Jumping through the hoops...

So I had made the decision for bariatric surgery. Bariatric is the medical term for FAT! The first step in the process was to attend an informational seminar. Virtually all bariatric surgeon practices require this. The seminar goes through the good, bad, and ugly of obesity itself, the different kinds of surgical options (bypass, banding, or vertical sleeve), what to expect after surgery, the risks of surgery, and ultimately the hoops you have to jump through to be approved.

Dr. Schmitt was the speaker the night I went. Honestly, considering it was an evening seminar and the audience, I truly thought they would offer snacks but I was disappointed. Truthfully it kind of felt like we were cattle being herded in there. Dr. Schmitt said a lot of things that everyone in that room could relate to regarding all the diets and weight loss attempts we had each made before coming to that seminar. He went into detail about the co-morbidities that go along with obesity...diabetes, sleep-apnea, depression, reflux, joint pain, loss of skin integrity (that means fat bumps between skin folds), and the list went on and on. Once he finished, I went to schedule my initial office visit.

When I arrived at the office for my first visit I can say I was actually the smallest person in the room. A lady sitting by me actually asked how long it had been since I had had my surgery. Wow...that is what I pass for these days, the bariatric patient not reaching her goal yet. A few laugh-lines ago I was mistaken for pregnant! The visit was quick and included my weight, calculation of my BMI (boo hoo) and before pics. Then I got all the requirements to complete before I would be scheduled for surgery. There were so many requirements it kind of felt like looking at the credits required for a bachelor's degree. I would have to have a psych evaluation, medical clearance from my primary care provider with a multitude of labs, clearance from my pulmonologist for my sleep apnea, attendance of a 3 hour nutrition class, attendance of a support group meeting, and the most difficult of all...documentation of 14 days compliance with my cpap (boo hoo hoo).

I set out to complete all the requirements. The psych eval was my favorite. Truly they should have a seperate one for folks in the medical field. The session went something like this.....
Q: Do you ever hear voices or see things that other people do not see?
A: No, I'm not schizophrenic
Q: Do you ever go for days without sleeping or go on spending sprees?
A: No, I'm not manic
The questions went on and on to cover all mental health diagnoses in DSM-IV.

The nutrition class was very enlightening. There I sat with my real coke while she was stressing that carbonated beverages were a no-no after surgery. That may be my biggest hurdle to over-come! I didn't realize there were different kinds of protein but sure enough there are many. I guess it is kind of like steak, there is the filet, ribeye, sirloin, and in the world of protein supplements there are isolates, concentrates, etc.

So far none of the requirements were too difficult. I was anxious about what my primary care doctor would say but he was very supportive noting that I was facing short-term risks of surgery vs. long-term risks of obesity if I didn't succeed at losing weight. I checked each one off until I got to the last one...CPAP compliance. I thought of every way possible to find a work around it but to no avail. I guess the reason my doctor's office has such low compliacation statistics is that they dot every I and cross every T, including CPAP compliance.

Regarding sleep apnea I am disgusted. I cannot believe that we can put a man on the moon but the best treatment we can come up with for apnea is a darth vador mask. I really, really tried to be compliant when I got my machine in 2006 but just could not pull it off. I am a mouth breather so the mask I had to have covered my whole face. In the middle of the night, without fail, the condensation from the humdifier would build up, I would lose suction, and wake up with air blowing my eyes wide open. It's miserable to have to go to the bathroom but be attached to a hose. Finally, the masks are hard enough to get on and off when you are wide awake, much less in the middle of the night. After 3 different kinds of masks I gave up and put the CPAP away. I asked the doctor about the sleep apnea surgery but he said my obstruction was not enough for insurance to cover the procedure. He continued my ambien to help me sleep at night and added a stimulant to take during the day....great, now I'm on the Elvis regimen.

My CPAP compliance would be verified by taking my machine to the medical supply place and letting them read the data card. Well hurdle number 1 was that my machine is 3 yrs old and does not have a data card. To upgrade my machine would be several hundred dollars out of pocket. I thought of using mom's but she threw her data card away...didn't need it. After much anxiety I was to a point of irrational panic so Cayce got involved. He started looking at the owner's manual to my machine and how about it does keep up with usage, just not on a data card. Why in the sam-hill didn't they tell me that? I called the office and sure enough they confirmed that yes, they could give me what I needed from the hard-drive memory on my card so now I just had to start wearing it. My plan was to use the last mask I had been using which I had tolerated the best. However, somewhere between it being under my bed, up to the attic, over to my sisters and then to her attic I had lost the clip for that mask. I had no choice but to revert to the very first mask...the worst mask. I took a full 10mg ambien and a swig of nyquil. I figured if I just knocked myself out I could make it through the night and thankfully I did. My surgery date is contingent upon receipt of this CPAP compliance letter on Wednesday this week but last Tuesday night I checked my usage log and it only registered 3 sessions. What??? I woke up at 2:00 in the morning and the machine was off. That had happened Monday night too. I have too much at stake so I took it in on Wed to be checked. It is set to automatically turn off if you are not breathing into it so when I was losing suction it was turning off. The machine only registers sessions >4 hours so when it was turning off due to suction loss or when I went to the bathroom I was not getting credit for my time. They re-programmed the setting to not turn off and I got the missing clip for the preferred mask. One more week to go with the pesky mask.

So...here we are just a few days away. I have been on liquids since last Monday with the goal of shrinking my liver. The surgery will be laparascopic but the most common reason they have to convert to an "open" procedure is due to an enlarged liver obstructing the view. All obese people have fatty livers so they encourage weight loss before surgery to shrink the liver. I must say that the last 3 days have been easier than the first 3 when I was certain I was going to die. I've lost 6 lbs on the liquids but am irritable! I had a horrific headache Monday, Tuesday, and Wednesday but thankfully not the last few days. I have even found a protein shake I can honestly say that I like. It contains the filet mignon of protein and with a little ice, frozen strawberries, and equal is quite tasty. Carnation instant breakfast is also pretty good so honestly it hasn't been nearly as miserable as it could have been. My goal over the next few days is to further wean myself off my diet dr. pepper and increase my water.

Alright...I know I promised these will get shorter but we are current so now I will just be blogging about my daily experiences. Like my strategy for resisting bday cake tonight was holding baby Isaac...granted I did almost nibble on his shoulder:) Or about how E asked me to buy some brownie mix...and she wasn't kidding. I told her that my NOT buying it would be a great example of how she is going to lose weight as a by-product of my surgery. Don't misuderstand, after the first 2 weeks of surgery I will be able to have bday cake and brownies, just small portions. So while I am trying to prepare for surgery the least she can do is not tempt me, especially when I so successfully resisted my favorite thing in the whole wide world...bday cake.