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

I found out through watching 20/20 or 60 minutes about three years ago. At that time surgery was still frowned upon like it was in the 80's. The surgery that was available was the Fobi pouch and the Vertical Banded Gastroplasty. After watching the show, I thought that might be the only way I would ever fit into size 6 jeans. (Wrong attitude at the time, I'm glad my carrier at the time turned me down.)About a year ago, I was insured by Kaiser Colorado. I heard about the RNY and thought that might be a better way to go. My attitude had changed a lot too, and I knew I was ready for the challenge and changes.

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

My experience was a long and hard road. However, Kaiser Colorado did tell me from the outset what exactly needed to happen for an approval to occur. So at least I knew what I was up against. I discovered a patience which I was sure I did not have. The only advice I would have is for Kaiser Colorado patients, but it should serve them well. Remember that these are people who are protecting their own butt first and foremost and that no matter how hard you push or how many times you call, you still must follow the same protocols as everyone else. In fact I think it might be detrimental to be a pest. The same people that you pester are in on your approval meeting and I'm sure they have long memories. Educate, educate, educate yourself, that and patience and a thorough understanding of the Kaiser Colorado system is the only way to go.

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

Dr. Debra Davis-Merritt is straight to the point. She confirmed a few facts about my approval with me. It seems that she was testing me to see if I was pulling the wool over their eyes. But after that she went into a very clinical discussion of exactly what the surgery does. She answered all my questions without complaint, although she did seem slightly offended by my questions of mortality rates. By the way, they are zero at this time. Very business-like, but I haven't had a real chance to see her bedside manner.

What made you finally decide to have the surgery?

My baby brother is graduating high school next year. There is a magnificent outdoor arena here called Red Rocks. It is very popular for high school graduations and there is a very good chance that his commencement will be held there. Problem is, being in Colorado, we have lots of high elevations and Red Rocks is located in our foothills. Some of my thin friends even have trouble going to Red Rocks. There is no way I am going to miss this event in his life because I am too fat to handle the stairs.

How did you decide which proceedure to have?

The decision was really made for me. Kaiser only offers the Open RNY. This is after I tried to receive approval for the VBG and I am glad it did not happen. I have read everything I can find on the RNY and I am very comfortable with the procedure. Also, my surgeon removes very little of my intestine and I am more comfortable with that in terms of malnutrition risks.

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 know that this surgery has the same risks as any other major surgery. I also have to have my gall bladder out at the same time and I am wary of the extra time under anesthesia. I have begun preparing a will and living will and powers of attorney. I am not afraid of death, but it's different when you are putting all your life's treasures on paper. I think about it, I know it's a possibility, but at least I am doing something for my quality of life. As for those who are struggling with the same fears, fall back on your faith, whatever it may be. Talk with your loved ones and friends and let them know how important they are to you. And always remember that you made this decision because you are sick of watching life pass you by. You have decided to join the human race and any risk is acceptable in achieving your goal.

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 family is very supportive and are as excited as I am. I am not married nor do I have any children so I did not feel I was making this decision for anyone but me. My friends, who are all thin, support me but they can never really understand my motives. They can't understand the pain of trying to be invisible and I can't fault them for that. They are afraid for me, and I love them for supporting me when they are scared of the consequences.

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

My supervisor was understandably frightened for me. I told them that it was a matter of life and death (True). That if I didn't have this surgery, I would die and soon. They were great about the whole thing. I was out for 6 weeks so I was on Short Term Disablity. It was easy for me.

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

It was awful at times but generally not too bad. I had no real pain past the first two days and I did have a morphine pump. (Get one!) Hospitals are hard to sleep in, so I used my pump for a sleep aid. During the surgery, my surgeon was unable to staple my small bowel to my pouch and had to use sutures. These leak more so I had my NG tube in for 4 days instead of one. This tube goes up your nose and into your stomach pouch. It is attached to a pump that removes your stomach contents, which are then displayed on the wall behind your bed in a clear cup. That was the absolute worst part of the stay. I couldn't breath through one nostril, I couldn't swallow without a sore throat, and my sinus was so backed up, my head hurt and my right eye was bugged out of it's socket. On the 4th day, my birthday, I was taken to have an upper GI to make sure I wasn't leaking. That was miserable as well. The tech filled my pouch too full and it was painful. It was the only time I was excited to go back to my room and plug myself into the vaccuum. Then they removed the NG tube and my sinus drained, my eye went back the way it should and the angels sang and gods wept. :o) In total I was there for 5 days. Bring all of the things from home that make you comfortable. I brought a small desk fan that hooked to the railing. I had a hard time regulating temperature after anesthesia and was hot all the time. I also brought a book, which I didn't read much of. If you have night wear that is easy for nurses and doctors to work with, bring that. You will be more comfortable in your own clothes.

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

The only complication was the sutures instead of staples. The NG tube was miserable, so I walked around the hospital floor a lot to keep my mind off it. And I slept a lot using the morphine. Fortunately, I healed well and had no pain to speak of.

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

When I first got my surgery date, I was ecstatic. I just felt a sense of relief. It had been a long and hard road to that point. I never had any real anxiety until a few hours before going to the hospital. 13 hours before surgery, my surgeon called and said they were concerned about my EKG. That it was showing a possible heart defect. Fortunately, I had been tested already for this defect and I did not have it. My surgeon said she would confer with a cardiologist and the anesthesiologist and then call me back that night. She never did, which increased my anxiety because I didn't know if I was going to have surgery or not. However, I just decided I'd show up and see. Fortunately, the surgery went ahead as planned.

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

My first week was the worst. I couldn't sleep lying down for 2 1/2 weeks. I rigged a way to sleep in my own bed and still be able sit up. After that week, things evened out and I was just glad to be home. I was very weak and napped a lot. Learning to eat again was very strange and for the first 2 weeks, I was on a soft food diet. I found that I missed chewing the most. Once that time was over, I just began experiementing with cheese, scrambled eggs, yogurt. Anything with protein. I had a cast iron stomach before the surgery, so I was able to start more foods earlier than most. Definitely a person should not expect too much from themselves for the first few weeks. Your incision is sore, you can't eat real well, and you're tired. Don't push yourself.

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

I did not have to travel far at all. The surgery was in my city.

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.

At first, I could eat only yogurt, soup, cottage cheese and other soft foods. After about a month, I tried chicken, cheese, eggs, crackers, toast, tuna and other complicated foods. I did not try fruit or veggies until 6 weeks after. Then I tried salad and pears and apples (no skin) as well as other softer fruits and veggies. I have no tolerance for milk, nor can I eat bread unless it's toasted. I have not even tried a processed sugar. I stick with natural fruit sugars only. My tolerances haven't changed much. If I ate a food that I couldn't tolerate, I don't try it again. The only thing that I couldn't tolerate at first that is better now is peanut butter. I haven't tried any soy products yet. I'll get back on that. Tried soy, it's ok, but doesn't do it for me. I am now 9 months post-op and can eat anything pretty much. Too much milk makes me sick, I can have just a small cup. Too greasy makes me nauseous. I do well with meats as long as I chew well. I can even have a little bit of sugar. Like a snack size Snicker or whatever. More than that makes me want to vomit and I get severe flatulence for some reason. I have just a piece of chocolate now and then and don't really crave it too much. I use one and a half scoops of Pro-complex chocolate protein powder with about 6 oz of water in the morning and evening. I mix this well with an immersion blender and then add ice. It's the best protein drink so far. I take my vitamins with these and with just the protein powder alone I get about 55-65 grams a day. This is extremely important as I did have sever hair loss due to my protein intake. If I had this powder earlier, it wouldn't have happened. I also keep a close eye on my vitamins as well. Take at least 1200 mg of calcium citrate as calcium carbonate doesn't digest as well in our pouches. Osteoporosis is a real risk now.

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

For the first week out of the hospital, I took it very easy. The staples in my incision pulled a lot, so I was careful in how I moved. I began walking immediately whether I felt like it or not. At first, I could only walk a few houses away from mine. In about 3 days, I could make it to the end of my block. Now on my four month anniversary, I can walk 2 miles in under a half an hour. I have never had this much energy. I take stairs instead of elevators and I don't huff and puff when I get to the top any more. About 3 1/2 months out, I began to have a hard time getting up in the morning and I was tired all day at work. I still had energy, I just felt exhausted. I had some labs run and I was a little low on iron. I bought a mult-vitamin that has iron in it and I feel much better. I don't think I have ever felt this good. At 9 months post-op, I exercise 5 days a week and I can do more physically now than when I was a child. My energy is sky-high and I love being able to work out. I just got back from vacation in Savannah and I was able to walk everywhere in that amazing city. It was just the best.

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

I am taking a protein supplement. The drink provides 32 grams per serving and is GNC Unflavored Ion Exchange Whey Protein. I also supplement the drink with Pure Protein Bars. I buy the Double Chocolate and the Peanut Butter Chocolate. They have only 2 grams of sugar (non-processed) and taste the best. Also I take a multi-vitamin w/iron and a calcium and D vitamin supplement. And a separate Folic Acid and Biotin for the hair. (Didn't work, but helps the nails and immune system). I have switched to Pro-complex chocolate with 6oz water 2x a day. I take a multi-vitamin, calcium citrate, biotin, folic acid, lutien (for eyes) as well as I am starting a vitamin c supplement too.

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 have had few side effects. I did have a sleep disturbance for a couple weeks out of hospital. I had a hard time getting comfortable and had to sleep sitting up. After my staples were out, I felt much better. I also had bad diarreha after I got home. After 4 days, I bought Imodium and have had normal stools since. My hair loss is the worst. In high school I prided myself on my beautiful long auburn hair. In my early 20s it started to thin due to genetics. Within the last year before surgery, it was getting real thin on top. I am getting checked for poly-cystic ovarian syndrome, which side effects include facial hair and male pattern baldness. About 2-3 months out, my hair just started falling out. It comes out in small hanks and is terrifying. As a fat person, I looked for and found the one thing that I liked about myself. It was my hair. Now it's falling out so fast and I actually have patches where there is no more hair. I am oing to bite the bullet and buy a wig. Hopefully this will end soon. I have heard that around the 5th or 6th month the hair loss slows down and eventually stops. Unfortunately, I will be bald by then. That goodness for wigs. I did have to get a wig. I wore it for 2 months, but fortunately my hair loss has reversed itself. I will still need to purchase special shampoo to get the little hairs to grow to full size. I am donating the wig to the American Cancer Society.

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

The worst part for me was the hospital stay. Not all of it, but most of it was uncomfortable. I had a great roommate and mostly competant nursing with one exception. Because of a surgery complication, I had to have my NG tube in for 4 days. It was awful. I couldn't breathe and my right sinus couldn't drain past the tube, so it was painfully blocked. So blocked that my right eye bulged a bit from it's socket. I couldn't have any food or water for those days. I was allowed to suck on a small sponge that I dipped in water, but the NG tube vacummed it out of my pouch immediately. 4 days later (my birthday), I was taken to have an upper GI to make sure I wasn't leaking so that could take that damn tube out. It was miserable. I had to drink some vile stuff that would show up on the xray. I couldn't gag enough down so they injected it right into my NG tube. It was the first time my pouch was filled and it was cold. The they added some water for contrast. It was too much. It hurt and I felt like barfing. I had to have them drain it from the pouch immediately. Fortunately, the scan came back with no leaks and they pulled that tube out. It was heaven to be able to breathe again and swallow without soreness. On my 5th and last day, I had my first BM. I couldn't turn enough to wipe myself and asked for a nurses assistance. She apparently did not wipe at all. I got up out of bed to take a shower before going home and there was a mess in my bed. Thank goodness that the shower heads were hand-held so I could clean myself. That was the only time that I was treated badly by the staff. I had wonderful nurses and I imagine the morphine pump made everything much better. Even for all that misery, I would do it all again.

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

I have two. The first is Healthy Spirits. It is a non-Kaiser specific group run by a wonderful woman named Terri Verbickis (sp?, sorry Terri). It is nice that once a month, I can be with people who know exactly where I am coming from. The other is for Kaiser patients only. And it is also helpful in the comraderie department, but is much more focused on our health. It is run by our dietician and is also a wonderful place to be once a month. I no longer attend a support group. It was time to move on for me and I couldn't rehash my experience every month. I felt like I was stuck in the past and I had this surgery for my future.

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

After four months it is still pretty ropey and wide. I put Vitamin E and something called Scarmassage on it every night. It seems to help as it is slowly disappearing. I am now 9 months out and my scar is still ropey and although it seems to be shrinking on the ends the middle is still angry and occasionally tender. Even right after the surgery, it looked like there was minimal care taken putting the edges of the wound together for stapling. Anyway, I think this is as healed as it will get. And it's still bad and rather embarrasing. 2 Years out. It's not as pink anymore, but since such a lack of care was taken, my plastic surgeon says it's going to hamstring him in the abdominoplasty. He may even have to cut it out and resew it back together causing a large X to be carved into my abdomen. I'm not happy about it and neither is he. If my surgeon (or her resident) had taken just a little more care in the closing of the gastroplasty, my cosmetic chances would be much better. Oh well....

Please describe any plateau experiences you have had since surgery.

I have had one thus far and it wasn't too bad. I am losing inches in strange places like my feet and upper back. I wish it would come off of my butt and gut and hips, but I know it will soon. No more plateaus since I got my workout machine. I am losing slower, but still losing. I am about 50 lbs away from goal. I believe I am at my end now. No more losing. I've been stable for 8 months. I am happy where I am at and don't plan on trying to lose more. Should my toning and workout regimen cause me to do so, that's okay by me though. :o)

Do you notice people treating you any differently now?

Absolutely. I work with law students and there are two male students who are good looking. When I first came back to work, they would hardly talk to me. Now, they greet me enthusiastically. Another friend treats me like glass and rarely calls anymore. My family has been wonderful, but even they treat me differently. Like I'm more fragile. It's strange. And I get more double take looks from men than I ever have. 2 Years out and it still amazes me how much differently I'm treated. It's sad really, because I am the same person I always was. I didn't change, I just got smaller. Also, doctors treat me differently. Before, everything that was wrong with me was because I was fat. Now, it's because I've had a gastric bypass. I have to be very forceful in explaining that I know that there is something other than surgery wrong with me.