How did you first find out about bariatric surgery and what were your initial impressions of it?

It was recommended by my primary care physician when I was first diagnosed with osteoarthritis of the knees. My inital impressions were absolute denial that I would ever have this surgery. I interviewed with a physician, and his staff, and people who had good or bad results, and it made me hysterical even talking about it! I initially thought I would rather die young than go through with any surgery that would take away the comfort and pleasure of food, and make me vomit frequently! I couldn't imagine anything more frightening!

Describe your experience with getting insurance approval for surgery. What advice, if any, do you have for other people in this stage?

My first step was to call the insurer, and ask if they ever covered bariatric surgeries. Their response was yes, if medical necessity could be proved, and documentation was provided. Then I called my primary care physician to ask for a referral to a surgeon. After I spoke with the surgeon, I found out who sends what where, and how I go about getting the proof I needed. My advice at this stage is to ask a lot of questions, and BE NICE. My insurer is Blue Choice, an HMO affiliated with Blue Cross/Blue Shield. UPDATE: 10/20/99. I received my approval from insurance on 10/15/99. My surgery is scheduled for 10/29/99. It was a painless, though nerve-wracking experience. Be sure you have all the documents needed for the insurers, and that there is no exclusion clause. There is none with my insurer.

What was your first visit with your surgeon like? How can people get the most out of this meeting?

Meeting with the surgeon, I took along another person to be an extra pair of "ears". I took a Loooong list of questions, and extra paper and a pen! I asked a few questions, let him tell me all about what he does and how he does it, and then reviewed my questions to see what he didn't tell me that I wanted to know. Be sure you have done your research. He was surprised that I could ask questions with specific references - like what type of surgery? Distal or proximal? He asked me if I knew what I was talking about, and I showed him that I did. It makes his job easier, and you will feel more confident, too.

What made you finally decide to have the surgery?

After researching the surgeries and weighing (pun intended!) the pros and cons, I found that I wanted to live a better healthier life than I had right now, and I want to live a long time. Without surgery, I don't believe either of those wishes can come true. At this weight, I think I have proven to myself that I cannot "just diet" and lose the weight, I need HELP!

How did you decide which proceedure to have?

The surgeon in Rochester NY only does the open gastric bypass RNY. I found out that it is the only surgery endorsed by the NIH, also, so I am quite comfortable with that. Also, my particular eating behaviors (I love sweets and pastries) indicate that I will do better with this type surgery than with others.

What fears did you have about having complications or even dying from from the surgery, and what would you tell other people having the same fears now?

Having had major surgery before, I am well aware of the complications and difficulties of surgery. Initially, this knowledge stopped me from considering surgery for my obesity. I tried to convince mself that I could diet my way to a healthy life. But I know I can't do it, because I have tried all my life. And to combat the fears of surgery, I think about dying of a heart attack before I'm 55, or remaining so crippled with this arthritis that I may as well be dead, because I am not enjoying my life as it is, and thinking that I have never seen an obese old person. Surgery seems like a ray of sunshine in comparison!

How did your family and friends react to your decision? Would you have communicated anything differently if you could now? How supportive were they after your surgery?

Most all the friends and family I told were supportive in wonderful ways. I was pleasantly surprised. Everyone knew that I had tried all the diet routines, and the results are obvious. Most people who love me want what is best for me, and they can see that I have done my research. Others - well, they don't really matter all that much to me, if they are not supportive.

How did your employer/supervisor react to your decision? What did you tell him/her? How long were you out of work?

I am not employed out of the home, so it is not applicable.

What was your stay in the hospital like? How long where you there? What things are most important to bring?

My stay in the hospital was shorter than I thought. I was there only 3 days and nights. I brought my own robe and slip-on slippers, their gowns are more practical for hospital use, and I brought my own personal toiletries. Although some are provided by the hospital, I prefer my own - such as facial tissues. Chapstick is great. Your lips are going to thank you. I took a calling card, for the long-distance calls I wanted to make, and some light reading material, which I ignored! Take as little as possible, there is no place to keep stuff. I wished I had brought along a small mirror. I brought a clock, but the room had one. Not all do.

Did you have any complications from the surgery? If so, how did you deal with them?

I had no complications, thank God.

In the weeks after you got your surgery date, how did you feel? How did you cope with any anxiety you might have felt?

I alternated between nervous tension, anxiety, and relative calm. I tried not to obssess on the upcoming date, and shifted my focus to things that needed to be done so I wouldn't have to do them post-op, such as my holiday shopping. When I got really stressed, I talked it out with my husband, or looked for support on-line with other stressed out pre-ops!

Describe your first few weeks home from the hospital. What should people expect from this period?

First week home - you will feel terrific the first day or so - it's a result of left-over hospital drugs. Try not to get to excited. You will crash. Remember that you have just put your body through a major SHOCK. It was happy, being fed all it could hold, getting whatever you gave it for rest, and then suddenly, you opened it up, rearranged it, and stopped feeding it! If you don't treat yourself with a great deal of pampering, and insist that others do, too, you will soon feel like the mack truck has indeed, run you over. Use this time to get in touch with exactly what your body says, and why. Get used to the slow introduction of foods and flavors, and savor them. Remember the true feeling of hunger, and not "mind-hunger". You are going to be sore, but you can do things. Each person reacts differently to pain, and if you are in pain, do not try to be brave. Fix it! Call your doctor if you need to. Allow yourself time to heal.

How far did you travel to have your surgery? (If far, how did this affect your aftercare?)

My surgery was done in a local hospital. No traveling - except for 30 minute car rides - was necessary.

Please describe in detail what things you could and couldn't eat in the weeks and months following surgery. What foods have been off limits? Please explain how your dietary tolerance changed week-by-week, and then month-by-month since surgery.

Initially, my surgeon gave me a strict diet to follow of clear liquids. I followed it. It remains in effect from the second day after surgery until the staples come out. After that, for 9 weeks, the diet is full liquids, which includes yogurt, cottage cheese, (non-fat, of course), and applesauce, unsweetened. Skim milk in coffee and tea if you wish. Creamed soups are okay now, and the solids can be consumed providing they are extremely mushy. I am also permitted non-carbonated beverages, and sugarless, and V8 juice, as well as fruit juices. I tolerated each thing very well! At about 5 weeks out of surgery, I began to experiment with different foods, without my surgeon's approval. I tolerated everything well. I did chew carefully, eat slowly, and avoided sugars and fats. Up until about 3 months after surgery, I avoided all raw veggies, nuts, and hard to digest items. I have still not tried sugars or highly fatty foods. I don't intend to! A thin spread of reduced fat peanut butter and jam on a soda cracker (actually, 5 soda crackers...) caused a "dumping" episode. I was slightly nauseated, and became very shaky. This was at 3 months. For the most part, now at 11 months post op, I can eat anything I want, with the exceptions being things that make my pouch uncomfortable. For instance, pasta, breads, and rice make me feel too full. I avoid them. I eat whatever else I want, still avoiding deep fried foods, or sugars. I can do a small amount of diet sodas, and enjoy them as a treat. I no longer want the sugary stuff I thought I couldn't live without! I am now able to eat considerably more than I could at first - in the liquids, for instance, I could only do a sip or two at a time, then an ounce or two. Now I can do nearly four ounces at a time, if I really want to drink it. Food, I can consume about a cup or two (depending on the density of the food) at a meal. I still eat slowly and chew carefully. I still do not drink with meals.

What was your actvity level in the days and weeks after surgery?

I have more energy one week post op than I have had in over two years. I am sleeping normal hours, and looking forward to getting a real life back. Too soon yet to discuss exercise program. At 3 months post-op, I am in physical therapy to strengthen my legs. I am attending twice a week. I used to require 10 or more hours of sleep per night, and now am feeling more normal, and do nicely on 7. At 11 months post-op, I am scheduled to have knee replacement on my right knee. I could not find a surgeon to touch me a year ago. I was far too heavy for good results. I am so busy with my life now that my firends are complaining that I am hard to get a hold of!

What vitamins and/or dietary supplements have you taken since your surgery?

My surgeon permits only one multi-vitamin daily until the pouch is really healed well. Then, I may add back some of my preferences, providing they don't irritate the pouch. He also included a B12 vitamin with iron, which I will be taking for the rest of my life. At 3 months post-op, I have added back a skin, hair and nail supplement, and calcium and magnesium supplements, which I took prior to surgery. I discussed these with the doctor before returning to them, and was given the "go-ahead", if I wanted. At 11 months post-op, I continue to take those mentioned, and I take extra vitamin C, D, A and E. I take glucosamine and chondroitin.

What side effects (nausea, vomiting, sleep disturbace, dumping, hair loss etc.) were worse for you? For how long after surgery did they persist? How did you cope with them?

One immediate nausea episode was the worst for me, but it was a fear factor. I was so afraid that it would hurt my new pouch, and I was fortunate not to have vomited. I had several days of sleep disturbances as a result of a reaction to meds. It was uncomfortable, and as soon as it was resolved, I began to feel better. I called my surgeon to change meds. As of 3 months post-op, no hair loss yet, and no other side effects that I have noticed. Now nearly a year post-op, still no hair loss, no vomiting EVER, and dumping is only if I make a mistake and ingest sugar!

What was the worst part about the entire bariatric surgery process?

I found the dependence on others at the hospital to be one of my worst feelings. I was hooked up to so much that I could not get out of the bed to pee, and I had to wait, in pain (meds wore off), IV backed up, for over two hours before the nursing staff attended my needs. It was getting scary. This of course had nothing to do with the type of surgery. The surgery process itself was one of the better surgical experiences I have had. If at all possible, have your surgery where the staff are accustomed to dealing with people of size!!!

What aftercare support group/program do you have? How helpful/important is this?

A support group, on line and/or 'live' is important, so that you can compare notes. It helps to realize you are not alone when something happens. And things do happen - sometimes serious things, sometime just curious things. I have found BOTH types of support, as well as friends, family and extended family are extremely important to recovery and sustaining the motivation to keep working with this new tool we have been given. I would recommend it to every one having this surgery. Be sure you have some sort of network in place to guide you. There was no support at the time of my surgery - so I formed a support group. We are now, 2 years later, over 120 people strong, with all types of health issues and support to offer each other. It's awesome!

What is your scar like? Is this what you expected?

My scar runs from just below the breastbone down the center of me, to about 2 or 3 inches above my navel. I have staple marks on each side of it - 20 of them - and the incision line is very straight. I expected that. I did not expect the top part of the incision to separate, and the scars where it did are going to be wider and rounder. Also, there is a tiny scar where the drain was inserted, just above and to the left of the incision. I am not upset about the scars - this surgery was never about vanity, and I don't plan on wearing two piece bathing suits, no matter how much weight I lose. As long as it heals well and I don't get a hernia I will be very happy. Nearly a year post-op, scar is fading, though still not lovely, and I don't care! No itch, no pain, no hernia! ***Two years out, the scar is much more faded, causes no problems, and no hernia.

Please describe any plateau experiences you have had since surgery.

At 3 months post-op, I have begun to experience my first plateau. I have increased my activity as much as possible with the wheelchair still being my main means of transportation, and have returned to a diet of predominantly liquids, without sacrificing protein, just for a few days. It's still sort of early, so I am not worried about it yet. In June, after a loss of 111 pounds, I began a plateau, which lasted for nearly 3 months. I was at a point in the weight loss that my body felt comfortable with - a place I had "lived" for about 20 years. In desperation, I started a plan of increased activity, increased water intake, and doubled up on the protein shakes - I have lost another 15 pounds this past month. I am really happy. I have about 80 more pounds to lose to goal! Now, two years post op, I have lost a total of 154 pounds. I would like to lose 50 more. The loss is stopped, so I am working out, and "fine tuning" my eating style, which has slid back to grazing. Not a way to get to goal!

Do you notice people treating you any differently now?

I think it's too soon to tell, really. Most people that know I have had the surgery are anxious to ask all sorts of questions, and I am very willing to discuss it with them. Because I feel better about myself, I am more confident, and therefore, getting beter reactions from strangers. I find after losing 124 pounds, not much has changed. I was always treated well, I think. No big difference.