETTY MOUCH A RUTINE VIST DIDNT REALLY GO OVER ANYTHING NEW BUT A POUCH TEST FOR DUMMIES ARTICAL I FOUND ON THE WEB THAT I TOK N TO HER WE BOTH FOUND IT VERY INTERESTING AND I WILL POST IT AT THE END OF THE BLOG FOR ALL THAT ARE INTERESTED REALLY IS A GOOD READ
UMMM OK LAST WEEK I HAD MY #4 VISIT OF THE 6 IM REQUIRED TO DO ALL WENT SAME OH SAME OH TILL THE END OF THE SESSION SHE GAVE ME SOME HOMEWORK TO DO IM THINKING OMG I HAD THIS STUFF I ALWAYS FEEL THAT WITH HER BEING A SHRINK AND ALL THAT WHATEVER I WRIGHT IS GOING TO BE PICKED TO DEATH TO FIND SOME DARK SECRETS I HAVE HIDDEN INSIDE ME LOL BUT ANYWAYS THE FIRST THING ON THE PAPER WAS I HAD TO GIVE 4 ANSWERS TO THE QUESTION WITHOUT MY CONFLICTS ABOUT MY BODY AND FOOD, MY LIFE WOULD BE ????
MY FIRST THOUGHT WAS MY LIFE WILL NEVER BE WITHOUT THESE CONFLICTS WE ALL HAVE BODYS THAT NEED TO EAT TO LIVE AND HAVE TO ON A DAILY BASES THINK OF WHAT WE ARE PUTTING IN OUR MOUTHS TO LIVE HEALTHY RIGHT? SO I THOUGHT SHE WANTS HONEST ANSWERS HERE SO I WROTE THAT OFF TO THE SIDE THEN ANSWERED THE 4 AS FOLLOWS
1) MY LIFE WOULD BE IN BETTER HEALTH
2) MY LIFE WOULD MORE ACTIVE WITH MY FAMILY
3) MY LIFE WOULD BE EASIER TO EXERCISE HAVING MORE MOBILITY
4) MY LIFE WOULD BE EAISER TO ENJOY WITH LESS WORRYS ABOUT FITTING IN OR ON THINGS.
THE SECOUND QUESTION ON IT WAS WHOM DID YOU GET THE MESSAGE THE IT WAS UNACCEPTABLE TO BE YOURSELF?
AND ASKED ME TO CHECK EITHER MY MOTHER MY FATHER MY BROTHER SISTER GRANDPARENT FRIEND LOVER ECT. BUT IN ALL THE ONES TO CHOOSE MINE WAS NOT THERE SOCIETY SO I WROTE A BOX FOR IT AND CHECKED IT THE NEXT PART OF THE QUESTION ASKED TO LIST THE MESSAGES I HAD RECEIVED AND THIS IS HOW I ANSWERED IT
I DONT REALLY GET MESSAGES FROM ONE PERSON OR EVEN A FEW PEOPLE ID HAVE TO SAY SOCIETY AS A WHOLE WE ARE RAISED IN A SOCIETY WERE OVER WEIGHT PEOPLE ARE NOT ACCEPTED FOR WHOM THEY ARE BUT FROWNED ON FOR THERE SIZE. WE GET ALL KINDS OF MESSAGES FROM TV COMMERCIALS ADVERTISMENTS, MAGAZINES, EVEN CHILDHOOD TOYS SUCH AS BARBI AND KEN DOLLS WHO HAVE UNREALISTIC SIZE PREPORTIONS IF THEY WERE REAL PEOPLE THE OBVIOUS MESSAGE THEY SEND US IS SKINNY IS BEAUTIFUL AND FAT IS UGLY
I GO TO SEE HER FOR MY #5 VISIT TOMORROW AND IM WONDERING WHAT SHE WILL SAY ABOUT MY ANSWERS BUT I GUESS TIME WILL TELL LOL WELL THATS IT FOR NOW ILL TRY TO WRITE MORE TOMORROW AND POST WHAT SHE HAD TO SAY TILL THEN ......
Pouch Rules for Dummies
INTRODUCTION:
A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren’t really trying to lose weight. The truth is it may be because they haven’t learned how to get the satisfied feeling of being full to last long enough.
HYPOTHESIS OF POUCH FUNCTION:
We have four educated guesses as to how the pouch works:
1. Weight loss occurs by actually slightly stretching the pouch with food at each meal or;
2. Weight loss occurs by keeping the pouch tiny through never ever overstuffing or;
3. Weight loss occurs until the pouch gets worn out and regular eating begins or;
4 Weight loss occurs with education on the use of the pouch.
PUBLISHED DATA:
How does the pouch make you feel full?
The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness.
What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal?
For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs.
We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible.
OBSERVATIONAL BASED MEDICINE:
The information here is taken from surgeon’s “observations” as opposed to “blind” or “double blind” studies, but it IS based on 33 years of physician observation.
Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage as I was able to follow my patients closely. The following are what I found to effect how the pouch works:
1. Getting a sense of fullness is the basis of successful WLS.
2. Success requires that a small pouch is created with a small outlet.
3. Regular meals larger than 1 ½ cups will result in eventual weight gain.
4. Using the thick, hard to stretch part of the stomach in making the pouch is important.
5. By lightly stretching the pouch with each meal, the pouch send signals to the brain that you need no more food.
6. Maintaining that feeling of fullness requires keeping the pouch stretched for awhile.
7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears.
8. Incredible hunger will develop if there is no food or drink for eight hours.
9. After 1 year, heavier food makes the feeling of fullness last longer.
10. By drinking water as much as possible as fast as possible (“water loading”), the patient will get a feeling of fullness that lasts 15-25 minutes.
11. By eating “soft foods” patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain.
12. The patients that follow “the rules of the pouch” lose their extra weight and keep it off.
13. The patients that lose too much weight can maintain their weight by doing the reverse of the “rules of the pouch.”
HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE:
By following the “rules of the pouch”, it doesn’t matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved.
OUTLET SIZE:
Regardless of the outlet size, liquidy foods empty faster than solid foods. High calorie liquids will create weight gain.
EARLY PROFOUND SATIETY:
Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full.
After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time.
OPTIMUM MATURE POUCH:
The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 ½ cups at a time.
IDEAL MEAL PROCESS (rules of the pouch):
1. The patient must time meals five hours apart or the patient will get too hungry in between.
2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal.
3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure.
4. No liquids for 1 ½ hours to 2 hours after each meal.
5. After 1 ½ to 2 hours, begin sipping water and over the next three hours slowly increase water intake.
6. 3 hours after last meal, begin drinking LOTS of water/fluids.
7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called “water loading.” IF YOU HAVEN’T BEEN DRINKING OVER THE LAST FEW HOURS, THIS ‘WATER LOADING’ WILL NOT WORK.
8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
THE MANAGEMENT OF PATIENT TEACHING AND TRAINING:
You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective.
NECESSITY FOR LONG TERM FOLLOW-UP:
Trying to practice the “rules of the pouch” before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn’t work. The real work of learning the “rules of the pouch” begins after healing has caused hunger to return.
PREVENTION OF VOMITING:
Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick.
It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient’s mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth.
In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting.
Vomiting will occur only after eating of solid foods begins. Rice, pasta, granola, etc. will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when “comfortably satisfied,” until the patient learns the size of his/her pouch.
SIX WEEKS
After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 ½ hours after meals.
REASSURANCE OF ADEQUATE NUTRITION
By taking vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on proteins and vegetables at each meal.
MEAL SKIPPING
Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two oz of protein at each meal.
ARTIFICIAL SWEETENERS
In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets.
AVOIDING ABSOLUTES
Rules are made to be broken. No biggie if the patient drinks with one meal – as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party – that’s OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up.
THREE MONTHS
At three months, the patient needs to become aware of the calories per gram of different foods to be aware of “the cost” of each gram. (cheddar cheese is 16 cal/gram; peanut butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures.
THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY
1. Fill pouch full quickly at each meal.
2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 ½ hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours.
3. Protein, protein, protein. Three meals a day. No high calorie liquids.
FLUID LOADING
Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz.
Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time.
POST PRANDIAL THIRST
It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won’t make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow.
URGENCY
The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time.
SIX MONTHS
Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat.
INTAKE INFORMATION SHEET AS A TEACHING TOOL
I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them “back on track.” Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to “get it”, and a small percentage never quite understand these rules, even though they are quite intelligent people.
HONEYMOON SYNDROME
The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don’t need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the “honeymoon syndrome” and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient’s weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track.
EXERCISE
In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down.
THE IDEAL MEAL FOR WEIGHT LOSS
The ideal meal is one that is made up of the following: ½ of your meal to be low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health.
VOLUME VS. CALORIES
The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don’t worry about calories. This is the easiest way to “count your calories.” For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings – it would stuff them way too much.
ISSUES FOR LONG TERM WEIGHT MAINTENANCE
Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off.
COUNTER-INTUITIVENESS OF FLUID MANAGEMENT
I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a “soup” in the stomach that is easily digested.
SUPPORT GROUPS
It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others “get it” and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a “peer pressure” to stick to the rules that the staff at the physician’s office simply can’t create.
TEETER TOTTER EFFECT
Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left.
Now if you don’t concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh.
TOO MUCH WEIGHT LOSS
I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially “break the rules” of the pouch. Drink with meals so they can eat snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories.
A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don’t “get” that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger.
BARIATRIC MEDICINE
A much more common problem is patients who after a year or two plateau at a level above their goal weight and don’t lose as much weight as they want. Be careful that they are not given the “regular” advice given to any average overweight individual. Several small meals or skipping a meal with a liquid protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets.
SUMMARY
1. The patient needs to understand how the new pouch physically works.
2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes.
3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch.
The goal is for the patient to become an expert on how to use the pouch.
EVALUATION FOR WEIGHT LOSS FAILURE
The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up.
1. the staple line needs to be intact;
2. same with the outlet and;
3. the pouch is reasonably small.
1) Use thick barium to confirm the staple line is intact. If it isn’t, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut.
2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call “soft calorie syndrome.” This
causes frequent hunger and grazing, which leads to weight regain.
3) To assess pouch volume, an upper GI doesn’t work as it is a liquid. The cottage cheese test is useful – eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn’t be able to hold more than 1 ½ cups in 5 – 15 minutes of quick eating.
If everything is intact then there are four problems that it may be:
1) The patient has never been taught the rules;
2) The patient is depressed;
3) The patient has a loss of peer support and eventual forgetting of rules, or
4) The patient simply refuses to follow the rules.
LACK OF TEACHING
An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago.
DEPRESSION
Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for awhile only to return having gained a lot of
weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression.
A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly.
If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry.
EROSION OF THE USE OF PRINCIPLES:
Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their “new” life surrounded by those who have not had bariatric surgery. Everything around them encourages them to live life “normal” like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician’s office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer “refresher courses” for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again.
TRUE NON-COMPLIANCE:
The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no ‘connection’ between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude.
A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven’t figured out how to do that yet… Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.
PHASE #7
Mar 06, 2009
WELL ON MARCH 2 I GOT A LETTER FROM HURLEY SAYING THAT I HAD TO DO MY 12 VISITS TO A PSYH BEFORE I COULD HAVE SURGERY AND I WAS NOT HAPPY ABOUT IT SO I CALLED THEM TO ASK WHY CAUSE I HAVE A APPROVAL FROM HIM IN ONE PARAGRAPH AND THEN HE STATED I NEEDED THEM IN THE NEXT J FROM HURLEY TOLD ME THAT IT WAS OK CAUSE I WAS DOING MY SESSIONS FOR DIETARY ALREADY WITH THE OTHER PSYH AND IF SHE SIGNED OFF ON ME THAT WOULD BE FINE ....THANK GOD SESSIONS ARE NOT CHEAP FOR ME SO ON MARCH 5TH I WENT TO SEE MY PSYH AND TOLD HER WHAT HAD HAPPENED AND GAVE HER A COPY OF MY PSYH EVALUATION FROM THE FIRST QUACK SHE READ OVER IT AND TOLD ME I ACTUALLY HAD A VERY GOOD PSYH EVALUATION I SAID GOOD THAT MEANS I'M NOT CRAZY RIGHT SHE SAID NO AND WE BOTH LAUGHED AND SHE SAID THAT I WOULD HAVE NOTHING TO WORRY ABOUT THAT I WAS DOING A GREAT JOB IN HER EYES I WAS SO RELIEVED TO HERE THAT I NEEDED NOT TO SPEND ALL THAT EXTRA MONEY FOR 6 MORE SESSIONS
SO AT THIS POINT I'M FEELING GOOD NED TO STOP SMOKING NOW BEEN CUTTING BACK BUT I SWEAR ITS THE HARDEST THING I'VE EVER DONE WELL I GUESS THAT'S IT FOR NOW TILL NEXT VISIT WITH MY PSYH..... WOOOHOOO ONLY 3 MORE TO GO
0 comments
SO AT THIS POINT I'M FEELING GOOD NED TO STOP SMOKING NOW BEEN CUTTING BACK BUT I SWEAR ITS THE HARDEST THING I'VE EVER DONE WELL I GUESS THAT'S IT FOR NOW TILL NEXT VISIT WITH MY PSYH..... WOOOHOOO ONLY 3 MORE TO GO
PHASE #6
Feb 26, 2009
ITS NOW FEBRUARY 24TH AND I GOT UP THIS MORNING AND CALLED HURLEY TO SEE IF MY PSYCH RESULTS WERE IN AND IF EVERYTHING WAS OK THEY SAID THEY HAD NOT RECEIVED IT YET SO I CALLED THE PSYCH OFFICE AND SHE SAID SHE NEEDED TO HAVE A MEDICAL RELEASE FROM FILLED OUT SO THEY COULD FAX IT OVER SO I SAID WAIT TILL I GET TO WORK AND ILL CALL YOU AND YOU CAN FAX ONE OVER AND ILL FAX IT BACK SO I WENT TO WORK AND THATS WHAT I DID AND 5 MIN AFTER I FAXED IT BACK TO HER SHE CALLED ME AND SAID THAT SHE SENT THE WRONG FROM OVER AND THAT WE HAD TO DO IT AGAIN I SAID OK GOT OFF THE PHONE THINKING WOW THAT OFFICE REALLY HAS ISSUES I'M GLAD I'M THRU WITH THEM (DON'T KNOW IF I MENTIONED THAT THIS WAS NOT THE PSYCH I WAS SEEING NOW DIFFERENT ONE) WELL WHEN I GOT HOPE FROM WORK THAT NIGHT I GOT MY PSYCH EVAL IN THE MAIL OPENED IT AND IT READ REAL FUNNY TO ME IN ONE PARAGRAPH IT READ I DO NOT SEE ANY MENTAL HEALTH ISSUES WHICH WOULD DISQUALIFY THIS EXAMINEE FROM WEIGHT LOSS SURGERY. AND IN THE VERY NEXT PARAGRAPH SAY THIS PATIENT WILL NEED TO COMMIT TO AND PARTICIPATE IN A MINIMUM OF 12 INDIVIDUAL THERAPY SESSIONS PRIOR TO HER SURGERY AND A MINIMUM OF 12 MONTHS POST SURGICAL I WAS LIKE WHAT I'M FINE AND HAVE NO ISSUES BUT YOU STILL WANT ME TO COME SEE YOU FOR 12 SESSIONS BEFORE SURGERY????? DIDN'T MAKE SENSE AND I WAS MAD AS H E DOUBLE HOCKEY STICKS THINKING THIS QUACK JUST WANTS MY MONEY AND I'M NOT HAVING IT AGAIN GOT SUCKERED INTO 6 SESSIONS ALREADY CAUSE OF SOMETHING STUPID ON BOTH MY PART AND HURLEYS AND OF COURSE IT WAS TO LATE TO CALL HURLEY TO SEE IF THIS MENT WHAT I THOUGHT IT DID SO I GOT NO SLEEP THAT NIGHT WORRYING ABOUT IT AND CALLED FIRST THING IN THE MORNING ON FEBRUARY 25TH AND THE LADY HANDLING MY CASE SAID MY FILE WAS ON THE SURGEONS DESK TO SIGN OFF ON THE PSYCH EVAL AND SHE WOULDN'T KNOW ANYTHING TILL THE NEXT DAY I WAS SO FRUSTRATED, STRESSED, TIRED AND MAD AT THE WORLD THAT DAY BUT NOTHING I COULD DO BUT SIT AND WAIT!!! AND ONCE AGAIN ANOTHER NIGHT OF NO SLEEP UP WORRYING AGAIN CALLED HURLEY ON FEBRUARY 26TH AND THE LADY HANDLING MY CASE SAID THEY GOT PSYCH EVAL AND I WAS ALL SET I ASKED IF THERE WAS ANY PROBLEMS WITH THE EVAL AND SHE SAID WELL HE RECOMMENDED THAT YOU SEE HIM FOR SOME VISITS BUT SINCE YOUR SEEING OUR PSYCH YOUR ALREADY DOING THAT NOW AND IF SHE SIGNS OFF ON YOU WHEN THE 6 VISITS ARE THRU THAT SHOULD BE FINE I'M LIKE SWEET I WAS SO REJOICED AND RELIEVED EVEN DID A HAPPY DANCE LOL NOW THAT I'M OVER THAT HURTLE HOPEFULLY ONLY A FEW MORE STEPS AND ILL BE THERE
0 comments
PHASE #5
Feb 26, 2009
OK ITS FEBRUARY 23 BEEN A TOTAL OF 3 WEEKS SINCE IVE STARTED MY TRAINING I CALL IT (I HATE THE DIET WORD)FOR MY NEW LIFE STYLE THINGS HAVE ACTUALLY BEEN NOT TO BAD I'M GETTING THE WATER DOWN WITH NO PROBLEMS THEN ALLOW MYSELF MY CRYSTAL LIGHT AFTER THAT I BOUGHT THIS 32OZ JUG SO I KNOW WHEN IVE DONE 2 ITS FLAVOR TIME LOL 3 0Z MEAT PORTIONS ARE OK HARD NOT TO HAVE MORE WHEN ITS SOMETHING I REALLY LIKE ONLY ALLOWED 1/2 C OF POTATO'S AND WHEN I MEASURED THIS OUT I WAS LIKE OMG THEY GOT TO BE KIDDING LOL SO I DON'T EVEN BOTHER WITH THEM THAT WOULD BE LIKE TEASING MY TASTE BUDS THE ONLY THING THAT IS REAL HARD FOR ME IS MY BREAD ONLY CAN HAVE 2 SLICES A DAY AND THAT'S HARD IF YOU WANT TOAST AND THEN A SANDWICH UMMMM AS FAR AS THE PROTEIN SHAKES I AGREE WITH MY PSYCH VANILLA IS THE BEST I MIX IT WITH MY CRYSTAL LIGHT OR FROZEN FRUIT AND SPLENDA AND YUM!!!! IT TASTE LIKE IS SINFUL LOL GAVE UP ALL POP HAVEN'T EVEN WANTED IT BUT BY FAR THE HARDEST THING IS NOT DRINKING WHILE I'M EATING I DON'T KNOW HOW PEOPLE DO THIS ITS LIKE TORCHER VERY VERY HARD STILL NEED WORK ON THIS ONE I'M TAKING SMALL PEA SIZE BITES AND CHEWING REALLY GOOD FOR TREATS I GOT SUGAR FREE PUDDING, JELLO, POPSICLES, COOL WHIP AND ALSO SOME STRING CHEESE ALL IN ALL ITS NOT BAD AND MY HUNGER SEEMS TO BE OK WITH THE CHANGE HAVEN'T FELL OFF THE WAGON ON IT IVE BEEN LOGGING WHAT I EAT EVERYDAY AND IN 3 WEEKS I'M DOWN FROM 318 TO 307 THAT'S 11 POUNDS BABY LOL WENT TO SEE PSYHC FOR MY SECOND VISIT SHE BASICALLY LOOKED OVER MY JOURNALS MADE A FEW DIFFERENT SUGGESTIONS ON DIFFERENT WAYS TO MAKE MEAT AND HOW TO GET CREATIVE WITH CHICKEN AND FISH LIKE TACOS FAJITAS ETC TOLD ME I WAS ON THE RIGHT TRACK AND EVERYTHING LOOKED GOOD AND THAT THIS WEEK SHE WOULD LIKE ME TO ADD EMOTION TO MY JOURNALS TO SEE HOW MUCH THEY PLAY ON WHEN WE EAT I WAS LIKE I CAN DO THAT BUT YOU KNOW ITS REALLY HARD MAYBE JUST FOR ME CAUSE I'M A REAL HAPPY PERSON AND I'M NOT THE TYPE TO SAY I'M REALLY MAD I NEED A BURGER OR WHATEVER ONLY THING I CAN COME UP WITH IS HAPPY WHEN ITS A DISH I REALLY LIKE OR BOARD SO ILL GRAB A MUNCHY AND I'M ALSO A BIG TV MUNCHER TO WELL ALL I CAN DO IS WRITE WHAT I FEEL HOPE ITS WHAT SHE IS LOOKING FOR I WILL SEE HER NEXT THUR MARCH 5 SORRY IF A BABBLED IN THIS ONE LOL BEEN A LONG DAY SORRY!!!! TILL NEXT TIME......
0 comments
PHASE #4
Feb 26, 2009
OK SO ITS FEBRUARY 2 AND I M MAD AND SCARED AND STRESSED OUT THAT I HAVE TO GO SEE THIS PSYCH I WALK INTO HER OFFICE AND FIRST THING THEY WANT IS WHAT???? A BOAT LOAD OF PAPERWORK FILLED OUT YOU WOULD THINK THEY WOULD JUST SEND IT OVER WITH THE REFERRAL BUT THAT WOULD BE TO EASY HUH LOL ANYWAYS I FILL IT OUT AND PAY MY GOD AWFUL BILL AND SIT AND WAIT LOOKING AROUND I NOTICE A SIGN THAT READ IF YOU HAVE BEEN WAITING LONGER THEN 10 MIN TELL THE GIRL AT THE DESK I'M THINKING OK AT LEAST ILL GET IN A TIMELY FASHION AND GUESS WHAT I DID WAS FAST REALLY THE LADY OPENED THE DOOR TO CALL ME BACK WAS DRESSED VERY CASUAL LOOKED AND SEEMED VERY FRIENDLY SHE CALLED MY NAME AND I FOLLOWED HER TO HER OFFICE WHERE I GOT TO SIT ONCE AGAIN ON ONE OF THOSE BIG COMFY SOFAS LOL SHE STARTED OUT BY LOOKING THRU MY FOLDER AND ASKED WHY I WAS THERE AND I SAID I'M NOT REALLY SURE AND STARTED TO EXPLAIN THE WHOLE STORY TO HER WHAT HAD HAPPENED AND WHY I GAINED WEIGHT BLAH BLAH BLAH YOU ALREADY KNOW IT LOL SHE WAS VERY FRIENDLY AND MADE ME FEEL VERY COMFORTABLE IT WAS LIKE TAKING TO A FRIEND REALLY SHE TOLD ME THAT SHE HERSELF HAS HAD THE SURGERY AND THAT MADE ME FEEL EVEN MORE INTERESTED IN WHAT SHE SAID SHE INFORMED ME ABOUT BOOKS TO BUY AND READ AND THE GOOD PROTEIN POWDERS TO BUY AND LOTS OF USEFUL STUFF ABOUT WHAT I MIGHT NEED AFTER SURGERY AND TRICKS SHE DOES TO MAKE SOME THINGS EASIER ON HERSELF AND LESS WORK AND TIME TO DO SHE GAVE ME SOME SAMPLES OF SOME PROTEIN MIXES TO TRY TO SEE WHAT I LIKED BUT INFORMED ME THAT VANILLA WAS ALWAYS A SAFE BET CAUSE YOU COULD MIX IT WITH JUST ABOUT ANYTHING FOR DIFFERENT TASTES AT THE END SHE SAID HOW MANY VISITS DO YOU HAVE TO DO I SAID 6 FROM WHAT I WAS TOLD SO SHE LOOKED IT UP AND YUP 6 SHE SAID WELL LETS DO THEM WEEKLY SO WE CAN GET THEM OVER QUICK FOR YOU I'M LIKE COOL SHE REALLY DOES KNOW WHAT IT IS LIKE TO HAVE TO WAIT AND WAIT FOR SOMETHING SO IMPORTANT TO YOU BUT ALSO INFORMED ME SHE WAS GOING ON VACATION FOR 2 WEEKS STARTING NEXT WEEK... OUCH THAT HURT BUT OK WHAT IS 2 MORE WEEKS SHE ALSO GAVE MY JOURNAL SHEETS TO FILL OUT AND BRING BACK TO HER AT OUR NEXT APPOINTMENT (HMMMM THAT SOUNDS LIKE WHAT I WANTED TO DO AT HURLEY BUT WAS TOLD NO MAYBE CAUSE THEY WANTED MY MONEY HMMM ) PROBABLY BETTER OFF WITH THIS LADY THO SHE SEEMS TO BE PRETTY COOL AND KNOWS HER STUFF) SO OFF I WENT TO START MY TRAINING FOR MY NEW EATING HABITS AND LIFE STYLE ....
0 comments
PHASE #3
Feb 26, 2009
OK SO I MENTIONED EARLIER IN THE FIRST BLOG THAT I HAD TO TURN IN A MEDICAL RELEASE FORM FORM MY DOCTOR AND WAS GOING TO GET WEIGHED AGAIN SO PAPER SHOWED MY BMI AT 50 SO INSURANCE WOULD COVER IT AS I WAS HEADING TO HURLEY TO DO THIS I GOT A CALL FROM THE PSYCHIATRIST OFFICE SAYING THAT THEY FORGOT TO GIVE ME SOME FORMS TO FILL OUT AND ASKED IF I COULD STOP IN AND DO SO I'M LIKE SURE ILL BE THERE IN LIKE A HOUR AND CONTINUED ON TO HURLEY WHEN I GOT THERE I TURNED IN MY FORM AND ASKED TO BE WEIGHED THE NURSE CAME AND GOT ME TOOK ME BACK AND WOW I GAIN MORE THEN I THOUGHT WEIGHED IN AT 318 
OMG HEAVIEST IVE EVER BEEN BUT IT DID PUT MY BMI AT 51 SO I GUESS YOU TAKE THE GOOD WITH THE BAD JUST KNEW NOW WAS TIME TO GET INTO EXERCISE ROUTINE AND DIET CHANGES FOR SURE ANYWAYS HAD THE NURSE LOG IT ON MY FILE AND I WAS OFF TO THE PSYCH OFFICE AGAIN... GET THERE FILL OUT WHAT SHE NEEDED AND WALKED OUT THINKING YES EVERYTHING IS DONE NOW JUST SIT BACK AND PRAY TO GOD AND KEEP MY FINGERS CROSSED
FOR A APPROVAL FROM INSURANCE.... BUT OF COURSE THINGS CANT GO THAT EASY FOR ME WHEN I GOT TO MY CAR I HAD MISSED A CALL FROM THE DIETITIAN FROM HURLEY TELLING ME SHE NEEDED TO SPEAK TO ME I'M THINKING OH GREAT WHAT NOW SO I CALLED HER BACK AND SHE STATED THAT SHE WAS CONCERNED ABOUT MY WEIGHT GAIN SO I GO ON AND EXPLAIN THE WHOLE BMI NEEDING TO BE 50 BEFORE INSURANCE WOULD APPROVE AND THAT I CALLED TO SEE IF IT WAS ALRIGHT IF A CAME IN FOR ANOTHER WEIGH IN AND THAT THE GIRL TOLD ME THAT SHE COULD NOT TELL ME TO GAIN WEIGHT BUT I COULD GET RE WEIGHED SO THAT'S WHAT I DID SHE SAID WELL IN THE PAPERS WE GAVE YOU AT THE CONSULTATION THERE WAS A DIET YOU WAS SUP-POST TO START IN THERE AND ITS OBVIOUS YOUR NOT DOING IT I SAID NO I'M NOT I JUST EXPLAINED THAT I WASN'T I ASKED WELL COULD I START IT NOW AND COME IN WEEKLY TO SHOW YOU I'M DOING IT ALONG WITH A JOURNAL OF WHAT I'M EATING SHE SAID NO THAT ID HAVE TO SEE THERE PSYCHIATRIST FOR 6 VISITS ON LEARNING HOW TO EAT I'M LIKE YOU GOT TO BE KIDDING ME SHE SAID NO I'M SORRY THAT'S OUR RECOMMENDATION FOR YOU I'M THINKING GREAT THAT'S ANYWHERE FROM 6 WEEKS TO 6 MONTHS LONGER I'M GOING TO HAVE TO WAIT NOT TO MENTION THE EXTRA 350.00 OUT OF MY POCKET CAUSE INSURANCE DON'T COVER BUT HALF OF THE SESSIONS BUT IVE CAME THIS FAR MIGHT AS WELL RIDE IT OUT AND IT REALLY WAS MY OWN FAULT FOR NOT STARTING THE DIET AND JUST WORKING ON THAT 5 TENTHS OF A POINT FOR INSURANCE COVERAGE 
BUT STILL NOT HAPPY ABOUT IT SO I CALLED THERE PSYCH AND SET A APPOINTMENT UP FOR THE FOLLOWING MONDAY....OH GREAT NOT LOOKING FORWARD TO THIS!!!!
0 comments
OMG HEAVIEST IVE EVER BEEN BUT IT DID PUT MY BMI AT 51 SO I GUESS YOU TAKE THE GOOD WITH THE BAD JUST KNEW NOW WAS TIME TO GET INTO EXERCISE ROUTINE AND DIET CHANGES FOR SURE ANYWAYS HAD THE NURSE LOG IT ON MY FILE AND I WAS OFF TO THE PSYCH OFFICE AGAIN... GET THERE FILL OUT WHAT SHE NEEDED AND WALKED OUT THINKING YES EVERYTHING IS DONE NOW JUST SIT BACK AND PRAY TO GOD AND KEEP MY FINGERS CROSSEDFOR A APPROVAL FROM INSURANCE.... BUT OF COURSE THINGS CANT GO THAT EASY FOR ME WHEN I GOT TO MY CAR I HAD MISSED A CALL FROM THE DIETITIAN FROM HURLEY TELLING ME SHE NEEDED TO SPEAK TO ME I'M THINKING OH GREAT WHAT NOW SO I CALLED HER BACK AND SHE STATED THAT SHE WAS CONCERNED ABOUT MY WEIGHT GAIN SO I GO ON AND EXPLAIN THE WHOLE BMI NEEDING TO BE 50 BEFORE INSURANCE WOULD APPROVE AND THAT I CALLED TO SEE IF IT WAS ALRIGHT IF A CAME IN FOR ANOTHER WEIGH IN AND THAT THE GIRL TOLD ME THAT SHE COULD NOT TELL ME TO GAIN WEIGHT BUT I COULD GET RE WEIGHED SO THAT'S WHAT I DID SHE SAID WELL IN THE PAPERS WE GAVE YOU AT THE CONSULTATION THERE WAS A DIET YOU WAS SUP-POST TO START IN THERE AND ITS OBVIOUS YOUR NOT DOING IT I SAID NO I'M NOT I JUST EXPLAINED THAT I WASN'T I ASKED WELL COULD I START IT NOW AND COME IN WEEKLY TO SHOW YOU I'M DOING IT ALONG WITH A JOURNAL OF WHAT I'M EATING SHE SAID NO THAT ID HAVE TO SEE THERE PSYCHIATRIST FOR 6 VISITS ON LEARNING HOW TO EAT I'M LIKE YOU GOT TO BE KIDDING ME SHE SAID NO I'M SORRY THAT'S OUR RECOMMENDATION FOR YOU I'M THINKING GREAT THAT'S ANYWHERE FROM 6 WEEKS TO 6 MONTHS LONGER I'M GOING TO HAVE TO WAIT NOT TO MENTION THE EXTRA 350.00 OUT OF MY POCKET CAUSE INSURANCE DON'T COVER BUT HALF OF THE SESSIONS BUT IVE CAME THIS FAR MIGHT AS WELL RIDE IT OUT AND IT REALLY WAS MY OWN FAULT FOR NOT STARTING THE DIET AND JUST WORKING ON THAT 5 TENTHS OF A POINT FOR INSURANCE COVERAGE BUT STILL NOT HAPPY ABOUT IT SO I CALLED THERE PSYCH AND SET A APPOINTMENT UP FOR THE FOLLOWING MONDAY....OH GREAT NOT LOOKING FORWARD TO THIS!!!!PHASE #2
Feb 26, 2009
OK WENT TO THE PSYCH EVAL ON THE 27TH OF JANUARY WAS SCARED 
NOT KNOWING WHAT TO EXPECT WASN'T SURE WHAT THEY WOULD ASK OR FIND LOL WHEN I FIST GOT THERE I HAD ANOTHER BATCH OF PAPERWORK TO FILL OUT NEVER SEEMS TO END IN THIS PROCESS THE PSYCHIATRIST CAME OUT AND GOT ME HE WAS A RATHER NERDY LOOKING MAN FIRST THOUGHT WAS OH BOY HERE WE GO GOING TO 50 QUESTION ME AND I COULD FEEL MY HEART A BEATING WHEN I GOT TO HIS ROOM I FOUND THE TYPICAL SOFA WAITING THERE WITH MY NAME ALL OVER IT I SAT LOOKED AROUND AND THOUGHT OMG HE NEEDS TO DO SOME FILING FOLDERS LAYING EVERYWHERE COULD NOT EVEN SEE THE TOP OF HIS DESK HE SAT IN A BIG OVER SIZED CHAIR AND EXPLAINED WHAT WAS GOING TO HAPPEN STEP BY STEP AND TOLD ME TO JUST RELAX AND ANSWER EVERYTHING HONESTLY AND THERE WOULD BE NO PROBLEMS THEN THE QUESTIONS STARTED AND IT REALLY WASN'T WHAT I THOUGHT IT WAS GOING TO BE AT ALL HE MADE ME RELAX MORE AND MORE ONCE THE QUESTIONS STARTED BASICALLY JUST ASKED WHAT DIETS I HAVE TRIED WHY DID I THINK THEY FAILED IF I WAS A DRINKER WHAT MEDS I WAS TAKING AND HOW MY HOME LIFE WAS AND THAT WAS PRETTY MUCH IT WITH HIM THEN HE WALKED ME TO THIS ROOM AND I HAD TO WATCH A VIDEO OF HIM THAT WAS ABOUT 30 TO 40 MIN LONG ON HOW TO EAT AFTER SURGERY AND THINGS THAT MIGHT HAPPEN AND HOW TO DEAL WITH THE EMOTIONAL PART AND ABOUT THE TEST THAT WAS COMING UP AFTER THIS VIDEO IT JUST TOLD ME TO TELL THE TRUTH AND ANSWER EACH QUESTION HONESTLY AS POSSIBLE IF NOT THE TEST WOULD DETECT IT AND MIGHT BE ASKED TO START IT OVER OR TAKE ANOTHER TEST AFTER THE TAPE WAS OVER THEY GAVE ME A 356 QUESTION TEST THAT BASICALLY HAD ALOT OF QUESTIONS ABOUT THE WAY I SEE THINGS AND IF I WAS A DRINKER AND EVER THOUGHT OF SUICIDE AND THEY ALSO HANDED ME ANOTHER TEST THAT WAS LIKE 600 QUESTIONS LONG THAT REPEATED THE SAME QUESTIONS OVER AND OVER JUST CHANGED A LITTLE OF THE WORDING TO TRY TO CATCH YOU IN A LIE WAS NOT A BAD TEST JUST A VERY BORING 
ONE I GOT SICK OF ANSWERING THE SAME STUFF OVER AND OVER AND OVER TOOK FOREVER TO DO FINALLY FINISHED IT AND TURNED IT INTO THE NURSE AND SHE TOLD ME TO HAVE A SEAT SHED GRADE PART OF IT AND SEE IF I HAD TO TAKE ANOTHER ONE AGAIN OR NOT SO I SAT AND SAT THINKING OMG THERE GOING TO MAKE ME RETAKE IT 
BUT SHE CAME OUT AND SAID YOUR FINE TO GO AND THAT THEY HAD TO SCORE EVERYTHING BY HAND SO MIGHT TAKE LIKE 2 WEEKS TO GET RESULTS I WAS LIKE WOOHOOO THANK GOD I COULD NOT WAIT TO GET OUT OF THERE WAS BORING BUT WORTH IT HAD TO BE DONE ALL IN ALL NOT AS BAD AS I THOUGHT IT WAS GOING TO BE .....
0 comments
NOT KNOWING WHAT TO EXPECT WASN'T SURE WHAT THEY WOULD ASK OR FIND LOL WHEN I FIST GOT THERE I HAD ANOTHER BATCH OF PAPERWORK TO FILL OUT NEVER SEEMS TO END IN THIS PROCESS THE PSYCHIATRIST CAME OUT AND GOT ME HE WAS A RATHER NERDY LOOKING MAN FIRST THOUGHT WAS OH BOY HERE WE GO GOING TO 50 QUESTION ME AND I COULD FEEL MY HEART A BEATING WHEN I GOT TO HIS ROOM I FOUND THE TYPICAL SOFA WAITING THERE WITH MY NAME ALL OVER IT I SAT LOOKED AROUND AND THOUGHT OMG HE NEEDS TO DO SOME FILING FOLDERS LAYING EVERYWHERE COULD NOT EVEN SEE THE TOP OF HIS DESK HE SAT IN A BIG OVER SIZED CHAIR AND EXPLAINED WHAT WAS GOING TO HAPPEN STEP BY STEP AND TOLD ME TO JUST RELAX AND ANSWER EVERYTHING HONESTLY AND THERE WOULD BE NO PROBLEMS THEN THE QUESTIONS STARTED AND IT REALLY WASN'T WHAT I THOUGHT IT WAS GOING TO BE AT ALL HE MADE ME RELAX MORE AND MORE ONCE THE QUESTIONS STARTED BASICALLY JUST ASKED WHAT DIETS I HAVE TRIED WHY DID I THINK THEY FAILED IF I WAS A DRINKER WHAT MEDS I WAS TAKING AND HOW MY HOME LIFE WAS AND THAT WAS PRETTY MUCH IT WITH HIM THEN HE WALKED ME TO THIS ROOM AND I HAD TO WATCH A VIDEO OF HIM THAT WAS ABOUT 30 TO 40 MIN LONG ON HOW TO EAT AFTER SURGERY AND THINGS THAT MIGHT HAPPEN AND HOW TO DEAL WITH THE EMOTIONAL PART AND ABOUT THE TEST THAT WAS COMING UP AFTER THIS VIDEO IT JUST TOLD ME TO TELL THE TRUTH AND ANSWER EACH QUESTION HONESTLY AS POSSIBLE IF NOT THE TEST WOULD DETECT IT AND MIGHT BE ASKED TO START IT OVER OR TAKE ANOTHER TEST AFTER THE TAPE WAS OVER THEY GAVE ME A 356 QUESTION TEST THAT BASICALLY HAD ALOT OF QUESTIONS ABOUT THE WAY I SEE THINGS AND IF I WAS A DRINKER AND EVER THOUGHT OF SUICIDE AND THEY ALSO HANDED ME ANOTHER TEST THAT WAS LIKE 600 QUESTIONS LONG THAT REPEATED THE SAME QUESTIONS OVER AND OVER JUST CHANGED A LITTLE OF THE WORDING TO TRY TO CATCH YOU IN A LIE WAS NOT A BAD TEST JUST A VERY BORING ONE I GOT SICK OF ANSWERING THE SAME STUFF OVER AND OVER AND OVER TOOK FOREVER TO DO FINALLY FINISHED IT AND TURNED IT INTO THE NURSE AND SHE TOLD ME TO HAVE A SEAT SHED GRADE PART OF IT AND SEE IF I HAD TO TAKE ANOTHER ONE AGAIN OR NOT SO I SAT AND SAT THINKING OMG THERE GOING TO MAKE ME RETAKE IT BUT SHE CAME OUT AND SAID YOUR FINE TO GO AND THAT THEY HAD TO SCORE EVERYTHING BY HAND SO MIGHT TAKE LIKE 2 WEEKS TO GET RESULTS I WAS LIKE WOOHOOO THANK GOD I COULD NOT WAIT TO GET OUT OF THERE WAS BORING BUT WORTH IT HAD TO BE DONE ALL IN ALL NOT AS BAD AS I THOUGHT IT WAS GOING TO BE .....
THE START OF MY WLS
Feb 25, 2009
ON JANUARY 6TH OF 09 I HAD MY CONSOLE WITH MY SURGEON AT HURLEY CLINIC THEY TOLD ME MY CONSOLE WOULD LAST ABOUT 3 HOURS WELL IT DID LAST 3 HOURS BUT WAS ONLY CONSOLED ABOUT 45 MIN OF THAT ERRRRRR!!!!!! WAS NOT TO HAPPY NEEDLESS TO SAY ANYWAYS WHEN I FIRST GOT THERE I HAD TONS OF FORMS TO FILL OUT THEN THEY CALLED ME BACK WHERE I GOT A LOVELY PICTURE TAKEN 
THE LADY WEIGHED ME EVEN MORE BAD NEWS 
THEN SHE CALCULATED MY BMI WITCH WAS 49.55 AND INSURANCE REQUIRED 50 OR GREATER TO WAIVE THE 6 MONTHS CONSECUTIVE DOCUMENTATION BY MY FAMILY DOCTOR SO I'M REALLY THINKING OH GREAT NOW AND TOOK ME TO A VERY NICE ROOM WITH NICE BIG COUCH TO SIT ON AND WAIT AND I DO MEAN WAIT NEXT THE NURSE FINALLY MADE IT THERE AND TOOK MY VITALS BLOOD PRESSURE AND TEMP AND ASKED A FEW QUESTIONS LIKE WHAT MEDS I WAS TAKING AND ANY MEDICAL PROBLEMS I HAD AND THE BIGGIE IF I SMOKED UGGGHHH I NEW THIS ONE WAS COMING BUT I DIDN'T LIE I SAID YES BUT I WAS TRYING TO QUIT AND SAID ID HAVE TO BEFORE THEY WOULD DO SURGERY I SAID I KNOW BUT ITS HARD!!!!!!! SHE WAS DONE WITH ME AND SAID THE SURGEON WOULD BE IN SHORTLY LOL YEAH RIGHT ABOUT A HOUR LATER HERE HE COMES HE WAS NICE THO VERY OPEN TO QUESTIONS AND AT THE END ASKED WHAT PROCEDURE I WAS LEANING TO I TOLD HIM THE LAP BAND AND HE ASKED WHY AND I TOLD HIM CAUSE I WANTED TIME TO WORK OUT AND HOPEFULLY NOT HAVE THE HANGING SKIN SO BAD HE SAID HE WOULD DO EITHER PROCEDURE ON ME I WAS A GOOD CANDIDATE FOR BOTH WAS MY CALL I CHOOSE LAP BAND HE SAID OK WROTE IT DOWN AND SAID DIETITIAN WOULD BE IN IN A MIN AGAIN LMAO THEY HAVE NO SENSE OF TIME THERE LOL WELL SHE FINALLY CAME IN AND HANDS ME A LIST OF THINGS I NEED TO GET DONE BEFORE WE CAN PROCEED ANY FURTHER WITCH WAS MY PSYCH EVALUATION AND A MEDICAL RELEASE FORM FROM MY DOCTOR SWEET I'M THINKING NO PROB AND SOME OTHER FORMS IN A PACKET EXPLAIN THE SURGERY ETC... AND TELLS ME I'M FREE NOW SO I LEAVE BUT CANT GET THE THOUGHT OF BEING REJECTED BY INSURANCE OVER 5 TENTHS OF A POINT ON MY BMI SO WHEN I GET HOME I CALLED THEM BACK AND EXPLAINED THAT INSURANCE WOULD NOT COVER IF BMI WAS NOT 50 OR GRATER AND ASKED IF I COULD COME GET WEIGHED AGAIN IF I COULD MAKE IT UP SHE TOLD ME SHE COULD NOT TELL ME TO GAIN WEIGHT BUT I COULD BE RE WEIGHED SO I'M THINKING SWEET WORK ON IT FOR A WEEK AND GO BACK IN AND GET WEIGHED AGAIN WHEWWWW!!! MADE APPOINTMENT FOR PSYCH EVAL FOR THE 27TH OF JANUARY AND DROPPED FORMS OFF TO MY DOCTOR FOR MEDICAL RELEASE THINK WOW I'M REALLY ON MY WAY TO WLS NOW WOOOHOOO!!!! WILL UPDATE MORE LATER!!!
0 comments
WAS NOT TO HAPPY NEEDLESS TO SAY ANYWAYS WHEN I FIRST GOT THERE I HAD TONS OF FORMS TO FILL OUT THEN THEY CALLED ME BACK WHERE I GOT A LOVELY PICTURE TAKEN THE LADY WEIGHED ME EVEN MORE BAD NEWS THEN SHE CALCULATED MY BMI WITCH WAS 49.55 AND INSURANCE REQUIRED 50 OR GREATER TO WAIVE THE 6 MONTHS CONSECUTIVE DOCUMENTATION BY MY FAMILY DOCTOR SO I'M REALLY THINKING OH GREAT NOW AND TOOK ME TO A VERY NICE ROOM WITH NICE BIG COUCH TO SIT ON AND WAIT AND I DO MEAN WAIT NEXT THE NURSE FINALLY MADE IT THERE AND TOOK MY VITALS BLOOD PRESSURE AND TEMP AND ASKED A FEW QUESTIONS LIKE WHAT MEDS I WAS TAKING AND ANY MEDICAL PROBLEMS I HAD AND THE BIGGIE IF I SMOKED UGGGHHH I NEW THIS ONE WAS COMING BUT I DIDN'T LIE I SAID YES BUT I WAS TRYING TO QUIT AND SAID ID HAVE TO BEFORE THEY WOULD DO SURGERY I SAID I KNOW BUT ITS HARD!!!!!!! SHE WAS DONE WITH ME AND SAID THE SURGEON WOULD BE IN SHORTLY LOL YEAH RIGHT ABOUT A HOUR LATER HERE HE COMES HE WAS NICE THO VERY OPEN TO QUESTIONS AND AT THE END ASKED WHAT PROCEDURE I WAS LEANING TO I TOLD HIM THE LAP BAND AND HE ASKED WHY AND I TOLD HIM CAUSE I WANTED TIME TO WORK OUT AND HOPEFULLY NOT HAVE THE HANGING SKIN SO BAD HE SAID HE WOULD DO EITHER PROCEDURE ON ME I WAS A GOOD CANDIDATE FOR BOTH WAS MY CALL I CHOOSE LAP BAND HE SAID OK WROTE IT DOWN AND SAID DIETITIAN WOULD BE IN IN A MIN AGAIN LMAO THEY HAVE NO SENSE OF TIME THERE LOL WELL SHE FINALLY CAME IN AND HANDS ME A LIST OF THINGS I NEED TO GET DONE BEFORE WE CAN PROCEED ANY FURTHER WITCH WAS MY PSYCH EVALUATION AND A MEDICAL RELEASE FORM FROM MY DOCTOR SWEET I'M THINKING NO PROB AND SOME OTHER FORMS IN A PACKET EXPLAIN THE SURGERY ETC... AND TELLS ME I'M FREE NOW SO I LEAVE BUT CANT GET THE THOUGHT OF BEING REJECTED BY INSURANCE OVER 5 TENTHS OF A POINT ON MY BMI SO WHEN I GET HOME I CALLED THEM BACK AND EXPLAINED THAT INSURANCE WOULD NOT COVER IF BMI WAS NOT 50 OR GRATER AND ASKED IF I COULD COME GET WEIGHED AGAIN IF I COULD MAKE IT UP SHE TOLD ME SHE COULD NOT TELL ME TO GAIN WEIGHT BUT I COULD BE RE WEIGHED SO I'M THINKING SWEET WORK ON IT FOR A WEEK AND GO BACK IN AND GET WEIGHED AGAIN WHEWWWW!!! MADE APPOINTMENT FOR PSYCH EVAL FOR THE 27TH OF JANUARY AND DROPPED FORMS OFF TO MY DOCTOR FOR MEDICAL RELEASE THINK WOW I'M REALLY ON MY WAY TO WLS NOW WOOOHOOO!!!! WILL UPDATE MORE LATER!!!
