I am sleeved!

I was sleeved on 11/22, but I haven't posted in a while so let me back up.

11/10 pre-op appointment.
I first went for a cardiac test because I have some arrythmias. I was also worried because I had a murmur when I was little, and was afraid they would see something from that and say "sorry, no surgery for you." I arrived early and it was mostly older people. They finally called me back. The technician was male. I hoped that I wouldn't have to show too much. he gave me a gown and tod me to put the gown on open in the front, and to leave my pants and shoes on. I was wondering how they would put the leads on, as I knew from childhood that they go around the breast. He was very discrete, and professional having me move the gown to keep the important bits covered while he attached the leads. He then had me lie on the table on my left side and did an ultrasound of my heart. It was way cool. I then had to walk on the treadmill while the machine measured my heart for the stress test. at first it was easy, but I thought I would pass out by the end, and I was sure I failed. The whole time, he kept reassuring me. It was good because he had the sleeve about 6 months before and spent the whole time telling me all the wonderful things I had to look forward to. After the stress test, he did a second ultrasound while my heart was still pounding. I never opened my eyes, as my total concentration was on obtaining enough oxygen to not pass out. I was surprised that I did not see the doctor at all. They sent the results to my surgeon, and I never heard about thm again. I will ask on Monday. Overall, it was not as bad as I expected. I then headed over to my doctors where thy did my pre-op weight. 283 (ugh, I haven't been working too hard and gained back 10 pounds.) We then had a meeting about the surgery and expectations, diet etc. I was starving at this point because last I ate was 6 AM and it was now after 2. We then went back to the office for a review of Insurance coverage individually, to pay our deposit, and then meet with the surgeon for any last minute questions. I was ready to be put on a liquid two week diet, but the surgeon said, "I see you have lost 15 pounds since we met In June. What have you been doing?" I thought to myself "yeah I lost 25, but gained back 10." Instead I told him about what I had done at first: 1-2 protein shakes, a couple of high protein snacks, and a protein mostly meal at dinner. He said "it seems to be working. Just keep doing what you are doing and start your liquid diet 2 days before surgery." I was shocked. I didn't have to do the liquid diet. Should I do it anyway? Would my liver be fatty? I had been eating horribly the last 3 weeks or so. So I finally got out after 5 and was starving to death. We went out for Mexican that night for a final meal. Guilt never worked on me for long.

11/19 Pre-op bloodwork
So I almost forgot my prep blood work appointment, but my phone reminder went off and I was able to get out on time. I went to Presbyterian hospital in Dallas. They went over my insurance and had me sign papers, electronically, in admissions, then went up to the 2nd floor for blood work. They took blood, verified my info and asked a ton of questions. Then said for me to come back there Monday at6 AM.

11/19-11/21
3 days of liquid diet. My mom came in to town to help with the kids. I was glad she was there. All I can say is three days was torture, I am so glad that I didn't have to do two weeks. On Sunday I had to take magnesium citrate at noon. I just chugged the whole thing. Grape was too sweet, but not the worst I have ever had. It worked. I drank 64+ ounces of water the rest of the evening to replace the fluids I was losing.

11/22 the day of surgery
We arrived at the hospital about 4:45. Have I told you that my husband hates being late? We were able to park and go in when the doors opened at 5 AM. At least I was the first in, being so early. They had me put on the gown and climb in bed, put on my bracelet etc. And finally at 7:05 they wheeled me, bed and all to the surgery recovery area. I was given a hairnet, an IV in my left hand (if you have a choice, always choose your non-dominant hand), a shot in my belly of blood thinner. I told the nurse, the, anesthesiologist, and the surgeon that I didn't want to get sick. Oh yeah, I also took vitamin k 5 days prior to thicken my blood, and a prescribed anti-nausea medicine that morning. The anesthesiologist gave me more anti-nausea medicine in my IV. They finally wheeled me out to the surgery room. I remember kissing my husband and then being wheeled through some double doors, we stopped for a second by this floor to ceiling white board and I saw my name, then we started moving again and that's all I remember. The next thing I remember is opening my eyes and the room spinning. I said I feel sick. Someone handed me one of those pans and I saw the nurse put meds in my IV. I woke up later several times but could not stay awake. I remember the nurse calling several times about my room. The next thing I remember is being in my room with my hubby. I think I walked, I know I got several shots of dilaudin, and I got up to go potty, otherwise I slept. Everyone did an excellent job. I never threw up or felt too much pain. I will put the post-surgery day in another post.

My Appeal Worked!!!!

I am finally updating. Until now, I really didn't have anything to post except wait... wait... wait... Now, I have some great, new, wonderful, exciting, awesome information. Since Friday was October 1st, I decided to call the insurance company to see if they had a resolution for my appeal. The number on my appeal letter went to a voicemail, and the girl said that she was out of town, leave a message or contact this other number. I had already waited a month and a half so I called the other number. Can you believe it? That number went to a voicemail as well, and she was out of town. Again the choices were to leave a message or call another number. I would call all day if I had to, but I was going to talk to a person. 3rd time is the charm. I reached a person. She looked up my information, and calmly said "your appeal was approved." I couldn't believe my ears. I said "what?" She repeated it, and I squealed. I said "thank you, I love you." She probably thought I was crazy, but I was so happy. Literally, I was jumping up and down. She said the letter was mailed on September 28th and should arrive any day now. So now more waiting. It didn't come Friday. More waiting. It didn't come Saturday. More waiting. No mail on Sunday. More waiting. Finally, the letter was in the mail on Monday. It was official. Hurray.

I talked to the Doctor's office today, dropped off the letter with the authorization code, and made arrangements for my surgery. I will have my surgery on (Drum Roll......)

Monday, November 22,2010.

YEAH!!!!!!

The pre-op stuff starts November 10th. I will have a heart stress test, my pre-op class and be given my pre-op diet.

I will let you know more then.

YEAH!!!! Again.

Insurance Appeal Letter

So I was denied due to the "experimental" nature of the surgery. I decided to appeal and have been working on that. I finally finished my appeal letter. I also requested an appeal letter from my doctor's office about two weeks ago. I plan on mailing it this week. I hope this works. Here is the letter:

To Whom It May Concern:
On August 02, 2010, I was denied coverage for the Vertical Sleeve Gastrectomy (VSG) as a standalone procedure for the treatment of morbid obesity. The reason given for denial was that the procedure is “investigational or experimental” due to not yet being determined as a valid treatment by peer-reviewed literature. In this letter I will offer research results that demonstrate the effectiveness of the VSG, as well as the reasoning behind why this is the best surgery for my problem.
The American Society for Metabolic and Bariatric Surgery (ASMBS) issued an “Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure” on November 9, 2009. This statement supported the use of the sleeve gastrectomy procedure as a standalone treatment of morbid obesity:
“Limited intermediate-term (3–5-year) data have been published in peer-reviewed studies demonstrating durable weight loss and improved medical co-morbidities in patients treated for morbid obesity using the [sleeve gastrectomy] SG procedure. The long-term follow-up data at 5 years for high-risk and super-obese patients are limited, in part because some patients undergo a planned second operation (Roux-en-Y gastric bypass or duodenal switch) within 2 years of their SG, either as part of an overall staged treatment strategy or because of weight loss failure or weight regain. Informed consent for SG used as a primary procedure should be consistent with the consent provided for other bariatric procedures and should include the risk of long-term weight gain.”
The ASMBS notes several studies that suggest that due to the fast paced changes occurring in this field, the medical and insurance community should review its statements of denial due to limited supporting evidence of the long-term outcomes of this procedure. Although originally this procedure was not standalone, but rather step one of a two step procedure for the extremely morbidly obese, due to several factors, many of the original participants never underwent stage 2, and maintained weight loss equal to that of other procedures with only the first stage (VSG).
Most importantly, the rates of improvement of secondary conditions such as diabetes, hypertension, hyperlipidemia, and sleep apnea are comparable to those seen in other restrictive only procedure. The rates of complications due to surgery are relatively low and again comparable to other gastric surgeries. The rates of weight loss are higher than that of gastric banding, and comparable to those who received the RNY surgery, both at 1 year and 3 years post-op.
Personally, I am a 37-year-old female in relatively good health (some mild edema, heart palpitations) other than morbid obesity (current BMI is 47). Many people who undergo this surgery have co-morbid conditions that I do not have. I am still young, though, and I have an extensive family history of conditions related to obesity on both sides of my family. Type II diabetes is a disease prominent in my family for at least 3 generations (including my mother and both of her brothers, my father, my maternal grandmother, my maternal grandfather, and my maternal great-grandmother). In addition, both of my parents have further medical problems that warrant disabilities due to secondary complications from diabetes (mother: diabetic neuropathy with Charcot foot syndrome, heart arrhythmias, and 1 heart attack) (father: Myasthenia gravis, diabetic neuropathy, dyslipidemia, hypertension, and 2 heart attacks). Both of my parents were obese but healthy into their early 40’s when they developed type II diabetes and went drastically downhill from there. This is my chance to keep from following the same family patterns. I do not want to wait until I am 45 and suffering from these conditions to finally be approved for this surgery. I want to maintain my somewhat healthy body, and live my life to its fullest.
I have researched all my options extensively and believe that the VSG is the best fit for me. The complications associated with banding, including wear, slippage, fill/port problems and the fact that you have a foreign object within your body for a lifetime, are all negative factors. Even doctors who do joint replacements and other such surgeries note that the lifetime of these type objects is not equal to the lifetime of the patient and will often require additional surgeries after 10 – 15 years. In addition, I am concerned about the mal-absorptive side effects of surgeries such as the RNY. I believe in maintaining a balance of health with exercise and good food choices that match the studies supported by the national health standards. Being unable to process or eat certain foods as well as problems absorbing vitamins is not something I want to do to my body. I believe the restrictive process of reducing my stomach size will allow me to return to the most normal, healthy eating pattern, with fewer calories, but maintain my ability to intake medications, vitamins and a variety of foods. In addition, by retaining my pyloric sphincter muscle, I will not have the problems of the pouch stretching at the bottom allowing food to just “pass through” that many RNY patients are reporting, resulting in a 20-30 pound weight gain, and a follow-up surgery to correct. I know that I can lose weight on a healthy restrictive diet. I have lost 20-30 pounds several times over on healthy restrictive diets such as weight watchers and portion/calorie control using internet food tracking plans. Each such time, it is impossible to maintain as I feel as if I am “starving to death.” The longer I am on the diet, the more intense this feeling becomes. The only time that this did not happen while on a diet was when I took the pondamin/phentermine combination medication. I was able to lose 50 pounds and maintain the weight loss for over a year. Due to the removal of the fundus during the VSG, production of Ghrelin is reduced and often results in the loss of that intense hunger feeling that so often impedes dieting. I believe that this would allow me to restrict my intake, follow a healthy diet, and not feel as if I am “starving to death.” I want to have a normal healthy long life and I believe that VSG is my best chance.

I could use some suggesstions or support.

Insurance - DENIED!!!!!

So, here I was waiting for the call. The one from Dr. Davidson's office (Bariatric Surgery Center of Dallas)to let me know that I was officially approved. When I answered the phone on Monday, I was soooooo happy to hear her say, "This is Dr. Davidson's office" and then WHAM! She told me that although I met the qualifications for both gastric bypass and lap-band surgery, my insurance (Blue Cross Blue Shield of California) does not cover the sleeve. I was overwhelmed by an intense disappointment. I don't want the other two surgeries, and this (the gastric sleeve) is the best one for me. I told my hubbie that I would just go without, but he knows me and said to find out how much self pay is and we will just find a way. So I did, and here we are.

Movie Theater Seats

We usually go to the theater near our house, but the one in Mesquite had better times, so off we went. Anyway, the seats were too small. I could fit, but the arms on both sides were hugging me. I get so embarrassed by things like this. I know that I am big, but I don't feel that big! Luckily, the arms were ones you can raise, so I raised one and watched the movie.

On a more positive note, I haven't laughed so hard at a movie in a long time. Dinner for Schmucks.

Hurry up and wait!

Just an update:

I spoke to the doctor's office today. They are faxing my insurance request with the information today. They said that BCBS CA usually has a response turnaround of 10 days to 2 weeks, but that they were allowed up to 30 days by law. ARGGGHHHHH!!!! More waiting.

I was told to start trying to lose weight to shrink my liver for the surgery. I wasn't sure how much time I had so I went full force. I have been on a low calorie diet with an emphasis on protein since my first visit. I have already lost 16.4 pounds. They said not to worry about losing too much for insurance approval since they use the starting weight. I am sooooo hungry and I want JUNK FOOD!!!!

I know... I know... it is just a start. Any weight I lose now will just make the surgery easier. I hear that after the surgery, it is easier, because you get full eating small amounts and you just aren't as hungry.

Another new thing I am considering is my goal weight. When I used to think about what I wanted to weight, I thought that I would be happy at my pre-marriage weight of 230. When I first started thinking about surgery, I thought, maybe I can even get back under 200. Since looking at people's posts on www.verticalsleevetalk.com I have considered that I may even eventually reach my "ideal" weight of 145. Since I have been the height I am now, 5'7.5", I have always weighed more than the charts recommended. My lowest weight in High school was 155, and I wore a size 10. I didn't stay there long.

Anyway, I am doing this to be healthy, not to look like some glam gourgeous skinny thing. I don't want any of the health problems that seem to run in my family.

Psychological exam

I went to get my psychological exam. Just an interview, filled out a background info paper about eating behaviors, and took the mmpi. I think it went well. It's strange to be on the other side of the desk.

Cheating

So I was driving to work the other night and there was a Whataburger right there in the parking lot. I thought, I have only had 853 calories today, I can have a small fry. I actually drove up to the drive through, but then I changed my mind and remembered I had a protein shake in my purse. So, I had the shake instead. It was definitely not as satisfying as a hot, salty, fatty french fry, but it was filling. By the time class was over, I no longer wanted the fries. Still, I see those chips in the cabinet every time I open it, and I smell the memory of fries with every fast food restaurant I pass. I know that after a while after the surgery, it is okay to eat fast food on occassion, and one woman at the nutritionist office says she eats chips with her lunch every day after VSG surgery. It is not forever, just until the surgery, and a little while afterward.

Frustration

This is why I hate diets and usually give up. I have not cheated or eaten any more than usual, but for two days in a row I have gained, not lost. Not much, and it's probably water weight associated to my cycle, or maybe it's because I haven't been exercising. I don't really know. It's just so frustrating. Ughhh.

I bought 2 new exercise Wii games today, Wii fit plus and Dance on Broadway. It's a whole lot more fun to exercise on the Wii with my daughter. This adds to the couple of games I already have. Just Dance is still my favorite right now. BTW I have lost 10 pounds in prep for surgery.

Visit to the Diatician

I went to the diatician yesterday. She took a history of my dieting and gave me a book to read. Some of the things that insurance requires is so funny to me. Do they think we spent our lives getting fat an woke up one morning, looked in the mirror and said " oh my god. I am fat. I think I will go and have surgery." seriously. Can't they just assume that most fat people have tried many diets. Anyway, I did my part. At least I don't have to try another diet for 6 months to get approval, like some people. The book gave me details on expectations for surgery and the diet I will be expected to follow. It makes it all more real. I dreamed about it last night. I watched them throw away my stomach and when I looked back I was skinny. It's strange to imagine the possibility of being skinny. I gave that dream up a long time ago, and now I can just barely imagine it.

MMMMM.... The Smell of Beef Slow Cooking

I started my new job teaching at a cullinary arts school here in Dallas. Its going to be torture. Smells... ahhhh.... the wonderful smells filled the halls all day long. I can only imagine how hard it will be once I have my surgery. Last night as I was eating my healthy snack, I could smell the rich aroma of beef slow cooking. The cherries just didn't seem so good after that. At least no one offered me any samples. I can do this! It has been a week since my Dr. appointment, and I have lost 5 pounds. I have a dietician consult tomorrow.

Finding Something Healthy at On the Border

I went out to eat with my family after a long day at my work (practicum). I usually have my shake in the morning, a light lunch, a light snack, and a healthy dinner. I knew I wouldn't get a break at work to eat so I ate a good breakfast, and had my protein shake between clients at about 2:00, so by the time I got to the restaurant, it was almost 8:00 and I was STARVING!!!! I love mexican food. I love the chips, salsa, cheese, sauces, tortillas, all the fat and salt. It is all soooooo good. So I hunted down the menu for something that appeared a little healthy, and I came up with the Tomatillo Chicken on the Fresh Grill page of the menu. It was not fajitas with guacamole and sour cream, but it didn't look half bad. I only ate 4 chips with salsa, and a little over half my plate of chicken, veggies and rice. I was very proud of myself. My hubbie did good too. He ordered the grilled chicken and pulled pork fajitas and stopped after 2. He is really trying so we can do this as a family.

Tomatillo Chicken 1 Serving 850 calories, 24g fat, 108g Carbs, 50g proteins, 6g fiber 2060mg sodium

I also took my before pictures. Yuck. Please sign waiver stating that you understand that you might suffer permanent damage to your psyche before viewing the pics.

At Hurricane Harbor Water Park

So I went to Hurricane Harbor water park with my kids today. I have given up thinking I will look anything but horrid in a swim suit and just hope that I am right that most people could care less. While there, I thought about all the rides that I won't be embarrassed to get on after I lose some weight. I am afraid of some of the tubes because I have nightmares of getting stuck and making the news "Fat woman thinks she can fit in the black hole" or something like that. Also, I wonder if the rides are rated for my weight. Am I going to be "the one" to break it. At least my weight makes me go really fast down the slides. I rode the kamakazi racers with my kids and ended up all the way at the end of the pool.

Diets suck!

Yesterday, the nurse said I need to try and lose 15 pounds before the surgery, because my liver is enlarged and it will make the surgery better. So last night I went for a walk. Did I tell you how much I absolutely hate exercising? Also I am supposed to replace one meal with a protein diet shake. Today, I was sooooo good. I had the shake for breakfast, a can of progresso 1 point soup for lunch and by 1:00 I was starving, so I ate a banana. By 2 I was still starving, so I bought some carrots and practiced chewing them so small, they could fit through a straw. I was a little satisfied for a while, then starving again. I ate two bites of cottage cheese before making dinner, because I was dying of hunger. Dinner was a bowl of skillet meal chicken Alfredo, with extra chicken to up my protein. It's now bedtime and I could eat again, but at least I don't feel as if I am starving. This is why I never succeed in the long run on diets. I always feel hungry. I am putting a lot of hope into this WLS to help me not to feel as if I am starving to death. Oh btw, I also played JustDance on the wii for 30 min. I CAN DO THIS!!!

The Decision.

Went to Dr. today. After much deliberation I finally settled on the WLS gastric sleeve. To me this seems like the perfect middle ground between gastric banding and gastric bypass. I have high hopes, but the first step is loosing 15 pounds before my surgery. It seems I have a fat liver. More to come......