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Shhhhh….

Marilyn ClarkLeave a comment

I haven’t posted since August? Where did September and October go? I promised myself that I wouldn’t let myself be a gastric bypass blog that stopped after reaching goal. 

In fact, I don’t want to be the weight loss surgery blog that shares the sunshine, rainbows and unicorns but not the ugly stuff.

So let’s get real.

I was on a roll. And then insert kidney drama. 

I was maintaining my weight up until then. And then I couldn’t exercise at all for 6 weeks while my body healed. And it was all good for a while then the number started inching up. So I was 7 pounds over my high goal range. And stuck. I started back working out after I was cleared. And I was still stuck. I had to go all the way back to basics and scale back to 3 mini meals and 2-3 protein shakes. The truth: it’s hard. Even though I had gastric bypass, I still am in the same boat where I need to eat 900 calories a day or less to lose. 

The good thing is that being strict helped me to reset my hunger impulses. I’m working my way back down. I will not let obesity win! Being 4’11”(ish) you just can’t hide 7 extra pounds. 

My message: don’t give up. Every day is a new chance to start over. I have tapped into my network of amazing support peeps, some from my Bariatric Support Group, and some “regular” folks. My health coaching program is the best opportunity for me to practice what I preach. I’m getting focused on balance, sleep, stress reduction, and nutrition. 

I’m building up my health coaching business which is incredibly exciting, so that’s where my focus has been. I will make an effort to check in here more frequently as I have a lot to share about my experience. Life in maintenance is a whole different game. And one you don’t read about that much, so I need to change that. 

✌️ 

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It’s complicated

Marilyn Clark2 Comments

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. 

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.

Where do I begin?

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15339-just-begin

I have an idea about what I want to do here, but how do you dive in to a story that has evolved over decades?

I am starting this blog as a departure from all other social aspects of myself, mostly revolving around my dogs. I want to tell the story of my lifelong struggle with obesity, a taboo topic. A topic that I have shared bits and pieces of over the years, celebrating the achievements and hiding during the setbacks. I’m going through something now that requires a lot of mental processing, and am hoping this will be a mechanism for that. And if I can help support or encourage anyone on their own personal journey –awesome! I’m hoping this will also bring some encouragement and motivation my way, too.

Here it is: on July 5, 2016, I had gastric bypass surgery.