The classrooms are not clearly marked, but I knew which one I'm supposed to be in because there are no thin people in the room. I peeked through the door in the room divider and had the stark realization that I absolutely must get to that side of the divider. In a few minutes, their room was full of thin, chatty, happy people. On our side, people shifted uncomfortably in their oftentimes-too-small-seats and gathered in small cliques of 2-3.
I struck up a conversation with a woman behind me who had not actually met the surgeon yet, but wanted to attend so she could compare him to a surgeon she'd met earlier in the week. "It's 6:30," she said, "where is the doctor?"
It turns out, the doctor didn't lead the session. Instead we had some of his staff - the PA, a dietician and some other folks. I felt they gave a balanced presentation on both the risks and benefits of the surgery and talked really openly about some of the changes that need to be made prior to the surgery so that you have a plan and have time to adapt rather than just being thrown into it once you wake up in the recovery room.
Gone will be the days where I could sit down to dinner with a glass of wine and inhale my meal. Now, that doesn't mean I can't drink and can't eat on the run, but it does mean that I will no longer be able to have any liquids with my meal. None. Zip. Zilch. Zero. Not even water. They explained that drinking with your meal makes you full before you're actually full and hungrier before you should be hungry. It pushes the food through the small pouch now known as your stomach and makes it more difficult to stick to the plan of eating every 3.5-4 hours.
"Take a chewy granola bar as an example," the dietician said, "how many bites should that take you to eat?" People in the room responded with 3-4-5, some guy even said two. "No," she continued, "I want that to take you 12-14 bites. Now I don't mind how you do that - whether you nibble on it and have it in that many bites or if you literally chop it up into smaller bites, do whatever it takes, but you can no longer pack a granola bar in your bag and swallow it in 3-4 bites."
That may sound like common sense to the rest of you, but not to me. I am always the first one to have cleared my plate. I have no idea how to even let it take me that long to eat something that small. And so, this is why I have the time now to practice.
The dietician drew this really amazing graph on the whiteboard that really summed up the effect of food on our body. "Take a half cup of apple juice," she said, "or a half cup of applesauce, or a small apple, or a small apple with two tablespoons of peanut butter; all will have the same mass when broken down in digestion, but the apple juice has no pulp and will give you a short spike in energy, followed by a big crash. The apple sauce will give you a slower spike, last a little while and then crash. The apple, with the skin, will take longer for you to feel the energy, but once you feel it, you'll have it with you for a while. The apple with the peanut butter is actually the best option for keeping you fuller, longer because it doesn't have a big spike in energy, it's more that it raises your metabolism and keeps it there longer." Now, words really don't explain how well her drawings demonstrated this, but the fact remains that I - for one - don't tend to carry peanut butter around with my apples. But maybe I should start doing so.
I also learned that taking birth control around the time of the surgery can cause blood clots, so if you're staying on your birth control, you'll have to self-inject a blood thinner for the first month post-op. Well, that's going to be a real challenge for me. I don't need the birth control to actually prevent pregnancy - Mother Nature already took care of that - but I do need it for the leveling of hormones. The idea of self-injecting anything completely sickens me. I simply can't do it. So, another monkey wrench is thrown into the plans and I'll need to see my OBGYN to discuss what my best option will be.
We talked about pain management, what to expect after surgery in terms of what we can and cannot do, how the surgery regulates the hunger hormones for about 2-3 years, after which time the success of the surgery is really on how strong the positive habits are that you've formed. And then, the big reveal. They opened the room divider.
The first woman who shared her story lost 220 pounds in the five years since she'd had her surgery. She looked like she'd never been heavy in her whole life. If I had met her somewhere else, I'd have never in a million years thought she'd be able to relate to where I am right now.
An older woman who had her surgery a decade ago shared her story. She'd initially lost 115 pounds and then gained back 50 and has since lost another 70. She said she gained it back by eating "junk" and once she went back to eating like she did after her surgery, the weight just came off. Then she proceeded to rant about some guy who was 500 pounds when he had his surgery and how he'd lost 200 pounds but he was still a "big, fat man." Proof positive that fat acceptance - even within its own community - is a very long way off.
We heard story after story - people who had surgery three weeks ago and people who had it years ago - all told us the same thing. "This is the best decision I ever made, and my only regret is that I didn't do it sooner." I was surprised by the honesty so many people expressed, "I used to do surveys to get free donuts at Dunkies" and "Did you know you can get two free donuts at Honey Dew if you buy a coffee after 5PM? Well, I was in line at 5:01 and then again at a different location at 6:30."
I left feeling energized by my decision to do this as well as overwhelmed by the severity of it all. Will I remember all of the rules? I worried. Maybe this is why they want it to take at least three months. Maybe I shouldn't rush this. Slow it down, really absorb it and give myself the best chance of long-term success.
The results from the echocardiogram are what was to be expected for a person who has been so overweight for so long: I have an enlarged heart. It's a muscle and like any muscle, it's routinely overworked. With that said, everything else was fine - EKG was normal (no arrhythmia), blood pressure was fine (that's what happens when you catch me at 9AM and not 9PM!) and because I'm young enough to not have had any heart attacks or be on any blood thinners or other things that could cause surgery complications, I was given my first medical clearance for surgery!
I'm super excited about it!
Five more to go: Primary; Pulmonologist; Dietician; Psychologist; Surgeon
"This is Lisa, I'm returning your call," I said as my doctor's office answered the line.
"Oh yes, I left you a message because we were reviewing the notes in your file and Your Primary Care Doctor cannot give you clearance for your surgery unless you're having it at Winchester Hospital."
"I don't want to have it there. I already had a surgery there with one of the doctors and I want to go with the surgeon I chose."
"I understand that, but we can only give clearance for doctors that are within our network."
"That doesn't make any sense. My insurance will cover it regardless of where I have it, so why does your network matter?" I was starting to get really angry.
"Because we only refer within our hospital network."
"That's bullshit. Listen, I'm not going to start all over with all of these doctors. I've already set up appointments with the dietician, cardiologist, pulmonologist and went for my first visit with the psychologist. I've been a patient of Primary Doctor for over a year, this is ridiculous."
"I understand you're upset, but this policy is for the benefit of our patients."
"Listen lady, I work in the field and that is the biggest crock of shit I've ever heard. Your policies are not in place to protect your patients. They're to ensure that your office and the physicians within your network get the maximum reimbursement from our insurance companies. Screw it. Send me my files and I'll find another primary doctor."
"Well, we don't want to lose you as a patient..."
I cut her off, "It's a little late for that. I'm not going to switch all of my other doctors when I could just easily switch this one."
This probably would not have made me so angry if they'd told me this three weeks ago when I called them to set up the physical and explained that this is what I was doing it. I even told them where I was having it and no one raised this concern then. So now, I've got all of these appointments set up and have even started going for some of the exams and tests needed, and they want me to start all over? More importantly, they want me to go through their network which means I have the choice of two doctors in the entire state. But even more importantly than that is that I'd already met with one of the two and decided I didn't want to have the surgery with him.
In my opinion, the surgeon in this case, is the most important piece of the puzzle. How many successful surgeries they've performed; The success their patients have had; the exact procedure they do; the recovery time; their program's requirements both pre- and post-surgery; these are all the most important pieces. All of the others are to supplement that. Why would I change such a key piece now, when I'm already so far along in the process?
So, I sent off a written request to have my records transferred and got on the phone callng a dozen other primary care doctors in the hospital network I've chosen. What a pain in the @$$!
Last week, I had my echocardiogram so this morning I will meet with the cardiologist to review the findings. I also have an appointment with my new primary care doctor. My records have not been released yet, but they should be in a week or two. It will be helpful to ensure I'm comfortable with this new doctor and talk to him about his process for clearance. I'm due for another physical next month, so I'm hoping I can get my clearance by the end of May/early June. I'd ideally like to have the surgery in late June/early July.
If you thought going to the grocery store with the approved food list of your latest fad diet was overwhelming, try keeping appointments for six doctors straight. Here's the scene: All six doctors are required for clearance. The vast majority do not have evening or weekend appointments available and you work a 50+ hour week, standard. You've got to get to all of the doctors for at least two visits in order to obtain clearance and oh yeah, you'd like to do this as soon as possible so you can schedule your surgery.
Who said bariatric surgery was the easy choice?
So far, I've had my initial appointment with the surgeon and I've scheduled my follow up appointment with him for mid-May. I also scheduled appointments with both the cardiologist (thank you, family history) and pulmonologist (thank you, asthma and potential sleep apnea). This morning I am headed to the hospital for the echocardiogram I need to have prior to even meeting the cardiologist; that, my friends, is scheduled for next week.
I've also signed up for the first support group, which is happening one night next week. The surgeon requires that we go to some of them so that we have a chance to ask others about their experiences post-op as well as to learn more about the surgery and meet others who are preparing for it as well.
Some of the things I am already finding challenging: eating slower (I practically inhale my food) and the idea that you cannot mix food and beverages. For instance, if I have a glass of iced tea with dinner, I can currently take a sip, eat some food and take another sip (repeat ad nauseum). However, once I have the surgery, I'm told I can no longer do this. Weird, right? Instead, I can drink before and/or after, but not during my meal. How many of us drink during our meal unconsciously? I know I do! Well, no mas.
On Saturday morning I had my first appointment with a psychologist who specializes in weight-related issues. I wasn't expecting a whole lot. I've done my research. I sort of know what to expect with the surgery. I want to have it for my health, not for cosmetic reasons. I have a great support network. I have a strong case for approval since I've been fat my whole life (no really, I was an active kid but I was always the fattest one in my team pictures).
But I was pleasantly surprised and we uncovered things I hadn't really given much thought to, like...how will this change the dynamic with my Big Italian Family where celebrations revolve around food? And, as stupid as this may sound, will I still have the desire to entertain? I absolutely love food - I love the smell of it, the taste of it, the texture, the sight, preparing it, arranging it, serving it, and of course, eating it. Part of what this surgery does is changes the connection from the stomach to the brain so that the signals work properly again. There was a huge concern on my part that I will still have the desire to cook big meals for our friends and family because let's face it...if you lose the ability to eat the way you used to, will you also have the desire to do all of that work for food you can't or won't eat?
"Do you know anyone who can prepare a big meal and not taste the food as they're preparing the menu?" the therapist asked.
I thought about it for what seemed like forever, "No."
"Well, you will be that person. You will still be you, you just won't feel the urge to taste everything you're making while you're making it and then sit down with multiple plates of food to eat it."
Well, that just sounds like a fantasy to a girl who has not ever, in over three decades, been able to achieve that. Not even with Willpower of Steel.
The therapist wants to see me one more time, after I've met with my dietician (which I still need to set up). She's told me she thinks I'm a good candidate for the surgery and the next meeting is primarily formality; I should have her clearance shortly. I am confident that my primary care physician will give me the clearance quickly as well. That leaves the cardiologist, pulmonologist, dietician and surgeon. And then, of course, the insurance company.
Onwards and downwards, friends!
Wow, it's been a while since I had anything to say here. Well, that's not entirely true. What I could have said over the last month and a half is that I've gained back all of the weight (and then some) that I lost on the HMR plan. I also could have said that I've started a new job, have been prepping for a lot more business trips than I've had in years, and that with my new schedule I haven't been to the grocery store in about a month.
But I haven't said any of that.
What I also haven't said - with the exception of a handful of people already hearing about it - is that I've decided to have gastric bypass surgery.
Stop the presses! Did she just say what I think she said?!?!
Yes, I did.
This isn't a decision that I've come to lightly. This isn't a Woe-Is-Me-If-Only-I-Could-Give-Up-Donuts pity party. It's based on a number of things including the general state of my health (asthma and arthritis make it difficult to exercise; PCOS and insulin resistance make it hard to lose weight and keep it off for any amount of time), the fact that my cholesterol and blood pressure are continuing to move in the wrong direction, and that carrying this extra weight is a serious health risk given my family history.
Like a lot of people, I used to think that gastric bypass surgery was the "easy way out," that simply not being physically able to overeat was easier than forcing myself not to eat large quantities of the wrong foods. But I was clearly misinformed.
When they [the researchers and doctors] tell you that the only solution is to make a lifestyle change, they're not kidding. Gastric bypass is a serious lifestyle change. It means I won't be able to imbibe adult beverages as often or in the quantities I am currently able to. It means I won't be able to have a drink (even water) with my meal, but only before or after it. It means I will have to force myself to eat slower, chew my food longer, or face the consequences of not being able to digest it. Unpleasant! And of course, it means the realities that go along with any kind of surgery.
The next three to six months of my life will be hyperfocused on this one thing, this one goal. There is actually quite a lot of work to do both before and after. I've already met with the surgeon and went for my initial labwork. I have scheduled a physical with my primary care doctor. I've signed up for the first support group in April (attendance is mandatory). I've scheduled evaluations with a cardiologist and pulmonologist and have calls into both a dietician and mental health professional - all of whom will need to provide clearance prior to my insurance company approving the surgery. This is scary stuff. For the next three to six months, I'll be a human pin cushion.
