RNY

Mindfulness 

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I’m taking a bit of a Facebook break to give myself a rest from the fallout of the election. Too many emotions are starting to stress me out. In just a day, I realize how much extra time I have when I am not constantly staring and scrolling at my phone.

I’ve decided to branch out the blog a bit. My various incarnations of the Hello Happy Pit Bulls blog were always about much more than the Happy Pit Bulls, and this blog needs to be about more than the unraveling of my intestines.

So let’s talk about mindfulness. The months leading up to my surgery were stressful for a lot of reasons. Still dealing with depression after losing my dad, struggling with some tough decisions at work, and feeling physically broken, I started looking for some ways to reduce my stress.  I actually took a training class at work about Stress Management and got some ideas about keeping a wellness journal to track things like sleep, moods, and physical symptoms and keeping a gratitude journal. I also started seeking some resources to help me better manage my anxiety and found a couple of podcasts I thought were helpful. One was 10% Happier with Dan Harris which talks a lot about mindfulness and meditation as the key to a happier, healthier life in interviews with famous people who practice meditation regularly. Check out the interview with the Dalai Lama. It’s awesome.

So enter the thoughts about mindfulness.

I started researching journaling techniques and discovered bullet journaling. Now, I am not going to be posting pictures of these beautiful habit trackers or spreads. I am not an expert doodler or hand drawn font superstar. But I did more or less follow the principles of bullet journaling. I’m using the Panda Planner.


This planner has spots for gratitude and goal setting and planning and weekly/monthly review and daily affirmations and more. It’s really forcing me to think about things in my life, the blessings I need to acknowledge, and ways to stay positive during troubling times. I keep most work stuff separate from this because quite honestly I would be horrified if anyone from work came upon some of the crap I have written in there.

So back to my Facebook blackout. I’ve spent my time away doing positive things like writing in my journal, searching for sources of inspiration on Pinterest and administering some self-care. It’s a wonderful feeling to be honest.

Now we aren’t going to discuss my planner/office supply fetish. That’s for another time. But I did buy a new Panda Planner that comes with coloring book pages! Therapeutic!

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Dressing Room Drama

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The last time I went shopping with my husband I cried in the dressing room because I had to go back to Plus sizes after being a size 14 for many years. It was heartbreaking and I felt like a failure.

I think that may have been the last time I tried on clothes as I resumed shopping plus sizes from Old Navy online.

Fast forward 2 years. Today, I went to the Gap for their Friends & Family 50% sale (code FFSALE if you are interest, through tomorrow).

I don’t know what kind of clothes I should wear. The don’t know how to shop. The whole thing stresses me out.

I picked up a couple of size S sweaters, waiting for some salesperson to give me the evil eye, then picked up a few pairs of size 10 pants. Anxiously in the dressing room, those pants just went right on. No crying at all!

Again, the sizes are a trip. I can wear anything across multiple sizes depending on who makes them. The LOFT makes me feel good with their vanity sizing.

Today, I felt like a normal person.

I asked Mike if I look like a normal sized person and he rolled his eyes and said “yes baby.”  Seriously. It’s a trip.

Now I have 3 pairs of pants I can wear to work without them falling down. Progress.

“It’s too much…it’s not good…”

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So, I’m in the break room at work and this woman walks in and says just that to me. She said I am losing weight too fast and it doesn’t look good. I told her that it’s between me and my doctor, which she should have interpreted as it’s a medical issue so mind your own damn business, but no…she kept at it. And then she said she doesn’t understand how I am doing it because she is doing diet and exercise and it doesn’t work. I ended up telling her I had gastric bypass and am under the care of a doctor but I appreciated her concern. She shut up. 

I have to say most people have told me how great I look and how happy I look. Which is how I like to project myself even when I am not having a good day. 

I have told some of my closer work friends and most of my family but not all. I assume that people will tell other people but I have found that people are pretty good about keeping medical information private. It surprises me really, but we deal with a lot of confidential information at work, so perhaps that’s why. 

When I first decided to have the surgery, I was embarrassed and concerned about what people would think. I’ve found that as I get closer to my goal, I am way more open. I don’t care what people think. I have yet to have anyone say I took the easy way out, but I have a good comeback for that one. 

“Support” Group 

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Before my surgery, I had to sign an agreement to go to the monthly support group meeting for a minimum of 6 months. I had every intention of checking it out before my surgery, but for whatever reason didn’t make it. 

My first time at support group was about 16 days after my surgery. I was leaving my house in actual clothes for the first time since my surgery follow up. 

The group was so unbelievably negative. One lady said to me “you don’t even look like you needed the surgery.” The last people I expected to judge were baritric patients. I remember this other lady walking in and talking about hot guys at her gym. I didn’t make it to the next two sessions…wonder why. 

The October meeting was different. I received an email, in advance, about the meeting and there was going to be a new therapist facilitating. I decided I would give it another go. Aside from the fact that it took me 90 minutes to drive there due to an accident and 5PM traffic, I made it. The meeting had already started when I got there and I guess they were doing introductions. There were two women who hadn’t had their surgeries yet so they were looking to hear about the experiences of the “veterans.”  This was hilarious. 

There was a guy, who I will call Mr. Lapband, who interrupted to throw in his completely unsolicited 2 cents providing horribly wrong information and the facilitator let this go on a while. My favorite input from him was about how he eats to much and throws up all the time but got used to it and it doesn’t taste bad. OMG — what kind of advice is that?  Then comes the woman who had gastric bypass and discovered she doesn’t get dumping syndrome while trying Halloween candy. Why would you do that???  

What’s my point? There are a lot of options for support in the bariatric community, including Facebook Groups where everyone is an expert ::sarcasm::  

You have to figure out where you need support and seek it there. I wouldn’t seek medical advice from anyone in these groups although it is interesting to see what other people are experiencing. And to hear how people who have been successful at maintenance have managed their lifestyle. 

Now I am curious. In November I am going back for more! 

Some serious scratch

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Anyone want to guess what my little adventure cost me a few weeks ago?

Surgery and hospital stay was $31K — all covered by insurance.

Ambulance $4,114 — none of it covered by insurance, unless the ambulance company provides them with my patient transfer report.  They better do that.  Sounds like I need to give my insurance company a call.  Should be covered from one hospital to another, especially since I was all doped up on morphine at the time.

Ugh.

It’s none of your business…

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…but it’s time for me to say something.

This whole post will surely be one doozy of a HIPAA violation — although technically I’m divulging my own information, so maybe that’s not really true.

My emotions about this surgery run rampant. Maybe it’s the hormones.  Well, that’s a good place to start.

I alluded to medical issues in an earlier post. I have a number of conditions that create the perfect storm of hormonal wackiness. I’ve had a pituitary tumor since 2003 (managed medically).  I have a low functioning thyroid. I have a bunch of girl issues that sometimes throw things out of whack. Since my dad died I have been struggling with pretty severe depression and anxiety. And stress. I’ve had a lot of personal and work stress. All of these things together not only require medications that have their own side effects, but they also create some hormonal imbalances that may impact my ability to lose and maintain weight.

My metabolism is sluggish.  Some people may say it’s very efficient, since my body tends to store everything I eat for the zombie apocalypse. And math? My body doesn’t know math.  You know, that formula calories in must be less than calories out? Well that one doesn’t work for me.  The math just doesn’t add up. I ran half marathons and trained daily and continued to gain weight, even with severely limited calories.  Before surgery, I actually lost weight more easily without exercise, or with very moderate exercise.

In anticipating all the reactions people will have when I come clean about this surgery, I feel like I need to justify why I didn’t just do it the hard way with diet and exercise.  Why I took the easy way out. My response — there’s nothing easy about it. My justification? Several physicians and my surgeon determined and documented medical necessity. That should be enough. So far everyone I have told has been very supportive. There will be no negativity allowed.

I wrote this post over the course of 4 days.  I hope it makes sense.

It’s complicated

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There are numerous Facebook “support” groups for weight loss surgery patients and they are full of people who have been given no rules, who are asking when they get to eat pizza again, and who are clearly not appreciating the benefits of surgery having gone through dramatic altering of their digestive system. You usually hear about these people ending up in the ER with dehydration or damage to their new delicate pouches or sleeves. I have had such smooth sailing in my recovery, I resolved myself to believe Rule Followers don’t get complications. 

But I changed my mind on that. 

One week ago from today I found myself in the ER doubled over with severe intestinal pain that started the day before. I couldn’t eat, I couldn’t drink — I knew something was wrong. I called my surgeon (note: call your surgeon, don’t consult Dr. Google) and she had me take my leftover pain meds overnight, but said I should go to the ER if it got worse. I spoke with her several times in the morning and decided the ER was my best bet. I went into the ER where they did blood tests and I got a bit of judginess from one of the nurses about “being talked into that procedure.”  I had heard stories of bias against weight loss surgery patients in the ER so I was dreading going in. I was seen really quickly, put on IV fluids and major pain meds. MAJOR. I had to do a contrast CT scan which required me to drink some nasty stuff over the course of 2-3 hours before they could do the tests. Morphine was wearing off in 2 hours so they bumped me up to dilaudid. It was crazy pain. 

About 6 hours later…a few hours after the CT scan, some nurse I hasn’t seen asked me if the surgeon had been in to see me. I was like “SURGEON???? WTF?”

My original nurse, Joaquin, who I thought was going to be a dick, turned out to be my biggest advocate. No one had come to tell me what was going on so he told me the CT scan revealed an internal hernia and twisting of intestines. They were trying to find a surgeon and I told him I only wanted my surgeon. He took all of her contact info and gave it to the ER docs and it took them another hour to figure it out, but my surgeon had them arrange for an ambulance to take me to her hospital for surgery. The general surgeon came in to talks to me in the ER and said he had done ONE gastric bypass in residency 10 years ago so they were happy to send me to her. I was pretty freaked out at this point but the pain meds were definitely taking the edge off. 

I got to the other hospital after a 40 minute ride with possibly the dumbest ambulance guy and was put in a room on the floor where they take care of bariatric patients. People who understand what was going on. My surgeon came to see me within the hour to tell me what she saw on the scan and told me I get a gold star for being her first patient to get one of these so early in my recovery. There were two cases in the ER before me, so my surgery was going to be at midnight. I was so out of it and in pain and thirsty  and going on 2 days of not eating I didn’t care. 

So out of surgery at 2:00 am Saturday, I find out I had a tiny piece of scar tissue that caused the spiraling of my intestines and all she needed to do was snip that and everything unraveled (hence the name of this blog). She explained that I had lost so much internal fat leaving spaces in the area where she did the bypass which allowed things to move around. She said she put in several permanent stitches to hold everything in place and I should be good to go. I could immediately tell that the pain I had been feeling was gone. Now I just had surgery pain. And I had to start over with my food progression. Liquids for a few days, then onto purées and then solids as tolerated. Still working on getting past puréed food a week later. 

I had to stay over night and had to meet all of the requirements to leave. 

  • Walking laps around the floor
  • Breathing exercises 10 x an hour (the anesthesia was a bitch and I still feel like I am catching my breath)
  • Drinking progressively more for several hours, 30 ml, 60, 90, 120. It’s hard to do but I wanted to go home. 

The nurses were awesome. I made sure to be extra nice and self sufficient so I could be their favorite patient. I even saw one of my favorite nurses from my surgery back in July. I’ve lost about 35 pounds so far and they were all so encouraging about how well I am doing. 

Anyhow…took the week off to recover and it is so much easier and faster than the original surgery. I’ve been doing some work from home so I know I will be ready to get back. 

So, I am a rule follower who had a fairly rare complication early on and I consider myself very lucky. 

Knocking on wood this is the last of it. 

Rules for Rule Followers

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I need rules. When I have rules, I can be successful. That’s a big part of why I chose the Roux-en-Y gastric bypass over other procedures. 

One of the rules for gastric bypass patients is that you cannot eat anything with processed sugar (pretty much anything sweet like a jar of Nutella, birthday cake, or the crap they bring to work on Fridays) or fried or fatty foods. Eating these foods can cause what is called Dumping Syndrome, which sounds horrifying without knowing what it is. Sweating, nausea,vomiting, cramping, etc. Sounds like fun — not! I liked that there is a consequence for doing bad things, but that also means I need to be careful of people who say, “just this once,” “just a little,” “in moderation.” I don’t need saboteurs. 

Here’s some more rules:

  • Protein first
  • Don’t drink at the same time as eating
  • Wait 30 minutes after drinking before eating
  • Meals should take 30 minutes to eat
  • Wait 30 minutes after eating before drinking again
  • No drinking with straws
  • No caffiene
  • No gum
  • No NSAIDs – ever!
  • No soda or anything with bubbles
  • No alcohol
  • No bread, rice, pasta and other obvious processed carbs
  • Goals every day are for 60-80 grams of protein from supplement every day
  • Minimum of 64 ounces of fluid
  • 3 meals a day 2 ounces or 1/4 cup each
  • Exercise 30-60 minutes 6 days a week
  • Bariatric formulated vitamins every day

It’s a lot of things to think about, and I am sure I am leaving something out. But it is structure. It is totally overwhelming the first few weeks because it’s so hard to do. My teeny tiny stomach holds about 2 ounces, so in the beginning when everything is still healing and swollen, it can take an hour to drink a protein shake. Everything took forever. Over time, all of 3 months so far, it’s become more of a routine and isn’t quite so overwhelming. 

But there is more. Since my surgery, I have never been hungry. Like ever. I can go for days without eating I have discovered (more on that later), so I have forgotten to eat. Especially since I went back to work. I set timers on my watch to remind me to eat and drink because there is no real physiological trigger. Apparently this goes away at some point, so I am trying to get the most out of this “honeymoon” phase. 

Other surprises since waking up from surgery:

  • I can’t tolerate anything sweet
  • I’m a spice wuss. I hope this gets better for sure. 
  • The thought, sight, or smell of chocolate completely nauseates me. This is the saddest one, but definitely is playing into my goals. 

These are rules for life. Forever. This is a giant lifestyle change. And worth every sacrifice. 

The Referral

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At the beginning of this journey, I had absolutely no clue about the cost or insurance. They sent the referral to the surgeon in November 2015 and I was promptly denied by my insurance company. I called to talk to the doctor’s office to see about self-pay or financing options. Um, $36k was a little hefty of a price tag. Getting denied this first time was probably the best thing that could have happened. It gave me the time to do my research to understand what I was getting into, and the starting point was talking to my primary care doctor.

She’s been along for the ride with me since about 2004. When I told her I was referred for surgery, she seemed encouraging. She thought with all of my metabolic challenges (more on that later) it might be a good option, saying it’s a tool, not a cure. That’s a phrase you hear a lot in the weight loss surgery community. It’s just a tool.

She started working with me and the weight loss center to pull together all of the documentation of my ongoing (and expensive) medically managed weight loss efforts, plus documentation of all of my co-morbidities that needed to be present for me to meet the insurance qualifications for surgery. All of this documentation was submitted, then promptly denied.

I decided to file an appeal following the insurance appeal process and addressed bullet point by bullet point all of their reasons for denial. Within a week, I was approved to take a 2 session nutrition class, which was biggest waste of time ever, but it was a requirement. By this time, it’s March. Within a few days of attending the last class, I got a phone call from my primary care doctor saying she had met the surgeon they would refer me to at a presentation the surgeon provided for the staff in the office. They briefly discussed my case and following that, I was instructed to go to a seminar to learn more.

I attended her seminar April 4 and learned so much more about the genetic and metabolic connection to obesity. I got enough information to change my desire to have the sleeve surgery to having gastric bypass, and I got into the queue for an initial consult. Until they have approval from the insurance company, no  appointment. It was within the week that I heard back that I was approved for the consult only and scheduled it for mid April.

The appointment was over an hour. I was able to ask my big huge long list of questions and Mike was able to get some reassurances about safety and complications (more on THAT later). We talked about my history, my knowledge of high protein, low carb living, all the efforts and work I had done. At the end of the appointment, she said I was a good candidate, waived the requirement to do nutritionist supervised weight loss, waived the requirement to have a psychological evaluation and set me up with a number of pre-surgical tests pending final insurance approval for surgery.

As I worked through each of the tests and requirements, the doctor submitted her statement of medical necessity and I was approved for surgery at the beginning of June.

I am exhausted just thinking about all that I had to go through.

The backstory

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So someone doesn’t just out of the blue decide to have gastric bypass surgery.

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I call this my “before” picture. Honestly, I have been overweight since childhood, despite my parents’ best efforts to indoctrinate me to Weight Watchers at the age of 11. My weight gain was gradual over the years, and I swear all through college and beyond I was always on one kind of diet or another.  I actually have a stack of Weight Watchers passbooks from pretty much every city I have ever lived.

Talking to my doctor in 2009, I was connected with a weight loss center called Obesity Treatment Center (OTC), now the The Hernreid Center for Medical Weight Loss. I started that program, a Very Low Calorie Diet (VLCD), which consisted of protein shakes and one small meal a day.  I did great on that program. I lost 75 pounds which I managed to keep off for a while. I started running and did half marathons…then I realized the more I exercised, the harder it was to keep my weight off. I maintained about 50 pounds of the total loss over the next 5 years, going back on the VLCD several times over the course of time. My lowest weight was 150 pounds, which doesn’t even move me from the medical classification of Obese Class I to Overweight. At 4’11” — I don’t have a lot of room to hide a few pounds.

A series of events starting in 2015 set me on this path. I was a caregiver for my dad as his health declined in January 2015, I was stressed, I was tired, I wasn’t paying attention to what was going in my mouth, and suddenly I was back to almost 200 pounds. There is nothing more demoralizing than failing at weight maintenance.  I started back on the weight loss phase of the diet to try to get that under control, and of course, that program works and my weight was coming down again. When my father died in June 2015, that was a trigger for a free fall into a bad place.  I was stressed, tired, had horrible depression, was unable to sleep more than 6 hours a night, I wasn’t exercising, but I was still eating about 1,000 calories a day and gaining weight. My doctor at Hernreid told me that there was nothing else medically they could do for me, so she was going to refer me for a vertical sleeve gastrectomy.

I was devastated.  That made me feel even more like I was a failure. Let me just leave this here for a minute. This was really the start of the journey.