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.