Psychological Evaluation

My psychological evaluation was scheduled for December 28th at 2pm.  Although I arrived 15 minutes early to my appointment, I had a sinking feeling that something was wrong.  I got to the window to check in, but they didn't have me on their schedule.  They penciled me in, instead, for December 29th.  By the time I had gotten back to my car, I was  fighting tears back.  I had mentally prepared myself for this and was so disappointed that it didn't happen.  I calmed myself down and reminded myself that it's just one more day. 

The thing is that my appointments keep getting cancelled and rescheduled, and I feel like it's never going to happen, that it's just too good to be true.  Really, after being fat all my life and working toward this surgery for the past 4 1/2 years, could it really happen?  Or, am I just fooling myself, setting myself up for another disappointment.  Is it really too good to be true?  I have a hard time believing that I'll ever be at a normal body weight. 

I went back for my appointment yesterday, cpap in hand.  I was told to bring it because I was seeing the sleep medicine doctor, who also has a background in psychiatry.  I was nervous about taking the cpap because I've been having so many issues with it.  The last few nights have been much better, and I've been able to sleep most of the night with it on - though, I think it's partly because I took some Tylenol PM before bed.  He read the little SD card in the machine and could tell that I've been gradually doing better with it.  My sleep time seems to increase each night.  Overall, he seemed happy with the progress.  He set me up for another appointment in April.  At that time, I'll get to bring home a device that will has a nasal cannula and a pulse-ox to see if my hypopnea has went down.  No more sleep studies for now, thank God!!  He expects me to be able to come off of it eventually.  That was like music to my ears. 

After we discussed the sleep issues, we went on to psychological issues.  He took a basic history - medications, family history, previous psych issues.  The only major issue that came up is that he confirmed about seven years ago, I had a major depressive episode.  It was right after I lost my daughter and I really struggled with daily life.  However, he said that it was understandable given the circumstance and I am fully recovered.  I do have a lot of stress in my life, though.  I have three kids ages 6, 6 and 5.  I am also going back to school to finish my Social Work degree and my husband has been recovering from a traumatic accident last January that left him permanently disabled.  I have decreased my school work load for the spring semester, only taking two classes which are mostly online, because I knew I wouldn't be able to handle the full course load.  He has recommended that I see a therapist once or twice after surgery to discuss any issues that I may have. 

One thing that stood out was him calling me a goody two shoes!  He said he could tell by looking at me that I didn't smoke, drink or do drugs.  He complimented me on the list I made a couple years ago of improvements I wanted to make in my life.  He thought it was a great idea and could see that I've strived to make that list a reality.  He also thought that I was the perfect candidate for this surgery because I am young, have no major health issues, I fully understand the procedure, am aware of the risks and complications and I have the determination to follow through. 

So, that's it!  I have been cleared for bariatric surgery.  And, he didn't commit me.  That's a huge plus. 

Revised Surgery Date

I just realized that I haven't updated in awhile!  I meant to, but Christmas kept me pretty busy.  The picture to the left is of me, making Christmas cookies with my family.  Sounds simple enough.  But, this was the gateway to unhealthy eating over the holidays.  I am a baker, I actually worked in a bakery for many years, mostly making birthday and wedding cakes.  I love to bake, and sugar cookies are probably my weakness.  Having all those cookies in the house was hard, and I caught myself sneaking one here and there.  This is why I don't buy sweets anymore, not even for the kids, because I just don't seem to have self control when it comes to certain things.  Aside from the sugar cookies, I also probably overindulged during get-togethers.  I didn't eat bad, but I did have carbs and I think they are a trigger for me. 

On Christmas Eve, my dad brought me a pumpkin roll.  His pumpkin rolls are delicious and I promised him I'd have a slice.  Three days later, it's still sitting on my counter, untouched.  However, when we went to my sister's yesterday for our Christmas get-together for my side of the family, my mom brought her legendary fudge.  This stuff is good.  Too good.  In fact, I use her recipe for our non-profit organization's annual fudge fundraiser and it always rakes in a lot of funds.  I had... gulp... 4 pieces.  And, when I stepped on the scale this morning, I had gained two pounds.  Now, I really don't think that I ate any more than any regular person (except the fudge, maybe) but look how fast those pounds packed on. 

It's clear that if I want to lose weight and keep it off, this surgery is a must.  When my brother asked yesterday about the surgery and I mentioned I had already lost over 20 pounds, he said, "Well why don't you just keep doing what you're doing and not have surgery?"  The answer is simple.  If I want to get to a healthy weight and stay there, I'd have to stay on 2 protein shakes, 4oz lean protein and 1 cup of veggies a day.  That's not very realistic, though.  With the sleeve, I'll be able to eat normally, but I will only be able to eat a certain amount.

Okay, now to the real purpose of this post.  My surgery date has changed from January 10th to January 17th because my surgeon will be out of town.  Now, I'm really starting to get nervous because classes start on January 18th.  My classes are online, but my husband's aren't, his will be on campus.  That leaves nobody to care for my kids.  I'm trying to figure it all out and hoping someone can help me. 

Also, the labs I had drawn a couple weeks ago all came back great!  My cholesterol is also way down.  My vitamin D is up, iron is fine, and everything looks great!  My psych eval is tomorrow, and I hope that goes well.  I also fell asleep with the cpap on last night and slept for about 4-5 hours, so we're making progress there. 

14 Vials of Blood

14 Vials of Blood on the wall, 14 vials of blood.  Take one down, pass it around....

No, it's not a lame song from Twilight Family Vacation.  It's how much blood they took at the doctor's office today!  Wow.  I was there for 45 minutes while they looked up codes and what colored vials they needed.  They said that I was only the second person to have needed this type of labwork before.  They tested for the following:

CBC/Diff CMP/BMP PT/PTT/INR Platelet Count Iron Levels Zinc Vitamin B1 Vitamin B12 Lipid Profile LFTs Copper

Calcium Phosphorus Magnesium Vitamin A,D,E,K Selenium HgA1c Thyroid Functions (T3, T4, TSH) PTH Intact Vitamin D-25 OH Total Folic Acid

 It looks like they are being very thorough.  It will also be a good comparison for after surgery so they can compare them to previous levels.  As far as other pre-op testing, I have already had 2 Sleep Studies (one with cpap titration), EKG, Nuclear Stress Test and Endoscopy.  I have already seen the nutritionist once and will need to see her one more time.  I also have a Psychological Evaluation scheduled for December 28th.

I am fortunate that I did not have any major health issues.  Some other bariatric surgery patients have to do the following:  Pulmonary Function Tests, Stress Echocardiogram, Dobutamine Echocardiogram, Regular Treadmill Stress Test, Nuclear Dobutamine Stress Test, Adenosine Stress Test, Wrist X-ray (bone maturity), pH study, Bilateral LE Venous Doppler, Mammogram, and Esophageal Motility Study.  Some patients must have an IVC Filter placed to prevent blood clots, and some must have an upper GI and Colonoscopy.  Some patients must be cleared by a Cardiologist, Endocrinologist, Pulmonologist or Hematologist.

This is not an easy process, and anyone who thinks it's just going to the surgeon and getting a surgery date is wrong.  It's a long, drawn out process and the patient must undergo a lot of testing before it's decided that they are a candidate for surgery.  It's more than medical, too.  There's a psychological component to it.  A person has to be ready for surgery and be willing to make a lifelong commitment.  This surgery is for life, it's not something that can be undone.  It also is not 100% fool proof, either.  It is possible to fail.  There are things called slider foods, mainly carbs - potato chips, french fries, etc.  Things that go down easy, that won't feel you up and are empty calories.  The sleeve is just a tool.  If you use it right, you will lose the weight.  If you don't follow the guidelines, you can fail.  It's really that simple.  Weight loss surgery is not something to go into lightly.  It's not the easy way out.  In fact, it can be much more difficult than conventional methods of weight loss.  The difference is that you have a tool in place to help you keep the weight off long term, to maintain that loss.  For a person with morbid obesity, it is almost impossible to maintain significant weight loss long term.  The body has a set point, and will try to maintain a certain weight, even if it's almost 300 pounds.


I have been keeping track of my weight and measurements.  I'm a bit methodical in it, and really rely on data to see where I stand.  I'm the type of person that likes to make a spreadsheet for everything.  So, here it is.

Date	Weight	BMI	Chest	Waist	Hips	Thigh	Neck
10/01/10	286	50.6
11/11/10	274	48.5	58	53	60
12/12/10	265	46.9	55	52	58	29	15

Seeing this in black and white helps me push forward.  I see that I am making progress and it's great motivation.  I love what I am doing for myself.  I'm already noticing a change in my energy level and have even noticed myself running up the steps to my front porch.  Amazing.  And, this is only a 20 pound loss, I can't wait to see how a 100 pound loss feels!  I've also noticed that my t-shirts are much more loose.  Looking at the chart above, I can see that's because I've lost 3 inches off my chest!  I just hope I don't lose too much of the girls.  I started this diet wearing a 48F and I'm now in a 46DDD.  I think my pant size has dropped from 28 to 26, but I can wear a 24 in stretchy pants.  I think my shirts have also dropped from a 28 to 24/26.  I don't think anyone notices yet, but I'm sure they will in a couple months!

Buckling Down

The first few weeks of my liquid protein diet were tough.  I did not do well.  I tried to, but I was just so hungry all the time that I would sneak things here and there.  I saw the nutritionist a couple weeks ago, and since then I have really buckled down and am sticking to the guidelines.  I'm still hungry, but I guess that's just something I'm going to have to deal with.  The first couple weeks, I lost about 14 pounds and then I stalled when I didn't eat so well.  Now that I'm back on track, I have lost 20 lbs.  My clothes are much looser, and I'm able to fit into clothes I haven't wore in awhile.  I think I've went down one pant size, from 28 to 26.  I had some t-shirts that were really tight, but they are now loose.  I'm exactly one month a way from my surgery.  My surgeon didn't give me a set amount to lose, but I was hoping I could lose 30 lbs.  After the stall, I wasn't sure if I'd make it, but it's starting to look more like a reality. 

I went to the CPAP Clinic the other day, and I had really been dreading it.  It turns out, there was no reason at all to dread it.  I didn't get a slap on the wrist for noncompliance like I thought I would.  I wasn't noncompliant by choice, I simply could not tolerate the high pressure they had set for me.  She tried several different pressures and end up decreasing it from 24/20 to 16/12.  It is so much better.  I felt very validated with my concerns, she saw that there were leaks no matter the fit of the mask, the pressure coming out was just way too much.  So, last night I tried it.  It took me about an hour to fall asleep, but I finally did and slept for two hours.  I woke up and the mask was just so incredibly uncomfortable, I had to take it off.  I asked her yesterday about a nasal mask, but she said it was not ideal with my high pressure and I have to stick with a full face mask.  It's going to take a lot of getting used to, I really hate it.  I wish it were more comfortable, then I would have no issue sleeping with it.  As it stands, it's really hard.  I hope it gets better.

Surgery Date!

I got some big news yesterday - my surgery date!  I've been stressing about this a little bit because I was afraid it may interfere with college.  Classes start back up on January 18th.  I'm scheduled for January 10th!  This is perfect timing.

I'll be able to send my twins on the bus to school, not a problem.  But, my daughter is in pre-k and I have to drive her to and from school.  I may have mentioned that my husband had a serious accident last January when he fell from a roof at work, and he's still not totally recovered.  He'll never go back to roofing again, so he has also went back to school, which also starts on January 18th.  So, he'll be able to at least take my daughter to school and hopefully I'll be able to pick her up. 

I also learned yesterday that my insurance does not require pre-approval, which is amazing.  It only requires documentation that the procedure was medically necessary (which is no problem!)  The only hurdle that I have left to get past is the psychological clearance.  Frankly, I am a little nervous about that.  Mostly, because it's the sleep study doctor who will be doing the evaluation and I'm having some major issues with the CPAP.  Hopefully those will be cleared up after I go to the CPAP clinic tomorrow, though.  The evaluation is scheduled for December 28th.  I hope that he will remember that I'm there for psychological clearance and not because I'm having issues with the CPAP.  I was told that I have to take the CPAP with me for the psychological evaluation.  I'm not sure why, it doesn't make sense, but that's why I'm worried about it.

Being a Social Work major, I have some knowledge of psychology and I really don't think he'll find anything to keep me from surgery.  I have no eating disorders, no major depression and no delusional disorders.  I've experienced some depression in the past, but it was after my daughter died, and I think that's pretty normal.  At most, I think he might find a bit of an Avoidant Personality Disorder, but since it really doesn't interfere with life functions, I really think it all boils down to my being shy and feeling awkward around everyone else - which most certainly can be weight related.  I'm embarrassed by my weight and don't like to draw attention to myself.  I do not think that losing weight will change my entire life.  I do think that it will make me healthier and will boost my self confidence.  I will go into the evaluation with an open mind and be totally honest.  I'm just worried that issues with the CPAP will keep me from surgery.  There is actually a lot of anxiety about that.

CPAP Issues

I got my CPAP a couple days ago and I'm having some major issues.
To backtrack, I do not have obstructive sleep apnea, I only had 3 OSA's during my sleep study and they diagnosed me with hypopnea, I had 188 of those.  They set my pressure at 24/20.  Someone mentioned that I probably have a BiPap, but I really don't know.  The lady who set it up said it was a CPAP (and that's what the paperwork says) but the user manual says Respironics BiPAP Auto Bi-Flex.  It has a ramp, and I was able to turn it down from a start of 11 to 4 and that helped enormously to get used to it.  The mask they gave me is a ResMed Mirage Quattro Full Face Mask.

The problems are:

1.  I'm a belly sleeper, and well, there's really no way around that.  To use this thing, I have to give it up.  I really can't afford one of those special pillows right now, my husband has been off work since January when he fell off a roof at work. 

2.  It's extremely uncomfortable.  I hate having it on my face, I even have an issue with my glasses, I just can't stand things touching my face.

3.  It's way too tight, but if I losen it there's leaks.  It leaves red marks all over my face and the tension on the back of my head is painful.

4.  I feel like I'm having a very difficult time fully exhaling, it feels like my lungs just can't hold any more and I can't force what's in there out.

5.  I only wore it for an hour, but my throat is so dry it hurts!   I have tried the humidifier at 3, 4 and 5 and nothing makes a difference.

6.  Once the pressure reaches 18, the mask starts lifting up.

7.  Once the pressure is 18-20, leaks start.

8.  Anything over 20 is full on leaks which I just can't control, the mask is already too tight and the pressure lifts the mask up and causes leaks.  No adjusting stops it.  So I hit the ramp button and start all over, then give up.

9.  Oh, another major thing I've noticed is that over 20, I actually stop breathing and that really freaks me out.  I'm scared to leave it on all night.

I am supposed to take the machine to the cpap clinic next week, so I just need to get through this until then.  I have a perpetual case of allergies and wonder if this is affecting treatment.  I also think I may have a sinus infection (green mucus, bloody nose, I know, eww - sorry.)

Is it normal for the mask to start lifting off the face?  I don't know how I can adjust it anymore, it's just too tight already.  When I go to the cpap clinic, I'll ask about different masks.  I'd really prefer a nasal one, the pillows that I've heard about.

Endoscopy

I'm sitting in my living room and still experiencing a bit of mild after effects of anesthesia.  My endoscopy was today.  I was really worried about waking up during the procedure since that's what happened during my last ERCP and am happy to say that I didn't.  However, I wasn't quite out of it when it started so I still felt a lot of it and remember dry heaving.  It wasn't too long though that I was out like a light and woke up back in the recovery room, feeling like I just took a nice nap.  I have a bit of a sore throat.  Anyway, the findings were that I have a Schatzki Ring, Hiatal Hernia. Gastritis and GE Junction Erosions.  A biopsy was taken and the results should be in within 2 weeks.  In the meantime, I'm instructed to avoid Aspirin and NSAIDS.  I'm so glad that I already gave up caffeine, including my beloved Excedrin.  Before now, I'd freak out at the thought of not being able to have my Excedrin.  The truth is, though, I've had far less headaches since I've given up caffeine and just don't need it anymore.  Tylenol does the trick.

I also got a call on Monday from the surgeon's office saying they are moving my December 1 appointment to January 5.  This is because my psychological evaluation isn't scheduled until December 28 and my first Nutritionist appointment isn't until December 3.  I have to have psychological clearance and two visits with the nutritionist before my case can be submitted to insurance.  So they scheduled me for the January 5th pre-op group and will likely see the surgeon before that.  I'm starting to get a little anxious about this, I was hoping to have this done before classes start on January 18th.  It's also going to make it tough because the kids will be back in school, too.  I can get the boys on and off the bus, but I won't be able to drive my daughter to school (she is in pre-k) so she may miss a week or two.  This means I'll have to explain to her teachers that I am having surgery and I was kind of hoping to avoid that.  I guess we'll cross that bridge when we come to it.

The 10 Commandments of Bariatric Eating

Yesterday at my weight loss support group, the nutritionist handed out a sheet with the 10 Commandments of Bariatric Eating.  There is a lot of good information, so I'd like to share it.

I. You Shall Include Protein At All Meals.  Protein rich foods keep you feeling full long after you've finished eating.  Good protein sources:  chicken, turkey, lean meat, fish, eggs, egg whites, nonfat/lowfat dairy products (cheese, cottage cheese, yogurt), beans, tofu and protein shakes.

II.  You Shall Choose Solid Foods Over Soft, Mushy or Liquidy Foods.  Solid foods fill up your pouch and stay in your pouch longer than soft, mushy or liquidy foods do.  Solids:  poultry, fish, meat, beans, whole fruits and vegetables, etc.  Mushy:  ice cream, some soups, coffee drinks, milkshakes, etc.

III.  You Shall Not Eat and Drink at the Same Time.  Doing so makes your solid foods mushy!  Avoid drinking 15-30 minutes before and after meals.

IV.  You Shall Avoid Beverages that Contain Calories.  Liquids pass through your pouch quickly.  Translation:  lots of calories without ever feeling full.  Avoid soda, juice, milkshakes, coffee drinks and sugar sweetened beverages.

V.  You Shall Take Small Bites.  Take bites only as big as a pea, pencil eraser or a dime to lessen your chances of causing an obstruction and to slow you down.  Tip:  Use a baby spoon.

VI.  You Shall Chew Thoroughly.  Chew each bite 25-30 times or until the food in your mouth is unidentifiable.  This will lessen your chances of causing an obstruction.

VII.  You Shall Eat Slowly.  Allowing 20-30 minutes to eat a meal prevents you from overeating which can cause you to vomit and/or cause your pouch to stretch.  Try putting your fork or spoon down between bites.

VIII.  You Shall Stop Eating as Soon as You Feel Full.  Overeating can cause distress.  Persistent overeating can cause your pouch to stretch.  Tip:  Signs of fullness include pressure under ribcage, pressure in chest/shoulders and nausea.

IX.  You Shall Stay Hydrated.  Drink 6-8 cups of calorie free, non-carbonated, caffeine-free beverages every day.  Drinking adequate fluid prevents dehydration and constipation.  (Remember to drink between meals, not with meals.)  Tip:  Drink 2 ounces every 15 minutes.

X.  You Shall Take Your Daily Vitamins.  Nutrient deficiencies are possible whether due to a lower food intake, malabsorption caused by weight loss surgery or both.

I'm My Own Saboteur

I've been on this liquid protein diet for two weeks now.  Breakfast is no problem.  I'm actually liking my lattes and mochas.  Lunch is getting tricky, though.  I don't like having the shake for lunch.  I need some real food.  I get so hungry and it's just not cutting it.  I'm going to try some broth, and wishing I had some unflavored protein powder to put in it.  I'm worried that I'm going to continue hating the lunch time shakes and being so hungry, that I'm going to sabotage the whole thing.  It's so easy to just grab something and eat it when I'm hungry.  I don't think it's head hunger, my stomach is actually growling.  Between breakfast and lunch, I'm lucky to get in 300-400 calories.  I can't wait to see the nutritionist.  If I could forego the lunch time shake for a can of Progresso Soup, that would help so much.  I can't imagine doing this for another 2 months before surgery.  Two weeks, maybe.  If anyone has any suggestions, I am open to them! 


Here are the guidelines I was given:

Two options exist:

1.  You will be able to have four protein shakes/drinks per day, for approximately 1000 calories a day.  The rest of the day, you will take clear liquids only, aiming for 64-72 ounces total fluid daily.  Clear liquids include: beef, chicken or vegetable broth; coffee or tea with or without artificial sweetener (no cream or milk); Kool-Aid; Gatorade; Crystal Light; Propel; Popsicles; Jello and water.

OR

2.  You will be able to have two protein shakes/drinks per day and one small to moderate meal consisting of a lean protein source and a salad or vegetable.  You must keep the total daily caloric value to 1000 kcal per day.  The rest of the day, you will take clear liquids, aiming for 64-72 ounces total fluid daily, as above.

Appointments Scheduled

I've been battling the stomach flu since Sunday.  This has not been much fun!  I did happen to weigh in on Monday, though, and I have lost 10 lbs.  So excited to see that!  I hope being sick doesn't mess up my weight loss.  I've kinda threw caution to the wind in the past couple days and ate things that weren't so great.  Plus, yesterday was my birthday so I sent my husband to get some Chinese takeout.  It did not sit well and I really regretted it last night.  I hope I'm feeling better by tomorrow so I can get back on track.  I've been slugging pepto and 7up like crazy.

My surgeon's office called this morning with some appointments.  I'll be having my endoscopy on 11/24, the day before Thanksgiving.  I will also have my bloodwork and chest x-ray on that day.  My psychological evaluation isn't scheduled until December 28th.  I was really disappointed to hear that it would be so far away, but I knew I probably wouldn't be having surgery until after January 1st anyway.  The only thing I have left to put on the schedule is the nutritionist, and she's supposed to be calling me tomorrow.

I started a twitter account to just post day to day unimportant stuff.  You can follow me at http://twitter.com/#!/disappearingme2

Second Sleep Study

I just got back from my second sleep study, and it was an awful experience.  I tried to go into it thinking positive thoughts.  They tried a mask on me and I sat for 5 minutes with it.  I immediately didn't like it but thought I'd go ahead and try.  I don't know how long I was asleep before I woke up feeling like I was having a panic attack.  I felt like I was suffocating, not because there wasn't enough air, but because there was too much.  I hyperventilated and even started to cry a bit.  The nurse came in several times to readjust because it was leaking.  I could not get comfortable at all and the strap on the back of my head was pulled so tight, it was very painful to my neck & shoulder muscles.  I slept even worse than I did for my first sleep study.

I did get the results from my first sleep study.  I had 2 obstructive apneas, 8 central apneas and 188 hypopneas.  Because of the hypopneas, my score was 31.  I'm so disappointed to hear this.  So, I'm a shallow breather.  I really wish they'd stop pushing this.  There is no way I can use that at home.  I guess I'm going to have to talk to my doctor and see if we can just wait on it because with it, I'm not getting any sleep.  I would think shallow breathing during sleep is better than no sleep at all.

Ode to My Jeans

I currently have just 1 pair of jeans that fit me well.  I bought them at Wal-Mart probably at least 4 years ago.  They are Faded Glory Stretch size 26.  They have a slight flare on them and are so comfortable.  The problem is that I've worn them for so long that they have a small hole developing where my upper, inner thighs rub together.  I need a new pair.

I also have a pair that I got from Lane Bryant.  They are Venezia size 28.  They fit perfect when I first got them but now they are baggy and I constantly have to pull them up.  I want the exact same pair in a 26, or even a 24.  I also have a pair of Jeggings that I got from Cato, size 26, which are super comfortable.  They are a great fit around the waist, but they are too long so they bunch up.  I am a short 5 foot 2 1/2 inches.

I'm refusing to buy any new jeans until I absolutely have to.  I have a few pair of size 24 and 26 jeans in my dresser that are just a tad tight, and I'm hoping I'll be able to fit into them soon.  But, I'm going to miss those trusty old Walmart jeans.  Funny how I like their fit (and look) better than the more expensive ones from Lane Bryant.

I was talking to my dad the other day and he said something that caught me off guard, "Just don't loose too much weight, okay?"  Now, my dad has always been a bit critical about my weight, but in a loving way.  I knew that he hated my weight but he never made me feel bad because of it.  There was one time I had to go to the doctor when I was about 15 because I was having stomach & heartburn issues.  I remember him asking the doctor if he thought it was because of my weight.  That's the only time I really felt bad about it.  So, him asking me to not lose too much weight just came as a surprise.  I assured him that I will not be wasting away, and I'd probably lose about 75% of my excess weight.  My ideal weight is 130lbs, and I'll likely reach about 150 if I really stick with the program.  Weight loss surgery is not a cure-all, it's just a tool.  It's very possible to not lose much weight at all if I do not use the tool and stick with the plan.    There's no worry here, though, I will be using my tool the right way and I hope to reach my maximum potential.

Shake Recipes

Today, I tried two new shake recipes.  The first one was something my mom came up with.  We'll call it Irish Cream Latte.  She used regular coffee, but I used decaf and it was very yummy.  This recipe is a definite keeper and I'm already looking forward to one.  She found the Sugar Free Irish Creme Syrup at Gloria Jean's in the mall.  I didn't adjust the temperature or add ice, I just drank it slightly warm.  It was thick, too, which was a great added bonus, I prefer the shakes to be thicker.

Irish Cream Latte
4oz. Decaf Coffee
4oz. Skim Milk
1 Scoop Vanilla Protein Powder
Dash of Sugar Free Irish Creme Syrup


I also tried Pumpkin Pie in the Sky.  It's a recipe that I got from the weight loss surgery support group.  It was good, too, though not as good as the Irish Cream.  I may try it with milk instead of water next time to give it a little more body.  It had an excellent flavor, though.



Pumpkin Pie in the Sky
1 cup water
1 Scoop Vanilla Protein Powder
1 tsp. Vanilla Extract
1 tsp. Pumpkin Pie Spice

I will be posting recipes that I try under the new tab on top that says Shake Recipes.  I'll also rate them on a scale of 1 to 5, 1 being awful and 5 being fabulous.  Each star represents each point.  I'm really regretting selling my Magic Bullet at a yard sale this summer.  It would have been perfect for making these single serving shakes, not to mention purees after surgery.  I may have to look into getting another one.

In other news, I took my twins to turn in their Book-it coupons at Pizza Hut yesterday.  I was a little bad in that I ordered a personal pan pepperoni pizza for myself.  I ate a salad first, though, and shared my personal pizza with my husband and still came in under 1000 calories for the day.

I go back this Friday night for my second sleep study.  They'll try the CPAP.  I'm getting very apprehensive about this.  I don't know why it freaks me out so much more than surgery.

Spark

I had three lonely packets of Carnation Instant Breakfast in the cabinet. This morning I walked into the kitchen and looked at the big 2lb jar of Whey Protein Powder sitting on my counter. Then I looked in the cabinet at the Instant Breakfast. I looked back at the Whey Protein Powder and thought to myself (being frugal and all) that I have got to use up the Instant Breakfasts. So I did. I made myself an 8oz glass with skim milk. I sat down in front of my laptop and pulled up my Spark account. If you're unfamiliar with this website, it will allow you to input your foods and activities each day and it will keep track of everything, from calories to protein, carbs, fat, cardio minutes and even calories burned. It's a great website, and it's free.

Anyway, I input my Carnation Instant Breakfast and compared it to the Whey Protein Powder. Needless to say, I will not be doing that again.

Carnation Instant Breakfast with 8oz Skim Milk:

• Calories: 216
• Carbohydrates: 39
• Fat: 1
• Protein: 13

Body Fortress Super Advanced Whey Protein Powder Vanilla with 8oz Skim Milk:

• Calories: 226
• Carbohydrates: 15
• Fat: 2
• Protein: 34

Body Fortress Super Advanced Whey Protein Powder Vanilla with 8oz Water:

• Calories: 140
• Carbohydrates: 3
• Fat: 2
• Protein: 26

Clearly, the best option when trying to limit carbs and increase protein is the Whey Protein Powder. The even better option is to do it with water instead of milk. Either way, I'm limited to 1000 calories a day.

The day I started my liquid protein diet, my husband said to me playfully, "Go to Taco Bell and get one of those XL Chalupas" after he saw the commercial on TV. I'm not sure if he quite understood what was happening, so I told him, "I have to drink these shakes and you want me to go get you a chalupa?" He said, "Well, I don't have to drink the shakes!" Then, last night he asked me to make him a milkshake. I looked at him and he said, "What?" He said he didn't realize that I had to avoid that stuff. I guess I didn't explain it to him well enough. It kind of makes it tough though, and I hope he'll be supportive in this like he usually is.

Consultation

I had my consultation with the surgeon yesterday. I've met him a few times before and I really like him. He recognized me right away from a support group meeting. I had asked about his policy on caffeine.

First thing I did was fill out some additional paperwork to the very large packet I had already completed. It was just the privacy policy and all that jazz. I paid my $200 program fee and was called back. I was weighed (285.4) and measured (5' 2.5"). In the room, the medical assistant made sure that all of the paperwork was there, and were very happy that I had brought in previous medical records, including my previous ERCPs and Laparoscopic Cholecystectomy. Then the insurance person came in and went over a few things. Turns out that my insurance is fairly straightforward and my only requirements are as follows:

• BMI greater than 40 -or- BMI between 35 and 39.9 with serious medical complications.
• History of active participation in non-surgical methods of weight reduction. Must be fully documented in the medical record.
• Documentation that endocrine disorders have been ruled out.
• Psychiatrist/Psychologist consultation and clearance.
• Documentation of Nutritional Counseling
• Pre- and Post-Operative dietary evaluation and nutrition counseling.

So, I am definitely qualified. When she left, the surgeon came in and talked to me a bit. I told him that I wanted the Sleeve, and he said that is what he prefers. He did a physical exam, checked for swelling, palpated my abdomen and thyroid, listened to my heart and lungs. He said since overall I'm in good health and my insurance requirements are minimal, he is putting me on what the call the Fast Track. This means that I can have surgery in as early as six weeks. It will probably be closer to eight weeks, though, because of Christmas and he will be on vacation. So we're looking at a surgery date around the first week of January. This will work out perfect for me because I am a student and it will be in between semesters.

When he left, the medical assistant came back in. She will be scheduling my psych evaluation as well as the endoscopy. The endoscopy will either be November 10th or November 17th and I won't know until the Monday before so that will be a bit challenging. I also have orders to take to the hospital to get a chest x-ray and labwork. Specifically, they are looking at:

• CBC
• CMP/BMP
• PT/PTT/INR
• Platelet Count
• Vitamins B1, B12, A, D, E, K
  
• Lipid Profile
• LFTs
• Copper, Calcium, Phosphorus, Magnesium, Selenium, Zinc, Iron, Folic Acid
• HgA1c
• Thyroid Functions (T3, T4, TSH)
• PTH intact
• Vitamin D-25 OH Total

I will also need to go for a second sleep study with CPAP titration. I am *really* not looking forward to this. I slept so horribly on the first one, I just don't want to do it again and I'm worried that the CPAP is going to be very uncomfortable. I'm also a stomach sleeper, so not sure how that will work out. I will also get an appointment to see the nutritionist to go over the diet.

So, I guess that's it for now! I go back on December 1. I'll probably have most of my tasks completed by then. I can't believe this is happening, I'm very excited!

Caffeine Free

I am very happy to announce that I have been caffeine free for a little over five days. My plan to slowly wean off and gradually reduce my caffeine intake worked. Previous attempts have failed, leaving me with massive headaches that forced me to drink more caffeine. But, this time, I was able to overcome it. I have had a few headaches, but none as severe as previous ones. In fact, two Advil were enough to relieve them. I admit that I had a candy bar yesterday (I know, bad me.) Not long after eating my Milky Way, I got a headache. I'm not sure if that's some residual caffeine addiction or it could be stress related, because I have an awful lot of stress right now. But, it will definitely make me think twice about reaching anything that contains caffeine in the near future, whether it be a can of soda or a candy bar.

I'm not much of a water drinker. It's not that I don't like it, it's just inconvenient, believe it or not. The local water tastes nasty. Anytime I buy bottled water, my kids drink it all and my husband does not like to buy more. Our faucet is not equipped to have a filter on it. The only other option is a Brita or Pur pitcher, so I may look into that. In the meantime, I've been drinking decaf tea with Splenda and have been quite satisfied.

My consultation with the surgeon is tomorrow. I'm very much looking forward to it and have several questions. I got a letter today about my sleep study last week. It was a form letter and was addressed, "Dear patient." It went on to say that I had significant sleep apnea and suggested I come back to try a CPAP for another sleep study. I'm not really keen on that, so I'm hoping my surgeon will say it's not necessary. For one thing, I slept horrible for my first sleep study, so much worse than at home. I'm never really sleepy during the day. I am fatigued, with a general sense of being worn out, but never sleepy. I also sleep through most of the night, except if I have to get up to pee. So I don't really see why it's necessary. They told me while I was there that any sleep apnea I had was mild and they probably wouldn't recommend a CPAP. So I'm confused. I called my primary doctor to see about getting the report.

I guess that's it for now. I'm hoping tomorrow appointment goes great!

Say Goodbye To My Little Friend

Caffeine. We've had a love-hate relationship for 30 plus years. I remember glasses of chocolate milk when I was little. Getting a soda out of the vending machine while going for walks with friends as a tween. The perpetual pitcher of sweet tea in the refrigerator as I got older (and fatter.) That sweet cup of coffee as an adult. Celebrating doing a great job on an exam with a trip to Starbucks for a pumpkin spice or mocha latte.



I learned that you were evil at an early age, yet I developed a dependence on you. I pushed you away, only to regret it with that dreaded caffeine headache. I remember being 17, having an awful headache and the first thing my mom would do was pour me a glass of Coca-cola. It always relieved the headache within half an hour and I felt so much better. My mom is also addicted to caffeine. I can't tell you how many times I've heard her say, "Don't talk to me, I haven't had my coffee yet."


My surgeon said that I will need to give up caffeine for my surgery. I am definitely willing to do this, my only hesitation is because of the headaches. I've tried to stop caffeine before, and failed many times. The caffeine dependence is negatively reinforced by the headaches and it creates a cycle. I stop the caffeine, I get a headache. I drink some caffeine, the headache goes away. We're not talking a mild headache either. This is one that you can't stand sounds, light, etc. It's very very similar to a migraine. The only difference is the location on the head.

We just finished studying substance abuse in my Abnormal Psychology class, and I was actually shocked that I fit the diagnosis of substance dependence. I never really thought of caffeine to be a drug, but it's true. I'm dependent on it and am low functioning without it. If you are wondering if you are caffeine dependent, consider this:

Substance dependence is a maladaptive pattern of substance use with clinically significant impairment or distress as manifested by at least three of the following:

1. Tolerance
2. Withdrawal
3. Consuming larger amounts for longer periods of time than intended
4. Desire with unsuccessful efforts to limit intake
5. Large amounts of time spent in obtaining, using or recovering from substance
6. Social, occupational and recreational activities are reduced due to use.
7. Use is continued despite physiological and/or psychological problems caused.

Scary isn't it? Quite a wakeup call. Personally, I experience tolerance, withdrawal, failure at limiting intake and use despite physiological problems caused. Before I really started the ball rolling towards weight loss surgery, I was consuming a lot of caffeine. I would have up to 3 cups of coffee and 4 or 5 glasses of tea or soda. For anyone counting, that's an average of 500mg of caffeine a day. In the past two days, I have had one cup of coffee and one can of Dr. Pepper. That brings my consumption down to 157mg. Huge difference! And, I have noticed a difference. I have a mild, continuous headache. It's just there, not bothering me much, but it's not going away either. I'm hoping to slowly wean myself off, I'm not quite sure that I can go cold turkey, at least not with a major caffeine headache. If I can get my body used to the 150mg of caffeine, I'll take it down to one can of soda, which is about 40-42mg. Then, I'll be able to deal with a mild headache for three days. At least that's my plan. I hope it works!

Psychologists

What's the difference when it comes to psychologists? The answer is only one in the whole area will be able to see me. I have to have a psychological evaluation to clear me for surgery. I've been on the phone all morning calling different ones in the area. Either they don't take my insurance or they aren't taking new patients. That's all I've heard all morning.

I can be a bit emotional at times. I admit that I get upset, I may even cry for a couple minutes. Then I pick myself up and am able to think with a clearer head. I just have to get it out. I don't think of it as a fault. I think of it as a pressure release valve.

So the tears were about to roll. My husband walked in from work and one of the first things out of my mouth was, "I'm going to be fat for the rest of my life!" I didn't see it, but I'm sure he rolled his eyes at me. I could pay out of pocket for it, but it's like $275 and we just don't have the cash right now with him having been off work for so long.

I fought back the tears, took a deep breath and calmed myself down. Then, I did what any logical person would do. I called the doctor's office and told them my predicament. I'm sure they see cases like mine all the time. She said she didn't realize that the only two doctors on the list they gave me were no longer taking new patients. But, she had a secret weapon. When I go in for my appointment in a couple weeks, they can schedule an appointment for me with a doctor in the very town I live in. He's not advertised as being able to do the evaluation, but he can. And he oversees the sleep study I'll be doing next week!

Phew, what a relief. I could cry now.

Yes, I can do that.

It's been a week since I last posted, but there's nothing really new. My sleep study is next week, which I'm a bit nervous about. I just get a little creeped out thinking there will be somebody watching me sleep. I think I'll take some melatonin to help me sleep that night.

In case I didn't mention it before, I plan on being quite frank and brutally honest in this blog. Those who read this blog and know me in real life probably realize that this is contradictory to my personality. I'm a very modest person. I don't like talking about private issues and body functions. It's quite embarrassing.

I'm only blogging to help chronicle my journey and show others exactly what happens during the process. It's not an easy way out by any means. It's a long and complicated journey that will require me to make lifestyle changes. In fact, it will be better in the long run because it will force me to make these changes. I'll have to eat smaller portions, because my stomach just won't hold much. Overeating can have serious consequences, including food coming back up. Also, if I don't exercise, I'll lose muscle along with fat and end up with a bunch of hanging skin. I certainly don't want that to happen.

About a year or so ago, I told my Dad about my decision to have weight loss surgery. He was supportive of it. He's always been a bit critical of my weight, but I know he loves me and wants me to be healthy. Anyway, he asked me a question that really caught me off guard. He said, "Can you wipe your own butt?" I thought, OMG, what kind of question is that?? Of course I can! Apparently, someone he knew who was a big girl could not do it and had to rely on her husband to do it for her. How embarrassing. I'm so glad I never got to that point. By the way, the couple mentioned above are no longer together.

I can do this. I can wipe my own butt, among other things. I can scratch my back, cross my legs, jog, be intimate with my husband, squat, get back up without an issue, touch my toes, tie my shoes, put on my pants while standing up and walk as much (or fast) as I want. A few of these things may be difficult, but they are absolutely doable. I tend to push myself even harder if I find a physical task is difficult. I'm happy to say that I have not allowed my size to interfere with physical tasks. I'd say probably the biggest effect it's had is that I cannot run and I get fatigued easily. I'm hoping that losing the weight will take the fatigue away. The time before that I lost over 70 lbs, I remember that I felt so good. I can't wait to feel good again.

Nuclear Treadmill Stress Test Results

I got the report today from the stress test and it looks like good news!

Here's what the report says, word for word:

Findings
Post stress images demonstrate normal left ventricular cavity size. Radioisotope distribution is homogeneous in the left ventricle myocardium. There is no evidence of stress-induced reversible ischemia. No fixed defect is visualized to suggest myocardial infarction. Left ventricular ejection fraction is 66%. Wall motion shows no abnormality.

Impression
1. Myocardial perfusion is normal.
2. Normal cardiac systolic function
3. Normal wall motion

Vertical Sleeve Gastrectomy

As I mentioned in my last post, the surgery that I have decided on is the Vertical Sleeve Gastrectomy, also known as the sleeve. It is much more effective than the lap band and less risky than a gastric bypass but with virtually the same results. The difference between a sleeve and a gastric bypass is that there will not be the same anatomical changes - in other words, the intestines will not be cut and attached to a small pouch on the stomach. Instead, the surgeon will cut a large portion of the stomach and create a long banana shaped stomach. This "sleeve" will hold approximately 100ml, whereas the typical stomach will hold 1 to 1.5 liters. It is also believed that the portion removed is what creates appetite hormones.

From reading a lot of other experiences and doing my own research, I've learned that the following will likely occur. It may change after I have my first consultation. After the surgery, I will have about a 2 day hospital stay. I will drink clear liquids for the first 2 weeks, purees for the second 2 weeks and start back on regular soft foods by the fifth week. By then, the stomach should be healing well and there will be less risk for leakage. The part of the stomach which was removed will have tests done on it. Since it has the same staples as the portion that is left, it will also be tested for leakage. I will be required to drink 64oz of water each day and consume 60-80g of Protein. The meal plan will be 3 meals and 2 snacks. Before surgery, I will also need to do a liquid protein diet to lose weight and make the liver healthier and more pliable.

To read up on the sleeve, visit the following links:
Obesity Help
Medline Plus

Of course, if you're like me and want to see exactly what it looks like, see these Youtube videos. The second video is of an actual surgery, so fair warning!
Animation
Actual Surgery

The Beginning of My Journey

My journey began a few years ago when I started researching weight loss surgery. At the time I was at a loss, having tried to lose weight so many times and either failing or succeeding only to gain the weight back plus some. I actually started the bariatric surgery process a year and a half ago but there were some snags and my plans were put on hold.

Now, I am back in full swing. My first step was to attend another information session with the bariatric surgeon. I did this on August 18, 2010. It was very informative, much more than the previous one and I felt that I really got a lot out of it. My next step was to see my primary care physician for a referral. I knew she would be all for it because we have talked about it quite a bit. The referral was simple. She got my height, weight and figured my BMI. At the time of my referral appointment, I had the following:

Weight: 282
Height: 5' 3"
BMI: 50
Length of Morbid Obesity: > 7 Years

Comorbitites:
Hypertension

• Managed with Propranolol
• Average 125/85
  

Dyslipidemia:

• Managed with Crestor
• Cholesterol Total: 163
• Triglycerides: 169
• HDL: 36
• LDL: 93
  

Stress Incontinence

• Seriously. Who doesn't pee when they sneeze?

Anyway, back to the referral appointment. I had a Novasure procedure done this past June. It's an endometrial ablation. If you're not sure what that is, just imagine an electronic pulse burning the lining of the uterus. It was a simple procedure, it did the work it was supposed to do and I couldn't be happier with the results. While my doctor was looking at the EKG I had as part of a pre-op before the Novasure, she noticed that I had an abnormal EKG. It said anterior infarction. So she sent me for a Nuclear Treadmill Stress Test. I have to tell you that was horrible and definitely not something I want to do again.

First, they set up an IV and put in some thallium to do a pet scan. Then they set up the treadmill test, hooked me up with an EKG and blood pressure cuff. Stage one was just a walking pace. Stage two was a slightly faster walking at an incline and stage three was more of a fast run/jog. I only made it just over a minute into stage three and I was done. My heart rate got to 168 and I was on the treadmill for about 4 minutes. The first part wasn't bad, but the second was tough. A minute before I stopped, they injected me with more thallium and took my blood pressure again. I was so out of breath and light headed and it took quite a while for my heart rate to come back down to 100. Then, they put me back in the pet scan to take more pictures. The whole thing took about 4 hours.

The EKG was just a little abnormal according to the nurse, and it did not change with the stress test. So she thinks there is probably no real issue. But, she says it can't be ruled out and they will have to review the second set of images to see if there is any blockage or damage. I am still waiting to hear the results from this.

The next thing on my list is a sleep study. I will be doing this on October 20th. Then, I have my first real consultation at the surgeon's office on October 29th. I have made up my mind that I want a Vertical Sleeve Gastrectomy. It is less complicated and less risky than a gastric bypass and much more effective than the lap band. I will explain it more in another post.

Putting My Plan Into Motion

I have tried several diets, weight loss pills and nothing has worked. Those that did work were only short term. I went low carb about 6 years ago and actually lost over 70 lbs. The problem was that I gained over 100 back. I am now at 279, just 8 lbs lighter than my heaviest weight ever. I am very unhappy with my body and have some other issues that might be because of my weight. I have hypertension, elevated cholesterol and have recently developed some heart issues. I am fortunate not to have had to deal with anything like diabetes.

I am doing this because I need this change. My body needs it as well as my mind. I am always so run down, and with three young children home, it just takes all I have to keep up with them. This weight loss surgery is actually part of a 5 phase plan to take back my life.

The first phase is my home life - my marriage, my children and my house. This includes building a stronger marriage, being there more for my kids, and working to keep my house in order.

The second phase is my health. This includes eating healthy, detoxing from caffeine, and having weight loss surgery.

The third phase is education - I am returning to school to finish my social work degree with a plan to go into perinatal hospice.

The fourth phase is financial. This includes taking care of all debts and eventually start saving and investing.

The fifth phase is fun. This includes anything that make me happy - from a night out with friends to a night in scrapbooking.

This list was made about a year and a half ago and I'm happy to say that I am still working on it. My marriage is in a much better place than it was. My house still seems to be in a constant state of clutter. I really think I have some hoarding tendencies but it's actually been kind of fun to start throwing things out. We had three yard sales over the summer and have gotten rid of so much, yet we still have a lot to go.

My health has unfortunately taken a turn for the worse. I had a nuclear stress test last week due to some concerns and am still waiting to get the report back. The caffeine detox isn't happening. It will, though. I don't want to totally give it up, but I'd like to go a few days without having it and not have to worry about a headache. The biggest part of Phase 2 will be the weight loss surgery. More on that later - after all, that is what this blog is about.

Phase 3 has been well underway for about three semesters now and I'm happy to say that I've even been inducted into the honor society. My GPA is high and I plan on applying for some scholarships when I transfer from the community college to the university.

Phase 4 has taken a back seat. My husband had a traumatic accident in January and has been off work since then. So, we're kind of living paycheck (er.. workers comp check) to paycheck right now. We'll get out of the hole eventually.

Phase 5, regrettably, has not even been touched. I've barely done anything fun. Maybe that's why I've developed heart issues. Someone needs to give me a swift kick in the butt and make me go have some fun.