Hang On. This Train Moves Fast.

I received a call from Angela (the Insurance Specialist at Centennial) on Wednesday, July 25th saying she had faxed all my information to our insurance company the day before.  She had already received a fax reply with approval for my weight loss surgery.  I was stunned.  I knew they had received everything they needed in order to proceed with the approval, but I was told it would probably take 2 or 3 weeks to receive word back with either a yea or nay.  Even Angela was a bit surprised.


I asked her what the next step would be and she said it was to pick a date for surgery.  When I inquired about the time frame we were looking at - she transferred me straight to the surgeon's office to discuss that.  I spoke with Kendra who told me they had August 21st, August 28th or the whole month of September except the 3rd.  She said that Dr. Olsen does his surgeries on either Monday or Tuesday.  I told her I needed to discuss it with my family and would call her back.  I wasn't expecting an August surgery date.  I expected them to call back with approval and then offer me a date sometime in September.  At that point, I was going to try to schedule the surgery during Fall Break.


It has always been my intent to disrupt the lives of all concerned in the least possible way with my surgery and recovery. School starts here at the beginning of August.  That means Jana needs me to care for Addison. If I am not available, then she has to find someone else.  I know her first choice is Jen.  I talked with Jen to make sure that she was going to be available to care for Addison while I was recovering.  I knew she was looking for a job and that would throw a wrench into the very vague plan that was rolling around in my head.  She assured me that she would be available at least through the end of August.


Jana and I then got together and discussed the merits of a date in August, September or waiting for Fall Break.  I was surprised when she decided that the August 21st date was the best choice. Her reasoning is sound and that is why I went with it.  Todd cares for Addison on his days off - every other Monday and Tuesday.  August 21 is a Tueday and is also Todd's day off.  If I have surgery that day, she would only need to find daycare for Addison the remaining 3 days of that week and all of the following week. Then, Todd has another Monday and Tuesday off.  That puts us at Labor Day weekend.  I could easily go back to caring for Addi on Sept. 5th and have a 3 day week to get back in the swing of things.  I called the surgeon's office and told Kendra to book me for August 21, 2012.  I am so excited and scared at the same time.


On Tuedsay, August 7th, I have to go up to Centennial for an UGI (Upper GI series), my pre-admission testing, and another consult with both the Dietitian and the Surgeon.  At this time, I will start my 2 week preop liquid diet.  More about that later.


One of the benefits of Bariatric Weight Loss surgery at Centennial is access to their many support groups.  Each surgeon in the group expects all their patients to attend meetings of their choice of support group for the first year after surgery.  While they can hardly make them mandatory (what are they going to do if you don't go, force feed you chocolate and pastries?) they certainly make it clear that it is strongly encouraged.  They do mandate that you attend at least one meeting prior to your surgery. Even before I found out that my surgery was approved and the date was set, I had plans to attend a psychologist led support group on Thursday at noon.  


I am so glad I went.  Besides Dr. Ihrig and his student assistant, there were 6 of us in attendance at this meeting.  He holds a meeting right at the Center for the Treatment of Obesity in their classroom several times a week.  I found out that this particular meeting is usually the smallest.  I was very comfortable with the small group setting.  As each person introduced themselves and explained where they were in the surgical process: date of surgery, weight lost, etc., I discovered I was the only one who was PRE op. All of the others had already had their surgery.  One was celebrating her 1 year "surgiversity" and another was just 5 weeks post op.  I would estimate that the weight loss for the 5 people who were there was close to my entire weight.  One of them was 4 months out and already off her blood pressure medications.  Another was 7 months out and no longer taking medication for her previously out of control Type II Diabetes. 

I listened as they exchanged recipes and hints for making their protein intake more tasty.  I took notes as they talked about how to best take their medications that have to be crushed before consuming them. I nodded as they spoke of how they all explained the main reason for taking control of their weight with this drastic measure was their desire to live longer and stronger for their families.  I laughed when one of the women said she was on to "bigger and better things" and the Dr. corrected her with "smaller and better things".  


I will definitely continue to seek out and attend support meetings.  They have the potential to provide a lot of helpful information - especially from those whom have gone before me.  Even 5 weeks after his surgery, one man was able to enlighten me and calm some of my nagging fears just by being there and speaking honestly.  I feel if I can come away with 10 new bits of knowledge from each meeting - it is well worth the trip.


Here - in no particular order - are 10 things I learned from my first support meeting:

• 1.  Kroger sugar free banana popsicles are the BOMB!
• 2.  After surgery, I will no longer be able to swallow a pill or capsule whole.  They have to be crushed or pierced.  If I put the crushed pill on a slip of paper, I can position the medication at the back of my tongue (past my taste buds), quickly take a swig of water and not taste a thing.
• 3.  Not every program for weight loss after surgery is the same.
• 4.  No matter where I attend support meetings - I have to take what I can use and leave the rest behind.
• 5.  Sugar free bar-be-que sauce is found at Kroger in the pharmacy department - not the condiment aisle.
• 6.  Walmart only has sugar free banana popsicles in a variety pack.
• 7.  myfitnesspal.com is an awesome free app for keeping track of calories, protein, carbs, sugar, etc.  I can even put my recipes in and it will tell me just how healthy (or not) it is.
• 8.  Fat free Greek yogurt mixed with some dry ranch dressing mix makes a tasty alternative to low fat mayo, a nice dip or a super flavoring for my protein source.
• 9.  I can mix my crushed pills with sugar free chocolate syrup to mask the taste of the medication.  (And quite possibly make me NEVER EVER crave the taste of chocolate again!)
• 10.  No matter what I weigh - there is always someone who weighs more than me or less than me.  

I can share my Journey with others - but it will always be MY Journey.

The Journey of a Thousand Miles...

Last Friday, July 13th - I made another trek into Nashville for the consult with my surgeon.  It was pouring rain for the entire trip so the level of my nervousness was even more heightened.  I left with plenty of time accounting for the weather and traffic.  I had a 10am appointment and I was there about 45 minutes early.  The surgeon's office is in the Tace Building at the Centennial Center for the Treatment of Obesity.  It is across the street from both the Centennial  Women's and Children's Hospital and the Medical Arts Building were we attended the seminar.  I am getting to know this area fairly well already!  I scored a parking spot fairly close to the front door and sat in the car for a bit waiting for the rain to let up a little.

They had mailed me a package of information and a stack of paperwork that needed to be filled out.  I did that prior to going, so it saved some time once I got there.  I simply checked in and waited to be called back.  I was the only person in the waiting room when I went in, but was joined shortly by a woman who was a month out of her surgery.  She said she lost 23 lbs for her first weigh in.  Very impressive.
  
When I was called back, the nurse weighed me (285.2 lbs), took my blood pressure (132/81) and heart rate (76).  She then took a picture of me for my file.  She explained they would take another picture 12 months post surgery.  At that time, I could decide to either allow or disallow them to use the pictures on their website.  As she escorted me to the room to await the surgeon, I could hear a woman screaming in pain.  The nurse seemed unfazed, but I was looking for the nearest emergency exit.   I don't know which bothered me more - the wailing lady or the fact the nurse appeared to be immune to the noise.


I was shown into the exam room and told to have a seat and the Dr. would be there shortly.  I sat down and took some deep breaths to calm my nerves.  When I am anxious, I have learned a couple different ways to stave off a full blown panic attack.  I do a lot of self talking. I spend some time talking to myself (with the little voices in my head) about just about anything other than what is making me anxious.  The other thing I do is pray.  This was a praying day.  I asked for guidance - some kind of direction as to which procedure I should have if my insurance company approved this weight loss surgery.  I asked that God provide me with the questions I needed to ask the surgeon in order to make an informed decision. Very shortly, I could no longer hear the screaming lady and I was feeling pretty calm.


I looked around the exam room and spent some time wondering who picks the colors and decorations that are found in rooms such as this.  While it was clean and organized, it certainly wasn't cold and sterile looking.  Very comfortable and inviting.  No obvious signs of torture devices.  I looked up on the wall and noticed this piece of artwork:

I looked at the picture and immediately saw it.  My answer.  I decided that if the surgeon was in agreement, I would pursue the gastric bypass procedure.  The medical techie name of that surgery is Roux en-Y.


Dr. Olsen breezed in shortly after I had snapped the picture with my phone.  He had a big smile on his face and asked if I heard the screams.  He almost seemed a little too proud of the torture he had obviously just witnessed.  When I responded that I had indeed heard it and that the last time I heard such a commotion, I was in labor and the screams were NOT coming from me - he just laughed.  He explained that it wasn't his patient, but he was assisting another doctor with a patient who had a small infection in their incision area and they needed to open it.  How exciting.


He spent a great deal of time with me.  I never felt rushed.  He basically covered everything he discussed during his seminar.  I explained that I had narrowed down my choices to either the gastric bypass or the sleeve.  He agreed that the lap band procedure was not the way to go.  He admitted that he had only performed one lap band procedure thus far in 2012.  His partners are even considering discontinuing it altogether, but he feels it is still an appropriate surgical option for some people.  We discussed my history - health, eating habits, and previous weight loss attempts.  He reiterated the pros and cons of weight loss surgery.  He explained in detail the risks and successes.  In the end, he told me that my choice between the gastric bypass or the sleeve was a simple "coin toss" for me.  He explained that either surgery would be equally appropriate for me.


I told him I wanted to proceed with the gastric bypass.  He was in complete agreement.  Since I have a hiatal hernia, he wants me to have an upper GI series before surgery.  If it is large, there is a chance he will need to repair it during surgery.  Apparently that requires a couple stitches.


There is only one more requirement to be met before submitting my file to the insurance company for approval.  I need to see my primary care physician for a 2012 documented visit and I need a letter of support from him.  My appointment with Dr. Cole is tomorrow at 2pm.  We have previously discussed weight loss surgery and he has always been very supportive.  I don't expect any complications there.


Another step forward in The Journey.

*********************************************

As a side note, there are apparently several different "versions" of gastric bypass surgery.  Snatched from Wikipedia, this is the method that Dr. Olsen uses:

Gastric bypass, Roux en-Y (proximal)

This variant is the most commonly employed gastric bypass technique, and is by far the most commonly performed bariatric procedure in the United States. The small intestine is divided approximately 45 cm (18 in) below the lower stomach outlet and is re-arranged into a Y-configuration, enabling outflow of food from the small upper stomach pouch via a "Roux limb". In the proximal version, the Y-intersection is formed near the upper (proximal) end of the small intestine. The Roux limb is constructed using 80–150 cm (31–59 in) of the small intestine, preserving the rest (and the majority) of it for absorbing nutrients. The patient will experience very rapid onset of the stomach feeling full, followed by a growing satiety (or "indifference" to food) shortly after the start of a meal.

Cheese Stick Anyone?

Last Saturday - Ed, Jana and I attended a weight loss seminar at the Centennial Medical Arts building in Nashville.  The seminar was hosted by Dr. Olsen - the surgeon I have chosen to perform my surgery. Although I had watched their online seminar, I am really glad we went to one in person also.  It was very informative and answered quite a few of my questions.  It also quelled some concerns that all of us had. At least I hope it did.  I don't like speaking for Ed and Jana.


Dr. Olsen went in depth regarding each form of weight loss surgery - including the statistics on the successes of each.  He discussed food addictions and unhealthy eating habits.  He went into great detail about the benefits - such as the large percentage of patients who find complete resolution of Type II Diabetes, high blood pressure and sleep apnea.  He also provided a comprehensive listing of possible risks and complications.  No sugar coating at this seminar!  (They even provided healthy snacks and repeatedly encouraged us to all partake.)


From the beginning of my research - I was torn between having the lap band procedure or the gastric bypass.  (I won't go into a lot of detail on the procedures - they are outlined on the previous post.)  
By the middle of the seminar, I had completely ruled out the lap band procedure.  I was surprised that Ed and Jana were both in agreement with me.  This procedure is the least risky and is completely reversible. But it involves a mechanical device to be implanted - a foreign body.   This is one of the newest weight loss procedures.  As the data is being collected, it shows that there is a large percentage of people who eventually need to have the lap band removed because of simple mechanical failure over time.  It has the slowest weight loss of all the procedures.  There is not sufficient data to determine the sustainability of that weight loss over a number of years.  In summary, the surgery to place the lap band makes it the least risky but the future uncertainties make it the most risky.


I had not considered the Vertical Sleeve Gastrectomy until the seminar.  This procedure has been around for many years, but in the past it was normally performed on SEVERELY obese patients (BMI 60+) as the first step in a two step process to lose weight.  They have recently started using this method on patients as a stand alone procedure.  The main difference between the Sleeve and the Gastric Bypass is that the Sleeve is strictly a restrictive procedure and the Bypass is both restrictive and causes malabsorption.

I left the seminar with a lot of information and a decision to make:  Sleeve or Gastric Bypass.  I decided to discuss the two procedures with my surgeon during my private consult before making a final decision.

*****************************************

On Monday, I traveled back up to Nashville.  This time to the Women's & Children's Hospital at Centennial for my Nutritional Consult.  I met with a dietitian who interviewed me on my various attempts at weight loss, my eating habits as well as food likes and dislikes.  She provided me with my "Owner's Manual" for Gastric Bypass Surgery.  (She told me that should my final decision be the Sleeve, I could trade in my manual.)

  

She went over step by step what my food intake would be like for the first several weeks post surgery.  I use the term "food" very loosely here.  There is a whole lot of liquid and not much else.  And none of it involves Diet Coke.  Fortunately, it is just a couple weeks while the stomach and intestines heal from the surgery.

She then explained what makes weight loss surgery successful.  It is simply a tool.  One that requires other tools in order to provide life long success.  It means a tremendous change in diet.  One that is centered around protein.  One that does not include almost all of the items in my current diet.  That is a good thing.  Obviously my present eating regimen is not a healthy one.

I left that meeting feeling very positive, encouraged and filled with great resolve.  I CAN do this.  It will not be easy.  In fact, it will be extremely hard.  A very formidable task.  But one that I will embrace with the knowledge I am using an awesome tool to change my life into a more healthy one.

Bariatric weight loss surgery at Centennial comes with a lifetime support from psychologists, dietitians and exercise professionals.  All free of charge.  While it might be an hour from my home - what is 60 minutes?  I spend that much time every day struggling to decide where and what to eat!

Informed Consent.

Types of weight loss surgeries that are available.  My insurance will only cover the first three on this illustration.  I have not decided which one is for me yet.  I am waiting to get more information at the seminar tomorrow and at my consult with the surgeon on July 13th.

 

I Would Like To Be A Florist.

I had to be in Nashville early yesterday morning.  My appointment was at 9:00am for my psychological evaluation.  They asked me to be there 10 minutes early to fill out paperwork.  (I don’t understand why doctors do that.  Why not just give me an 8:50 appointment?)  Google maps told me I had a 59 minute drive.  With the required stop at McDonald’s for my 99 cent any size Diet Coke and accounting for traffic and a few minutes of “I am lost and have no idea where I am”, I figured I should be leaving my house no later than 7:30am.  My scheduling was perfect.  I arrived at my destination right on time after driving past it once and going around the block.

I thought I would be anxious about this visit.  I was nervous, but I felt that was a normal feeling.  Being alone and going to a strange place can cause me anxiety and a panicky feeling.  I didn’t get that at all.  Just the butterflies and uneasiness that can be typical in a situation like that.

   

I walked into the Athena office at exactly 8:50am.  I hope I scored some points for being prompt.  I filled out the required paperwork and settled in to wait for the psychologist who was going to evaluate me.  The waiting area was small and cozy complete with a nice aquarium with beautiful fish swimming about.  I watched a big orange fish slowly making a hole in the gravel by systematically picking up a few pieces in his mouth and swimming a few inches away and spitting it out.  I resisted the urge to reach in and smooth that dip in the gravel just so he would have to start over.  I didn’t think getting caught with my arm in the water would make a good impression.  It would have probably erased all the good points I got for being prompt.

About 9:10, a man walked out into the waiting room, shook my hand and told me his name.  I didn’t catch the name, but since he was carrying a file folder, I assumed he was the Dr.  It was a good guess.  He led me down the hall, walked into a small office and invited me to sit on his couch.  Phew.  I could breathe easier.  I was on home territory now.  I have done this before.  He made a little small talk but I was on to his game.  He was looking for crazy and I was there to be normal.  I think.  I didn’t mention the neurotic goldfish because I didn’t want him to feel insulted.  I was polite and sincere.

Finally down to the business at hand.  He explained that he was going to ask me a few questions – some of which would require more in depth answers and others that would be more of a checklist type and required only a yes or no answer.  After that, he would give me a stack of written tests, explain each of them to me and then take me to the “testing room” where I could complete the tests at my leisure.  By this point, I was getting a little more nervous.  I absolutely stink at Algebra.  Okay, I admit I have not been able to pass college level Algebra.  Despite several attempts.  I know in my heart that this is the end of road for me and weight loss surgery.  He is going to ask me to explain why 3x + 2y = 72.  I was doomed.

Trying not to express my complete disappointment, I just smile and nod.  He then explained that everything discussed in that little office was completely confidential.  Unless it involved child abuse or any mention of me indicating that I was going to harm myself or someone else upon leaving that office, he would not divulge anything I said to him.  If so much wasn’t riding on this evaluation, I could have had a blast with this guy.  Quickly remembering I needed to score points to make up for the upcoming Algebra exam, I decided not to mess with him too much.

 

He started out by asking me questions about the surgery – what did I know about the procedure, the recovery and how it was going to affect the rest of my life.  I have done my research and made sure he knew that.  The next questions were typical doctor type questions – but in no particular order.  “Have you ever had cancer?”  “How would you describe your home life?”  “Have you ever wanted to kill or harm someone?”  “Have you been diagnosed with tuberculosis?”  His last question was my absolute favorite.  “Have you ever been involved in a homicide?”  Missing my opportunity to have some fun, I responded truthfully – no.  He said, “Well, it’s not like I could tell anyone if you had.”  I am sure he was egging me on.  I didn’t fall for it.  Sneaky little shrink.

Next, he pulled out an impressive stack of papers.  My tests.  He went through the entire stack and explained each one to me.  NO Algebra!  I was home free!  I resisted the urge to stand up and dance a jig.  (It was easy to resist such an itch because I have no clue how to dance a jig.)  He asked if I had any questions and then escorted me to the “testing room”.  He told me to pick a table, have a seat and complete the tests – taking as much time as I needed – and then to drop the completed exams at the front desk on my way out.  He shook my hand and wished me well.

Trying not to read too much into the “pick a table” command, I confidently plopped down at the closest one.  I picked one of the two pencils out of the cup on the table and started with the top test.  My first exam required me to draw a clock with all 12 numbers.  Then, I was to draw the hands on the clock to indicate the time 11:10.  I understand the purpose of the tests.  They are trying to determine if you are able to follow directions, make sensible decisions and are mentally stable enough to undergo this life changing surgery.  For that reason, I followed instructions and drew the clock with all 12 numbers rather than the digital one that I really wanted to draw.  End of art class.

There were several pages of tests that were the standard “rate this on a scale of 1 to 5 with 1 being totally agree and 5 being totally disagree”.  Easy peasy stuff.

 

My favorite tests were the ones that required thought and were more of the intelligence type exams.  For example, what comes next?

A B C D _ 

82 235 1324 19 61_

Z A Y B X C ­_

The last test was the famous MMPI-2.  The Minnesota Multiphasic Personality Inventory is just what the title indicates – a personality test.  Not sure what Minnesota has to do with this test.  I assume they just wanted something to be known for.  This test contains 567 statements that are as odd and random as anything I have ever seen.  They are all typed out in a booklet form.  I was advised that I was not to write in the booklet - as he opened it and indicated where those who had gone before me had ignored the admonition.  I was also given an answer sheet and instructed to indicate my response with either true or false by filling in the appropriate circle on the answer sheet with a pencil.  #2 lead, of course.

  

I only had to answer the first 370 questions/statements.  By this time, I had worn down the lead on both of the pencils in my cup and was trying to decide if I should snitch a pencil out of a cup on another desk.  Since random people were coming into the “testing room” at indiscriminate times (I am sure they were spying on me!), I opted to plod along with my dull pencil.  It was tedious and seemingly never ending.  I would love to see how I scored on this test.  I have found some of the statements online and have listed them here for your enjoyment. 

1. I like mechanics magazines.
2.  I have a good appetite.
3.  I wake up fresh & rested most mornings.
4.  I think I would like the work of a librarian.
5.  I am easily awakened by noise.
6.  I like to read newspaper articles on crime.
7.  My hands and feet are usually warm enough.
8.  My daily life is full of things that keep me interested.
9.  I am about as able to work as I ever was.
10. There seems to be a lump in my throat much of the time.
11. A person should try to understand his dreams and be guided by or take warning from them.
12. I enjoy detective or mystery stories.
13. I work under a great deal of tension.
14. I have diarrhea once a month or more.
15. Once in a while I think of things too bad to talk about.
16. I am sure I get a raw deal from life.
17. My father was a good man.
18. I am very seldom troubled by constipation.

My favorite question/statement on the MMPI-2 was:  I sometimes enjoy teasing animals.

 

I was never so glad I didn’t mess with that darn goldfish and his gravel!

Results to the Surgeon by Friday.  I hope I passed.

 

Once again, I am reassured that there is no real need to understand Algebra.

Do This and We Will Do That.

If one wants insurance to cover the costs of weight loss surgery, the approval process is quite daunting.  In fact, it is the main reason I have delayed this decision for so long.  Now, I feel I have reached the do or die stage of this process.  I have enough health issues to put myself in the category of high risk of having a heart attack or stroke.  This isn't my anxiety speaking - this is fact.  The way it is.  If I don't do something drastic to change it, my life is in danger.  I know that.  I feel it.  It terrifies me more than I can admit out loud.

I am blessed to have great medical benefits.  In fact, our insurance - Anthem BC/BS - actually is one of the very few insurance companies that "fast tracks" weight loss surgery approvals.  

I still have to meet certain criteria in order to qualify.  I must have a BMI (Body Mass Index) of at least 40.  Or, I can have a BMI of 35 in addition to other health issues that put me at high risk of premature death.  Those include conditions such as Type II Diabetes, Sleep Apnea, High Blood Pressure, High Cholesterol, and several others.

At 285 lbs and 5'10" my BMI is 41.  I am considered Morbidly Obese.  That makes me a suitable candidate for weight loss surgery.  Add the fact that I have:  Type II Diabetes, Sleep Apnea, High Blood Pressure, and High Cholesterol and *ding, ding, ding* Jackpot!  I just became an ideal candidate.  Lucky me.

I have begun the approval process with Centennial Bariatrics via the Centennial Center for the Treatment of Obesity in Nashville.  There is a wonderful Insurance Coordinator who is walking me step by step through what I need to do in order to gain the approval of the insurance company.  

They require that I attend an informational seminar.  I am scheduled to attend such an event on Saturday, July 7th.  I have already watched their online seminar, but feel attending one in person will be beneficial.  Especially since I want some family members to attend also.  I want them to be as informed as I am.

Another requirement is to provide medical records for the last 5 years.  I provided the signed release forms and was notified today that they have received the records already from my primary care physician.

I must have a nutritional consultation.  Scheduled for July 9th at Women's Hospital in Nashville.  For this, I am just hoping I can find a shirt to wear without chocolate stains.  No, those are not Oreo crumbs stuck between my teeth!

I am scheduled for a surgical consult with the surgeon of my choice on July 13th.  It's a Friday.  I am not superstitious.  The Center has three very qualified surgeons who perform weight loss surgeries.  I have studied their credentials and read their patient reviews.  I have chosen Dr. Douglas O. Olsen.  His patients say he is tough and straight forward.  No beating around the bush and hand holding.  That is exactly what I want.   If nothing else, he has great initials:  Dr. D.O.O. 

The last requirement is a psychological evaluation.  Whoa Nellie!  I should have zero anxiety over this one.  I have lots of practice, it seems.  Mine is scheduled for tomorrow - July 3rd.  They say it is going to last *4* hours and I should dress comfortably and bring along a book to read.  I am assuming one of my grease stained shirts and my well loved copy of 'Desserts, Desserts & More Desserts' are appropriate accompaniment's?  Almost all kidding aside, I am nervous about this appointment tomorrow.  I don't know what to expect and I don't know what THEY expect.  I guess I will just go and be myself.  Most would probably consider that a bad idea - but I am hoping that is enough to gain their approval.

I will follow up with details about the visit.