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.