Obese Bunny

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It has been a very long time since I updated this blog, but I have great news to share.  I am down nearly 200 pounds since my weight loss journey began, and I'm healthier than I've ever been.  Since my last entry way back in February of 2008, I have been able to quit taking virtually all of the medication I was on; my cholestrol and blood pressure levels are under control; I'm incredibly active; and I'm buying my clothes off-the-rack (woot!).

In September of this year (2009), I had an abdominoplasty  and vertical band procedure with Dr. Vincent DiNick (awesome surgeon, BTW).  This procedure removed just over 18 pounds of unsightly and stubborn skin and fat from my lower abdomen and stomach area, and took care of two (2) hernias I had been carrying.  Now my clothes fit, and my movement is no longer inhibited by the hanging flesh that resulted from my rapid weight loss.

Looking  back on my last entry it is evident to me what a dreadful state I was in at the time.  To anyone that happens upon this pitiful blog I would say in conclusion, that although this journey has been long and at times incredibly difficult, it was definitely worth it.  If you are even thinking about gastric bypass to deal with a lifetime of morbid obesity, my advice to you is shop around for a capable and experienced surgeon, and be prepared to suffer some setbacks.  But like most good things in life, we have to weather those setbacks and disappointments if we are to win the game.  People can really suck and life can be unfair, but there is good to be found if you keep searching.

Keep moving forward, always get up, never give in.

Cheers.

So I've been pushing against the tides for months now, trying to have open RNY surgery.  I got it, now I'm asking "What did I just do??"  Everyone tells me, including my wife (who had the surgery over 1.5 years ago) I will not regret my decision, but for now I definitely am.

The pain I had after my surgery was beyond description.  I had a horrendous problem w/ trapped gas and was in constant agony.  The beds in the hospital were, errr, not the best...and I struggled w/ constant back pain - never able to achieve a comfortable position.

Thank God for my wife Jennifer.  She was there almost constantly, providing care, or scaring up a nurse to help.  If it wasn't for her, I never would have made it this far.

Many thanks to those who left encouraging messages on my surgery day.  Your moral support and kind words mean a lot.  I made it home - 4 days out, and I feel like I was hit by a Mack truck.  Everything is already so different.  I expected that but.....then again, somehow it didn't all register.  On one hand I'm scared to death I've made an irrevocable decision with some nasty potential consequences.  On the other, I know I would have died for sure going on the way I was.  So I guess, drastic situations call for drastic action.  And that, home gamers, is what we have here right now.

So after my discouraging attempts to find competent medical assistance, I'm thinking to myself "fuck this shit, I'd rather eat and smoke myself to death than continue to endure any more of the medical profession's horse shit."  My wife (who had the surgery herself over a year and a half ago) tries to encourage me to keep fighting.  One day, she sees an ad on TV for Barix Clinics, and goes on-line to check out some of the clinic's surgeons (here on OH).  She gets the bio on Dr. Jon Schram and is very enthusiastic about his experience and patient reviews and recommendations.

So my wife contacts the clinic and sets up a consultation and lets me know "we're going."  Me:  "OK, I'll give this a try, but if I get fucked one more time...if i have a problem with one more psycho healthcare administrator, or another prima donna surgeon, I'm DONE!  Deal?"  She agrees.

Attending the Barix orientation is the standard tripe - shit, I've heard this spiel about 100 times by now... "it's only a tool"  "it's a total lifestyle change" "I had it and now I'm a proud anorexic".. yada yada yada.  Then comes Q&A with Dr. Schram.  My wife and I ask a BUNCH of questions (everyone else pretty much just sits there drooling).  Dr. Schram answers all of our questions ably and confidently, sensing the core issues we want to know about and answering them.  He's done somewhere between 2,500 and 3,000 of these procedure and never lost a single patient.  This is sounding quite good. He impresses me as competent, knowledgeable, compassionate, and down-to-earth.

I meet with a nurse whose a nice enough lady, but doesn't know how to take blood pressure properly.  She then comments on my "elevated blood pressure" (despite my medication).  I resist the temptation to tell her that taking it on a person's lowered forearm a full 8-inches below the level of their heart will raise the systolic and/or diastolic by up to 20 points (fucking idiot).

Dr. Schram comes in and after a bit of medical history chit-chat, immediately asks about whether I can loose 30-50 pounds.  I lower my head, sigh heavily, and resist the temptation to scream at the top of my lungs.  Just before I'm ready to get up and walk out he says "that's if you want me to try the laproscopic surgery".  I say "what about open?"  He looks kind of puzzled and says "no problem, I can do the open on you, that's not an issue".  Relieved I tell him I don't give a shit about the scar (I've long ago given up my dream of being a Chip-N-Dales dancer) or the extra week or so of recovery time (fuck my employer, they can wait)...let's just get it done!

He's quite helpful, and suggests that a small change in the letter from my family doctor should help gain approval from the insurance department.  My family doctor, bless her heart, changes the bloody thing for the ump-teenth time and Barix approves me.  

YEAH!!!!  So now my surgery is scheduled for February 4, 2008.  I've done the preliminary testing bit and passed (again, the nurse takes my BP on my lowered forearm...CHRIST!), insurance is approved, and I'm ready to go.  If it wasn't for my sweet Jennifer and God almighty, I would have NEVER made it this far. 

P.S.  FUCK YOU HURLEY! 

P.S.S.  SCREW YOU SCHOLTEN (arrogant fuck)!   

Having hit a brick wall with Hurley, I located another surgeon in Grand Rapids - Dr. Donald Scholten.  Dr. Scholten is a highly accomplished surgeon with over 3,500 bariatric surgeries to his credit.  My initial contact with his office was extremely positive, and I generally found his staff to be friendly and helpful.  

Dr. Scholten requires all prospective surgery candidates to attend both a support group session, as well as an initial presentation and consultation.  The support groups are free, and are led by staff members.  Support groups are offered once monthly at several locations across lower Michigan.  The people in the group were informative and supportive.  So far so good!

The orientation was fairly typical and well run.  The insurance people there review my information and tell me approval should be no problem.... everything appears  to be in good order.  

However, my consultation w/ Dr. Scholten was more than just a little bit strange and unnerving - to say the least! 

First off, he tells me that the main tools required for weight loss are eating properly, exercising regular, proper mental attitude, and of course, the surgery (OK, makes sense to me).  He asks me which of these tools I have.  I start to tell him I have worked on the first 3, but while I don't have any one "conquered" I have made some pretty good progress.  I attempt to provide him with examples, to which he abruptly interrupted me, and in a loud obstreperous tone says "NO! YOU DON'T HAVE ANY OF THE TOOLS!!"  Ummm, OoooKaay.  

So then he proceeds to tell me about how I have to prove that my "mind is right" by losing 30-40 pounds before he will even consider performing the surgery on me....mind you, that's ANY KIND of surgery.  Not just laproscopic, or RNY, but ANY type.  The answer?  A crash diet of course.  This is after he has just told me that "of course you know that diets do not work"......Uh, yeah, I know Doc, that's why I'm here, so why are you making me go on ANOTHER ONE?

So I'm trying not to be difficult, and I mostly just sit there, nod my head, and try to keep smiling.  He then starts into a tirade about how I can't "make" him do my surgery.  I respond calmly with.. "well, of course, I'm well aware of that".  "NO, you're not!"  Uh, yes, yes I am doctor (feeling very puzzled right now).

Then he starts telling me about how wealthy and successful he is.  How he doesn't "need (my) money to take a nice winter vacation."  HE "will take a winter vacation regardless and doesn't have to do "my" surgery" to get there."

So I'm thinking, WOW, this dude is REALLY into himself - big time.  We conclude the consultation with him pointing out to me a copy of a magazine in the examination room, which contains an article declaring him one of the "best surgeons in Michigan" (a fact already noted by his nurse and another staff member). It seems the laudatory article is present in ALL of the exam rooms, the patient lounge, etc., etc.. I walk away dejected again. This time, I have been approved by the surgeon's office for the procedure (insurance wise) but the egotistical surgeon won't perform the procedure because he likes to feel the satisfaction that comes from making a desperate fatty jump through one of his sadistic hoops.  I decide to leave quietly and try to find another surgeon.

And so concludes Round 3.  I'm just barely standing. 

After checking around on the OH website, and calling several nearby bariatric centers, my wife and I decided to check out Hurley Bariatric Center. The first consultation was a bit disorganized, but overall, the staff seemed to have their act together. I met with my intended surgeon, Dr. James Wagner. Dr. Wagner has around 300-350 laparoscopic RNY's to his credit, and I found him to be a pleasant, relaxed, and confident physician. He took plenty of time to address all of my questions, and both my wife (who had RNY over a year ago herself) and I were fairly impressed with him. Dr. Wagner said that at my weight, he could "just" do the laparoscopic procedure, providing I went on a liquid diet about 2 weeks prior to surgery to shrink my liver. They had a product they asked patients to use, but no formal, expensive program.

Everything looked pretty good. I provided diet documentation from a hospital supervised diet plan I had been on last year, and received instructions on how to go about getting a psych-evaluation. I was told that because I have BCBS, I could get either an "interview" style evaluation, or an MMPI, so long as the guidelines provided in the Hurley fact-sheet were adhered to. I double checked this with BCBS Customer Service, and they absolutely confirmed that an interview was more than acceptable.

I set about getting my psych evaluation done by a Psychologist I've seen for the last 3 years. This was provided to Hurley, reviewed by their staff Psychologist, and approved in September 2007. Finally I received a call from Hurley administrative staff saying "everything is clear" EXCEPT that I had only 11 months of documented supervised weight loss. BCBS now apparently asks for 12 months. The administrative supervisor suggested I have progress notes forwarded from a former physician. The purpose, was to find enough documentation in those records before and after the 11 months of diet documentation to prove to BCBS that I actually had 12 months or more in total. I did check w/ BCBS Customer Service TWICE, and both times, they told me that Hurley was being over-zealous. BCBS also stated that a letter from either my current or previous physician documenting my efforts would also be more than satisfactory. When presented with this information, the Hurley administrator flatly denied that this was acceptable (go figure).

So I went about trying to have my records released from my former physician. To make a long story short, I had terminated my former doctor of 10 years for a variety of reasons, including poor care and an "inappropriate" relationship with my ex-wife which I believed was adversely impacting the quality and confidentiality of our doctor-patient relationship. She was refusing to release the records in a timely fashion, so I contacted the healthcare unit responsible for overseeing her practice. The Information Director was mortified to say the least with my former doctor's behavior, and personally intervened to obtain the records and fax them to Hurley. She apologized profusely and stated several times that "this should have NEVER happened."

Upon finally receiving my file (after nearly a month of haggling with my former doctor), I received a distressed call from the Hurley administrator saying that the file contained a single note (dated from the day I fired my doctor) which painted me as some sort of unstable loon. She tried to convince me to get the Lap-Band as it would be "less stressful" (after all, as a full-time paper-pusher, she's obviously well-qualified to make major medical decisions).  I informed her of the circumstances surrounding my termination of my former doctor, and asked her to weigh that note against the far more recent psych evaluation (already cleared) and the recommendations of my current physicians.

She then told me she had discussed the matter with one of the Hurley surgeons, who in essence said, "No big deal. So the guy had a falling out with his old doctor. It happens." Well, this wasn't good enough apparently. She asked for written documentation on the incident with my doctor which I spent 4 hours gathering and preparing one evening. I also provided Hurley with an authorization to speak with the Psychologist who had written my psych-evaluation, as he had intimate knowledge of the afore mentioned "incident" and I encouraged her to contact him with her concerns.  I also contacted my Psychologist, and he was quite amenable to talking with her to assuage her concerns.

A few days later, I received a "speaker phone" call from the administrative person and the Hurley consulting Psychologist, Dr. Williams. At first, I expected a few questions from Dr. Williams to which I anticipated final approval. Much to my surprise (and dismay) the call was totally confrontational and hostile from the get-go. I was asked why I never had an MMPI performed, to which I responded that Hurley's own documentation clearly stated that an MMPI OR interview were both acceptable, depending upon insurance carrier requirements...besides, I pointed out, Hurley had ALREADY CLEARED my psych evaluation. I was then told that Hurley "always requires an MMPI" and the administrator denied that any such documentation to the contrary existed (later on, I dug it out of my Hurley packet and lo and behold, I was correct). We argued about this for a bit, and I asked several times why my psych evaluation had been cleared if it was not acceptable? I NEVER DID RECEIVE A RESPONSE TO THESE REPEATED QUESTIONS.

Finally, Dr. Williams said I was "argumentative" (Duh! Gee, why would anyone argue with a Machiavellian asshole?), and that because the psych evaluation mentioned that I had struggled with severe depression in the past, that fact alone disqualified me for surgery. When I pointed out that depression is a common co-morbidity of depression, Dr. Williams stated unequivocally, that "no one considers depression to be a co-morbidity." Uh, check the published literature dude. Want some references?

During the call, someone on Hurley's end hung the phone up on me. I know this, because I was on my cell at the time, and when a call is "dropped" you get a beeping sound and a message saying "signal lost". No beep, and the only message was "call disconnected." Now, really pissed, I called back only to find myself instantly on speaker phone again. I asked why they had hung up on me, and the administrator replied "no, you hung up on us!" I said I hadn't, to which she again replied "yes, yes you did!" On and on she went, like some grade school playground bully "uh uh, YOUR MOMMA!"

Finally, Dr. Williams told me he had "all I need in this file to make an evaluation." I asked what that was, and he replied "I cannot recommend to the team that you have this surgery." I finished the call by noting the following:

1. Hurley had cleared and approved my psych evaluation, only to then reverse themselves and refuse to answer any of my questions regarding same.

2. Hurley refused to acknowledge that my depression was under control as stated in the psych evaluation, had refused to acknowledge that depression is a very common co-morbidity associated w/ obesity, and had failed to contact the Psychologist who had performed the evaluation.

3. Hurley had, in an arbitrary and capricious manner, decided to deny me the surgery for reasons about which I can only speculate; and then manufactured "evidence" and precipitated a confrontation to justify their unjustifiable decision.

I then thanked them for their time, wished them both "a pleasant day" and terminated the call.

After the call, when I told my Psychologist and another physician (an M.D.) about Williams' comments on depression and obesity, they were, to say the least, incredulous.  My Psychologist further opined that Dr. Williams (and I'm paraphrasing here) wasn't much of a mental health care provider to treat a patient in the manner in which he did.

Needless to say, when I finally obtained PART of my Hurley file (they wouldn't release it all but that's ANOTHER story), I found a number of disturbing entries, including some which I would maintain were outright fraudulent. Upon speaking with some professional people "in the know" about the practices at Hurley, I was told I wasn't the first one to have this sort of experience with them, and that I should count myself as fortunate to not be having the surgery there. I would have to agree - I am lucky indeed.

So once again, an impertinent fatboy has the temerity to stand-up for himself, and he is viewed as being "argumentative" and having "anger issues" - oh please...does anyone have the right to show a bit of balls once in a while without being accused of being the next Oklahoma City bomber? Of course as we all know, fat people are weak-willed and despicable individuals, undeserving of equal treatment under the law much less basic human respect. Golly, I've got such nerve!  Spank me and call me bitch.

Ergo, scratch Hurley. And so the quest continues....

Following a recommendation of my cardiologist, I went to a consultation with Sparrow Bariatric in July 2007. The nurse conducting the consultation was well versed in the various procedures and outlined program expectations quite thoroughly. Unfortunately, one of Sparrow's requirements is that one diets prior to weight loss surgery. Now I understand the wisdom of this approach, but sadly Sparrow dictates not only that one loses weight, but that you do so on THEIR PROGRAM (no other options are acceptable). I was a participant in the Sparrow Weight Loss Program several years back, and my experience with them was nothing short of DREADFUL.

In that regard, Sparrow uses "Optifast" liquid diet products. This product was disgusting in taste, gave me rank headaches, and I was continuously nauseous even after several weeks. When I complained to the doctor (whom I was paying about $50 per week) he told me my problem was that I was an "uncommitted" fatty with poor discipline.

The first week, I lost about 8 pounds and was rather pleased with myself. However, the doctor quickly pointed out to me after the first weigh-in that I hadn't lost "enough" - it should have been more like 10-12 pounds according to him. He then accused me of not following the program precisely, which was patently untrue.

And so it went for the next 5 months. The doctors were condescending and positively vile. The nurses regularly drew blood but never provided data on things like cholesterol levels even after repeated requests. Classes consisted of trite exercises whereupon the facilitator would pass around brochures and propagandistic "fact sheets" and would demand that we penitent fatties read passages aloud in a manner reminiscent of a third grade reading class. Christ, I have 2 Masters degrees - I can read sweetheart, I don't need to pay you $45 per week for such nonsense. Other "behavior modification" lowlights included ridiculing the patients about their behavior as a "drain on society" and the public healthcare system. It was an "all stick and no carrot" approach. As if the obese haven't been abused enough by the medical establishment, their families, co-workers, and society at-large. Such drivel. I'd sooner have all of my teeth drilled sans anesthetic.

At any rate, I was to say the least, none-too-keen about another 1 month bout as an inmate in the Sparrow "concentration camp." Moreover, the out-of-pocket cost of the program was on the order of $3,000 pre-surgery (not covered by insurance). I extended my thanks and left the consultation, resolved to have nothing to do with Sparrow.