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

I had read about Carnie Wilson and Al Roker. When I found the Obesity Help website I read for hours and couldn't suppress the sobs when I realized there was real hope for change. As a nurse, I knew the risks of abdominal surgery. I also knew that the odds that back surgery would give me pain relief were slim. Gastric Bypass seemed to offer a better outcome with similar or less risk.

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

I had Healthnet in 2002 and they turned me down for a Duodenal Switch. I chose this procedure due to a recent histoy of duodenal ulcer. My appeal was denied stating procedure was considered experimental. I was so discouraged by the denial and that I gave up on having any bypass surgery. Months later I developed gall bladder symptoms and had a lap cholecytectomy which went so well that I decided to look at the RNY. We had changed insurance plans to Blue Cross of California. I saw the surgeon in March and was approved and scheduled within 2 weeks. I worked through the Blue Cross Case Management department which faciltated insurance approval.

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

I did quite a bit of research, read profiles and decided I wanted an experienced laparoscopic surgeon. I tried to get in to see 2 surgeons closer to my home but they had 12 month waiting lists for consults! My 3rd attempt was a call to Laparoscopic Asso. of San Francisco. They scheduled me with Dr. Jossart, my first choice, for an appt. in 3 weeks. Dr. Jossart listened to my story and we agreed to try for the DS. I made a graph of my weight over time, naming the weight loss programs along the way. This helped reduce the time spent determining if I qualified for the surgery. I also took in a list of all my medications, the prescribing doctors, and their addresses and phone numbers. I had a chronological health history also printed out. I took a list of questions and wrote down Dr. Jossart's answers for future reference. When I saw him again almost a year later, he remembered me and everything was in place for a quick approval.

What made you finally decide to have the surgery?

I decided to have surgery the day I shattered my antique dining room chair as I sat down on it. I had lost strength in my legs from my back problems and as I got more sedentary, I really plopped down into chairs. That was the proverbial last straw for me.

How did you decide which proceedure to have?

Dr. Jossart assured my that with a BMI of 40, the Lap RNY would be a good procedure. We talked about the Lapband briefly, but decided a RNY was a compromise between the DS and the Lapband. I was afraid of going through all this and not losing the weight. My reservation was my history of duodenal bleed, although my doctor thinks that was a reaction to Celebrex and would not reoccur if I avoided NSAIDS. Pre-op endoscopy showed some inflammation but no ulcers allowing me to have the RNY. I take Nexium to protect the stomach and duodenum.

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?

I most feared being viewed as taking the easy way out of obesity. I did not fear dying. Since I'd thought a lot about taking my own life, I was at peace about a possible death. Though not actively religious, I believe in an afterlife and meeting my loved ones again. As a nurse, I have watched people die and listened to many patient's near death stories and had no fear. Betty Edie's books also helped. I was, however, challenged in dealing with fears of my family and friends. Particularly my husband, who is a "glass-half-empty" kind of guy. He's analytical person who tends to focus on risks vs possibilities. He did, however, respect my decision, knowing it was taken only after much research and contemplation. He went with me to meet Dr. Jossart the first time and knew I was in good hands. He read the material Dr. Jossart gave us, although he would have liked more information about the long term challenges. I did write notes to my husband and son expressing my feelings and my wishes for us to meet again in the next life. My sister knew where the notes were if things went wrong during or after surgery.

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?

My Mom is a nurse and reassured about the choice of hospitals and laparoscopic procedure. My sisters who understand our familial weight challenges were also supportive. My youngest sister was the one who drove me to the hospital and walked with me to the OR door on the day of my surgery. She was there when I woke up and stayed through the first hours of recovery, a gift for which I am touched and grateful. My husband agreed to stay home and mind the pets and our son, although he probably would have preferred to wait at the hospital. I didn't want his fears to rub off on me as we waited, I wanted someone calm and positive there with me.

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

My immediate supervisor knew someone who had had this surgery and was very supportive. What we did not plan well was transition of my work load. Being the "glass-is-half-full" person that I am, I did not take enough time off after the surgery and made committments to maintain telephonic contact with my caseload that I could not keep. My boss has been most patient with my inability to keep up, in fact she's been a saint, offering help without criticism and the option to return when my current hormonal and mood problems stabilize. I am writing this at about 7 months post-op.

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

I had a private room which I requested on admission. I highly recommend this for rest. I also requested a sleep medication each night. I made a mistake having my urinary catheter removed before I was sure I was putting out adequate urine and had difficulty urinating for about 12 hours. Watch your IV site, where the needle was inserted for pain or swelling. Unfortunately, they dislodge and have to be changed to another site. The nurses at California Pacific Medical Center were skilled and patient with my tiny veins. Be sure you talk to your surgeon about a PCA, a pump that allows you to give yourself a little extra pain medication through your IV whenever your pain increases, like after walking. I went home on the 3rd day after surgery.

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

Complications were minimal. I had the trouble making urine and held a lot of fluid for a few hours, a reaction to surgery or trauma called 3rd spacing. I developed huge hives, a reaction to either Morphine or Tordol which were changed to Demerol. I think they gave me an antihistamine too for the hives. In the hospital I developed right hip pain which continued for months and was finally diagnosed after a negative MRI as bursitis and relieved with a steroid injection. The hip pain curtailed my walking and active exercise, necessitating the use of a cane. I did find Yoga on the floor which worked well from the beginning.

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 was so excited, I was buzzing like a bee. I only had 3 weeks to get ready. I had a lot to do so my family could get along on their own for awhile. I put my anxiety to work cleaning, cooking, and finishing up my work work. At bedtime I fell asleep reading something about the surgery from a book, the internet or the doctor. I was so ready. I did have my son prepare his portable CD player so I could listen to Motzart during surgery. I took flower essence Bach Rescue Remedy every day to prepare my system. I talked with friends and family and indulged in massages.

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

I was on the PCA for 2 days, switching to Vicodin on day 3. I felt little discomfort from my 5 abdominal poke holes. Just itching as they healed. They were a little swollen, and there was a little bleeding for a week or so, but this is normal. I did take Pain pills mostly for my back, hip and hands as I did pre-operatively. My biggest problem was low Potassium which put me in the local hospital at 2.5 weeks post-op for IV potassium replacement and heart monitoring. I had chest pain and heart enzymes were elevated. Low Potassium is very dangerous. Symptoms that I now recognize were tremors in my arms, legs and face and increased muscle weakness. I also had chest pain different from the "its-not-going-down" pain. At 2 months post-op I was scheduled to see my surgeon and a GI doctor for dilation of my stomach outlet due to intolerance of solid food. Pre-procedure labs showed my Potassium very low again despite taking prescription potassium supplements. I was hospitalized overnight for more IV potassium which is very painful due to my tiny veins. Despite the pain, I knew the potassium problem would be temporary. As soon as my blood pressure normalized, I quit taking the blood pressure medication that depleted my potassium. A little dramatic, but ultimately just a bump in the road to recovery.

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

My surgeon and hospital are about 120 miles away, but I don't mind going to San Francisco. Because I was so far from my home, I had not visitors. This allowed me to concentrate on my own recovery. Having the doctor at a distance was a little complicated when I had to stay overnight there for Potassium. I ran up a huge parking lot tab. Hopefully, I will see the surgeon closer to home in the future when he sets up a satellite office in Roseville. I will then be able to go to a support group.

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.

I could eat cottage cheese, natural apple sauce, cooked squash, and Myoplex shakes right away. Did not tolerate soups with even small chunks. I was excited when I found Dreyer Popsicles with No Sugar Added which were great. As I tried new things, sometimes they stayed down, other times they got "Stuck" causing pain under the breast bone, rising saliva in the throat, needing relief by vomiting. At 7 months, I still have trouble with bread, beef, or chicken despite two dilations. Fish is good, particularly fresh poached salmon. I try new things daily and find something that won't go down about once a week. I can eat a little bit of vegetable, rice, potato, and even pasta. Soups are great. I like split pea for the texture and protein. Crackers and cheese are good, but watch calories if you're not losing. Smoothies and yogurt with oatmeal are my breakfast staples. The most amazing thing to me is how the surgery affected my appetite. I can honestly say I am rarely hungry and very easily satisfied. I understand that the stomach grehlins become less active which changes the way messages of hunger are sent to the brain. It feels like I have a different brain to go with my new body.

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

I was pretty sluggish, but determined to keep active even the first week. I got out of bed and got dressed every morning to get my son off to school. I did indulge in afternoon naps and still do. We had a big formal family wedding 6 weeks after my surgery and I was able to last through all the festivities. At about 4 months, my energy level became quite variable, some days I was hyper, then I'd be unable to get out of bed. Emotionally I was all over the place. I developed the ovarian cyst and had to have surgey in hopes of settling down my hormones. I had irregular menstrual bleeding even though I hadn't had periods for 1 year before surgery. In short, I was going through menopause for a second time!!!! I am now off work due to severe migraine activity and adjusting to new medication for mood and migraine. I also have breast pain which is being worked up, hopefully just from sagging due to 90# weight loss.

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

I used Flintstones chewables until recently, then I switched to Centrum, then Natrol. I'm not entirely satisfied yet. I take Micro K potassium, L-glutamine, L-carnitine, B12 dots, Viactiv (caramel flavor!)for calcium, Flax seed caps, EFAs(#3 and #6), CoQ10, Sam-e, Folic Acid, and ADECs. I drink Myoplex Carb Sense with 43 gm. Protein. If you have been given antibiotics, be sure to take acidophilus to recolonize your colon. Watch out for vaginal yeast infections or mouth trush due to antibiotics.

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?

I do get nausea and weakness from anything with sugar. I had to give up Adkins Shakes because they make me dump, not sure why. Myoplex Carb Sense are OK. I had a little hair loss, but not like after my bleeding ulcer so I was happy. The hormone thing has really put me through some tough times. It has also cost me a lot of money in loss of income and pursuit of appropriate treaters (psychologist, psychiatrist, natural healing doctor). I think I had at least one doctor appointment every day for the last 2 weeks! I get frustrated with not feeling like myself and the mood swings, migraines, and all the tests I've been through these last 2 months. My husband is losing patience with the loss of income and frustrated the he doesn't think we were fully informed that the hormone and nutritional disruption could have such a profound effect on my personality. I do think spouses, family, and friends expect that when your incision is healed, so is everything else, which is not the case with any major surgery. I tell my patients to expect recovery to take 12-18 months from major operations. Even though the rate of recovery is high early on, it tapers off over time. I feel compelled to educate those who expect instant recovery about this.

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

For me, the hormonal upheaval has been the most trying because I look fine. In fact, I look great in my size 12 jeans and short sweaters. But I never know if I will wake up Hyper Hannah, Sad Sarah, or Perky Polly. The breast thing is painful and a worry as well. I started new medication which I hope will help. I hope my state disability comes through soon to ease the financial stuff. I hope I don't lose my job. I know I will feel like myself soon because I am a "glass-is-half-full" person!

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

I go to the internet for support several times a week. I have my medical books which I consult often, as well as my nurse friends to bounce things off of. My surgeon has been responsive and his office helpful in problem solving with the stricture and potassium problems. I like that I can reach them quickly by e-mail. I am looking forward to the possibility of a local support group conducted by my surgeons. My primary doctor is willing to learn from my journey and to refer me to specialists when necessary. I am grateful to the Neurologist who concurred with my assessment of the hormonal disruption and was willing to work on reducing my migraine attacks. I have also met a surprising number of "Travelers" who have undergone this type of surgery or are preparing for it. I have clerks at the grocery and old friends ask about my weight loss and I proudly tell them I had a gastric bypass and saved my own life.

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

I have 5 little scars from this surgery, to go with 3 from my gall bladder, 2 from the tubal ligatiion, and an old midline exploratory lap scar from 1964. I'm not ever going to be bikini material.

Please describe any plateau experiences you have had since surgery.

I felt like my weight loss was slow but at 6 months I was within goal range with 90% loss. I'd be satisfied if I did not lose another pound!

Do you notice people treating you any differently now?

Everyone treats me differently. The biggest factor has been my work. I manage injury cases for Workers Compensation and attend doctor appointments with my clients. My extra weight, I believe, damaged my credibility with some professionals and clients. I encounter none of that now. Most of all, I notice that I treat other people differently. On my good days, I go out, I smile, I joke, I interact, where before surgery, I kept more to myself, my head down, hoping not to make eye contact with anyone and see their reaction to my immense size and waddling gait. Even with my mood swings, I know my life is only getting better. I wanted to mention something about my reaction to others who might benefit from weight loss surgery. I experienced conflicting emotions as I lost weight myself and came in to contact with others with weight challenges. I did not wish to impose on people, yet I do wish to help others who might be suffering due to their weight. Consequently, I am friendly and open, and hope that in the course of conversation, perhaps over time, the subject will come up or they will ask me about my experience. In addition, I think ObesityHelp provides the perfect forum for spreading the word that there is hope.