another wise woman

A few months ago a friend of mine from an online community posted about a family friend who died of complications from being morbidly obese. She is very vocal about her support of WLS to save lives and change lives. Recently on the message board someone was being negative about WLS being like "cheating". And because of those comments I was disheartened about my decision to pursue the surgery. My friend disagreed with the comments and posted this:

Jen, you ARE doing the right thing. I can and have been judgmental about WLS, but there are also times when I say, "well, that was exactly the right decision to make."

When you said you were thinking about it, and were going to attend a meeting, my immediate reaction was, "YES! This is right." I actually was a little worried you might decide otherwise.

The other time I had this reaction was for my mom's best friend and it was the best thing SHE ever did. The only question was why she waited so long to do it. My parents even had a sit down with the two of them about 10 years ago, and they both were dismissive and uninterested. My parents never brought it up again, but then when he died of complications related to his obesity and she emerged from the fog of depression surrounding being widowed like that, she went to my mom with her tentative idea to look into it. My mom was supportive and for a while there we were BOTH agitated that she'd end up tabling it again for a decade. But she did it. And she looks and feels great. Killer yoga aficionado now. And, pissed she didn't do it years ago.

Anyway, point is, we all have different reactions in different situations. And I can honestly tell you that my reaction to your plans was 100% positive, with no hint of cheating or judgment. And I can still give an eye roll to Carrie's acquaintance, because I'm damn sure there's something going on there judge-worthy.

If you decide to go forward, I will unequivocally share in the joy of your transformation. And it will be authentic and earned. I also think that if I were you, I would hold my cards very close to my chest. Nobody is entitled to medical information about you other than you and your doctor. You don't need to feel like you owe anybody anything. If you can get away with reinventing yourself without being open about your surgery, then I say go for it. You can always talk about it later, but it'll be your choice then. Cats only come out of bags, not go back in. If you want to have it be a private matter for you to work through at first, then you should do it just like that. When you're strong, have seen progress and are perhaps in a more secure position about yourself like Denise is now, then share. Until then you owe nobody nothing. Say what you want to say and no more.

For the haters....

that say WLS is "cheating:

This was written by a woman I met online that had WLS about 11 mos ago....

I can say I've felt like a cheater.

But when I'm trying to think without emotions don't we do tons of cheating in our life?

You aren't going to NOT pay for a child's college just so they can have the pride of doing it themselves.

Don't admire me for having an unmedicated childbirth... It was easy and very little pain. Admire Romana who has terrible pain in childbirth but keeps doing it.

I wouldn't risk my life if I had a placenta previa to have my vaginal birth. I'd go sign up for a csection.

If I got skin cancer I wouldn't not get treatment even if it was my addiction to tanning beds that gave it to me.

We live in a culture that (sometimes rightly) sees fat as the results of major sin of gluttony. I am still fighting the voice inside that says I'm a bad person for getting so very fat.

My bad habit wasn't smoking that gave me lung cancer or sleeping around sans condoms that gave me an STD. My bad habit was to not stop eating when I was full. I just took an available medical treatment. Like I take an anxiety pill everyday for another thing I'm not strong enough to handle alone.

Test results

On Monday I saw my Primary Dr for a physical to get find out if I am healthy enough for surgery. All is well!

They listened to my lungs and all is clear and fine. They did an EKG and that was perfect. They checked out my skin to make sure it was rash free. I guess MO or just Obese people can get rashes/skin infections in the folds of their skin like under their breasts or bellies. Shrug. Never been a problem for me.

They also did a whole bunch of blood tests. My Dr send the results out in an email to me so here is the recap:

Your blood count was done. Your white blood cell count was 9.2. Your hemoglobin was 12.3. Your hematocrit was 36.3. Your platelets were 340000.0. This test was normal.

Testing of your sugar was done. Your glucose was 91. This test was normal.

Your liver panel was checked. Your ALT was 48. Your AST was 19. Your bilirubin was 0.6. Your alkaline phosphatase was 93. This test was normal.

Your kidney blood test was done. Your BUN 15. Your creatinine 0.9. This test was normal.

Your Electrolytes were checked. Your Sodium was 143. Your Potassium was 4.4. This test was normal.

Your thyroid was checked. Your TSH was 0.69. Your free T4 was 0.8. Your free T3 was 116. These tests were normal. No change in your thyroid medication.

Also my Dr gave me the preliminary Sleep Study Results. I have mild sleep apnea. I only have respiratory events (pauses in my breathing) during my REM sleep. And even then it is mild. My Dr says at this point he thinks that by me losing weight via the WLS that the sleep apnea will resolve itself. We are going to allow the sleep apnea to go untreated until after I am 1 year out from my WLS. If I am still having trouble sleeping then he would order a new sleep study and see if CPAP is needed at that time.

The one thing that is good that comes from this is that now the Drs at the hospital know that after my surgery I should probably be put on CPAP until I am fully awake. Apparently patients with even mild sleep apnea can have trouble with their airway after being put under general anesthesia. So this information will be passed along to the anesthetist at the time of my surgery.

Next step is the psych eval which is scheduled for Friday morning. I guess at this office that works closely with my surgery group they make you do a test on the computer and then see the Dr. The receptionist says it takes several hours. Ugh. I will post how that goes over the weekend.

Moving Forward

Updates from May. Three different updates on the progress I am making towards WLS.

May 9th, 2011

So after going round and round with the Drs office and the Ins company my PCP finally decided that he would write the referral letter to the WLS surgeons without completing the Sleep study. The WLS protocol is to screen me for it anyway prior to surgery so hopefully we can figure out the insurance and co insurance I owe by then.

But what that means is that the WLS surgeons are willing to see me for my initial consultation. My appt is this Friday at 2pm PST.

I have to say I am a little nervous but mostly excited to take this next step!

May 14th, 2011

So I went to my appointment this afternoon. The surgeon is super nice and I had an immediate connection to him. He has 3 kids in similar ages to mine. He answered all my questions fully and took lots of time explaining everything to me. We went over my medical history and talked about the RYN surgery in depth.

Then he did a quick exam to check out my previous scars (gall bladder surgery) and to see how big my liver is.

A few things to note....

The Dr told me I was one of the "healthiest" morbidly obese people he has seen. I have a BMI over 40+ but have no other co-morbidities. My BP was 122/72 today.

He does not think I have sleep apnea. After we talked about my sleep etc. we both think that I am sleep deprived because I am a mom of 4 with a crazy volunteering schedule and a toddler who co-sleeps & nurses 1-2x per night, He said he will not require a sleep study! Woot!!!!

Also he said that he doesn't care if Harlie is still nursing while I undergo surgery. He did say that my milk will likely dry up as I start to lose weight. But I am OK with that because it seems that would be a gradual process and Harlie would have no choice but to wean. Win-win I think! At any rate it is one less thing I have to worry about doing before the surgery.

He also said that he wants me to lose some weight before the surgery. I guess it will help my liver become more healthy and therefore make the surgery easier. A healthy liver is a good "consistency" and since they have to retract the liver to get to my stomach they want the liver to be a good consistency. Apparently obese people's liver is enlarged and flabby. If I lose even a small amount of weight 15-20 pounds it can make a huge difference in the consistency of the liver. Who knew?!?!? LOL So he wants me on a smaller portion diet and wants me to try to eliminate carbs as much a possible. And exercise more

The next step is to get the pre-pre- auth from my ins co. That is where they tell me what they will require before they authorize the surgery. Pysch evaluation, blood work, etc... This is also where they may require 3 or 6 mos supervised by Dr. diet and exercise plan. I will find out all of that next week.

So I am feeling good about the appointment, I am anxious to move forward. It was weird to walk into a Dr office that caters to Obese people. Huge arm chairs. Extra wide Exam Tables. Wrist BP cuff instead of Arm one. Huge in-floor scale. I am still processing how I felt about all that... emotions ranging from embarrassment to shame to ..... I don't know. Like I wished I didn't need their services.

Dr thinks that the timeline I am on and that most of his patients are on is 8-12 weeks out from surgery. I might have to do 3mo of diet with my Dr but he doubt that I will have to do 6. And because my last appt in March with my PCP was about weight loss... that should count and I am technically in my 2nd month of dr supervised diet. He thinks I should be able to have surgery this summer. Probably August. We will see.

May 31st, 2011

After my appointment with the surgeon I made an appointment with my PCP to talk about weight loss. I basically did this so if my insurance company did require 3-6 months of a supervised diet I would have 2 months of it already started. They weighed me in and I had lost 8 pounds since my previous appointment. And my BP was even lower than last time. Something like 118/66 . Dr was pleased and told me that he will write up a letter to the surgeons to say that I have been on a supervised Diet/exercise plan since March, so 2 months into it. All good things.

My PCP is still harping at me about the sleep study. He recently read a study that people trying to lose weight and have untreated sleep apnea have a very difficult time losing fat mass because of improper restorative sleep. Basically without restful/rejuvenating sleep your body holds onto the fat mass and instead losses muscle mass. PCP wants me to do the sleep study.

So last week I called and schedule my sleep study for June 9th. Then the next day they called me back and told me they had a cancellation and could get me in on the 26th. So I did it.

The sleep study was not fun. 15 or more wires attached to me with adhesives and paste. In my hair, on my face, on my legs. Some kind of monitor up my nostrils. Oh and 2 tight straps around my waist and upper chest. Ugh. The sleep tech of course could not "read the results" of the sleep study but I was not "bad enough" to have them add the cpap during the night. I guess if you have enough sleep apnea episodes during the the first 2 hr they put you on cpap to complete the last 4hrs of the study. I did not need cpap.

Last week the surgery case worker called me to tell me that she got the preliminary requirements from my Insurance company. They are requesting a psych evaluation and a Physical Evaluation specifically of my heart and lungs to make sure I am healthy enough for surgery. ******They do not require ANY supervised diet and exercise program at all***** WOOT WOOT!

Next week I have an appointment to get a physical and my sleep study results from my PCP. I called to get an appointment for the psych evaluation but the surgeons have to refer me for my Ins to cover it. So I am waiting for the referral. I am gonna follow up on that tomorrow.

Once we have those things accomplished the surgeons group will send the whole packet of my history and all the required stuff to my Insurance company for approval. I think they can take up to 30 days to decide. Once we get approval then my Ins co will tell me how much of it is my responsibility to pay for. Then the surgeon group will start all the pre surgery tests, blood work, dietitian appts, and special liquid diet. Then they will schedule surgery. My portion of the $ is due 2 weeks prior to my surgery date. After I pay they will confirm my surgery date and time.

I am excited. But nervous. I think I am holding my emotions back until we get the final go ahead from my Ins Co.