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Help, I think I have an eating disorder!

Meet Diane*.  She had struggled with her eating and body image as far back as she can remember.  Having been on every diet under the sun, she still couldn't keep the weight off.  In fact, she had dieted herself up to her highest weight ever.  When her doctor suggested bariatric surgery she decided it was her only hope. Fast forward to a year after surgery, and Diane has started regaining the weight she lost.  There was an initial "honeymoon" period during which she lost weight relatively easily, but now it's creeping back on.  She finds herself grazing on food throughout the day, and notes that her stomach holds more food than it did a few months before.   Diane cancels her upcoming appointment with her surgeon because she doesn't want to face the embarrassment of getting on the scale and fears ridicule from the surgeon over what she's been doing with her eating.  So she avoids in order to save face.  (And who can blame her, right?).   Time goes on, and eventually Diane is back at her pre-surgery weight.  She's devastated.  And ashamed.  And mad at herself.  "I failed again.  I'm such a loser," she thinks to herself.     But the truth is - SHE DID NOT FAIL.  And she certainly isn't a loser.  Diane was suffering from an eating disorder.   How is this possible?  How come nobody told her?  Didn't her surgeon see it?  Had she done this to herself? Despite efforts to screen people for eating disorders prior to surgery, they often go undiagnosed.  Studies suggest that roughly 30% of people seeking bariatric surgery actually have an eating disorder - with binge eating disorder (BED) being the most common one.   Realizing you have an eating disorder after bariatric surgery can be a shock.  Many times, people don't realize it until they have regained some or all of the weight they lost.  The eating disorder finds ways to have you eat "around" your surgery.   As a dietitian who specializes in BED, I have treated tons of people who have an eating disorder after bariatric surgery.  And what I can tell you is that recovery is possible.  You are not alone, and there are people out there who can help. If you think you might have an eating disorder, click here and start healing your relationship with food today.  You deserve it.    *Name and certain details have been changed for privacy.
 

How much to drink, getting cramps

I'm 5 days out and I'm getting a mild cramp when I drink water. Jello, broth, yogurt ect. go down well. I'm drinking slowly and taking small sips, but still get the cramp and a little bit of gas/air comes up. How long does this last? Am I taking in too much? No nausea yet so I've been lucky. Pureed food is looking really good about now but I'm following the plan. I've had absolutely no hunger or maybe I can't tell due to the abdominal pain.

Ladyhawkhere

Ladyhawkhere

 

Moving right along.....

The other day, I had my appointment with the NUT and my psych evaluation. I absolutely loved the NUT.  She was SO thorough with explaining everything the Dr. wanted for me to do and then she added in her own additional thoughts on everything as well.  We also discussed the things that I am to start changing immediately to get into some better habits. Well the biggies are not drinking 30 minutes before or after a meal or during.  I had actually started that this week anyway.  The other is not drinking my breakfast and to drink my morning shake as my mid afternoon snack instead.  And then the thing that I never in a million years thought I would have a problem with....not drinking with a straw.  Holy crap is this hard!!!!!!   I have a 32 oz mug at work and a 24 oz mug at home.  At work, I fill my mug 4 times during the day.  At home I fill it once or twice in the evening.  So i do drink alot of water.  Boy did I struggle to "sip" water and not gulp it down.  Who would have ever thought that at 48 years old, I am learning how to drink again?????  It really does suck though.

Anyway, the psych eval went good too with her saying she was sending in her thumbs up.

I guess the only things left will be the pre-op and I don't want to get any of that done until after the beginning of the year.

Jenwill630

Jenwill630

 

BIG NEWS! Several insurers are REMOVING supervised diet requirements

YOU MUST READ THIS if . . . Your health coverage comes from Blue Cross Blue Shield of Illinois, Texas, Montana, New Mexico or Oklahoma in 2019! (And probably should read it even if you're not!) Why? Those 5 companies are part of HEALTH CARE SERVICE CORPORATION (HCSC) and they are making a major change which affects anyone insured by them in 2019 who is considering having bariatric surgery. The HCSC Bariatric Surgery Medical Policy no. SURG716.003 is going to become effective February 1, 2019 and, believe it or not, they are eliminating any formal requirement that patients engage in supervised weight loss for a particular time frame (e.g. 3, 6, 12 months, etc.) prior to surgery. READ MORE HERE: BIG NEWS! Several insurers are going to REMOVE pre-surgery supervised diet requirements
 

I worry for nothing.

So my appointment at the PCP went perfectly fine.   There I was, all prepared with a speech in my head of how to tell him of my decision that i wanted weight loss surgery and that oh I must of shrunk because they measured me at the surgeons office and height is different.  I get in there and Dr. has a med student with him.....so that threw me off. Dr. decided to discuss my labs and asked if there was something I wanted to tell him.  I must have looked at him puzzled because then he told me that he saw another lab order in there from another Dr.  So that broke the ice.  He then explained the different surgeries to me and the med student, which one he felt would benefit me more and why.  Luckily it is the one I wanted.  LOL
He then told me that if he were to recommend a Bariatric Surgeon, without a doubt, he would recommend Dr. Gagne that he is one of THE best in the country at the bypass, his reputation is impeccable, his results are fantastic, he ran one of the best bariatric programs in the country at one point.  So hearing this truly made me feel even more comfortable with my decision. He also said he is behind me 100% with opting for surgery.....that's great...would have been nice if he had recommended this a couple of years ago though!  LOL So he very willingly filled out all of my paperwork that Dr. Gagne requires and on my way I went. I got home, looked at the paperwork and realized oh ****.  I forgot to tell them about my height being wrong and now my BMI is wrong on the paperwork I have in my hand!!!!!! This morning I called and spoke to the nurse explaining everything.  Of course she laughed at me (in a good way) and so I need to stop on my way home to get the height notated properly in the file and for the form to get re-done. Could I have waited until my next visit next month?  Probably, but I can't let things sit...my anxiety does not allow that.  If I had let it wait, my mind will play that game of "the worst possible thing will happen and I won't get the form re-done".  

Jenwill630

Jenwill630

 

11-2.....to the PCP I go

So this afternoon, I have an appointment with my PCP.   This will be the first time I have seen him since I decided I want to get RNY done.  I am a little nervous about this.  Why?  I have no idea.  That's just how I am....a scaredy cat when I have to tell people decisions that I have made and am not sure what their reactions will be.    

Jenwill630

Jenwill630

 

Spooky Halloween Tales from the Darkside of Bariatric Surgery Appeals

The ghouls and goblins don't just knock on your door yelling "Trick Or Treat"!  They sometimes reside in the so-called "Customer Service" departments of health insurers, proving on a daily basis that they are not interested in their Customers and not usually capable of providing Service.    We thought some of these stories, and we have oodles of them, made for an appropriately ghastly Halloween blog.  Make sure you read all the way to the end so you can see what the Devil has in store for some of these folks in the insurance industry!   "I don't have to give you any information about your appeal!" While this particular horror story involved an Aetna appeal years ago, problems like this happen all the time and we still can substitute the name of nearly every other major insurer for Aetna  and have a similar tale to tell.  Kelley was following up on an appeal we filed and was requesting confirmation that things were in process and inquiring about the status.  The "Customer Service" person simply refused to provide any information despite confirming were the appealing patient's representative.  So what......she just wasn't going to give any information to our office. Many reading this will know how incredibly nice Kelley is.  If you don't know her then you can be certain her reputation for patience in matters like this is beyond dispute.   Since this representative obviously wasn't going to budge Kelley calmly requested to speak to a supervisor.  That's when things got interesting.  The representative refused to transfer the call, stating the issue "did not rise to the level of involving a manager." A full thirty minutes later,  after repeatedly demanding to speak with a supervisor and ultimately threatening to file a complaint with the Massachusetts Department of Insurance, Kelley was finally transferred to a Supervisor's voicemail, who got an earful of "message" from our office concerning what occurred.  Kelley suggested the Supervisor listen to the recording of her exchange with the service representative because (don't forget) "this call may be recorded for quality assurance purposes."  When the Supervisor called Kelley back she profusely apologized and confirmed the customer service personnel are required to transfer the member to a supervisor immediately upon request and that the representative was way out of line.  The happy ending to the story is ultimately that Aetna approved the RNY gastric bypass that was the subject of our appeal! "I'm sorry but you don't have any right to appeal or obtain an IRO of this denial." There are some insurers who try to eliminate patient rights to appeal, especially appeals occurring before the surgery takes place.  Some denials are labeled as coming from "courtesy reviews"  with no appeals available.  (I personally find it interesting they use the term "courtesy review" when they rarely do much of a "review" and hardly ever show any "courtesy" . . . but I digress. . . .)  BCBS of Alabama is among a number of payers who sometimes try to bar appeals.  It is very rare that appeals are not available prior to having surgery so don't just accept their statements as being true.  We know when they are playing games and most of the time companies (like BCBS of Alabama) end up processing the appeal and when (shock of shocks) they tell us the member appeal was denied, we request an "external review."  BCBS of Alabama, of course, has an unusually high level of incompetence so we should not have been shocked their response was that the member actually did not have external review available because the denial we received resulted from (you guessed it) a "courtesy review."  Unbelievable! Enter Kelley (you'd think these companies would know better) who spoke to 2 different Supervisors about the situation, each of whom provided her with different (yet both still INCORRECT) stories about the nature of the member's rights.  After spending one hour and 10 minutes on the phone Kelley was finally transferred to an "Operations Manager" who was truly horrified at what occurred.  She immediately initiated an expedited IRO request and 7 days later our client was approved!  When the dust cleared Kelley and the Operations Manager had a conversation and she again apologized for all the misinformation which was conveyed and assured us that they were using this case as a "teaching example" for their customer service personnel.   "You didn't think that just because we APPROVED your surgery after your appeal we're actually going to PAY for it too, did you?!?" It can be truly horrifying for the physician and facility to not get paid after successfully getting an approval.  Worse still are patients like us who fear getting HUGE bills even though we thought everything was settled after "winning" a pre-surgery appeal.  This can happen, usually when the maze of insurance company Departments fail to update their systems to show things were approved.  We sometimes need to go back to a payer, even after a successful appeal, and re-start the battle.  It can time time, patience and knowledge to successfully navigate the insurer's system to get this fixed.  Fortunately every time this happens we have gotten these claim denials resolved and re-processed for payment before the providers and patients turn into angry villagers storming Frankenstein's castle to chase these Monsters for the payment they are due. So as I wish everyone a safe and happy Halloween, I offer special greetings (and a warning) to insurance company executives and their customer service representatives who seemingly delight in making patients and providers miserable.  They need to stop now.  A number of years ago, at the Obesity Action Coalition's first Your Weight Matters conference, my costume included a button warning those in the insurance industry who do not change their ways. . .Hopefully they listen! HAPPY HALLOWEEN!!  
 

10-24 Dr. appointment

After about 5 minutes at Dr. Gagne's office the other day, I decided I am really glad I chose him as my surgeon. For starters, having the surgery at Butler instead of going down to Pittsburgh is a big plus.  Especially since I have no idea how I am getting to and from the hospital, so if I have to get the male child or my uncle to do it, I am way better off doing through Butler. Talking with Dr. Gagne...he is very matter of fact, straight forward, yet seems to be very understanding. I had printed off my diary pages from MFP, put them in a binder for him and he said to just continue to eat as I have been doing because it was very good along with the exercise I have been doing.....proof positive that i need the surgery when he sees the work I am putting in and yet not so much as 1 ounce has been lost since my appointment the beginning of the month at Dr. Reyer. With regard to the holidays coming up....he said not to deprive myself, but by the same token please realize I am not going to the electric chair so please do not go overboard.  LMAO   Kelli told us that since Highmark has a change in medical policy, there is no more 6 month wait.  So I asked for an approximate of when I could possibly have my surgery if that is the case...they will be submitting it the day after New Years when it takes effect.  LOL   This is going to fly!!!!  

Jenwill630

Jenwill630

 

And so it begins

I thought I should start journaling this whole experience in a safe place, so here we go. On October 1st, I had my appt with my PCP Dr. Reyer and as usual, gained weight yet again.  Dr. Reyer suggested that we try yet another diet.  I left there just bawling because i have had enough.  I am at my highest weight EVER, feel like crap, look like crap and I truly can not stand it anymore.  I am sick and tired of being sick and tired. It was on that ride home that I decided that I needed to look into weight loss surgery.  When I got home, I immediately went online to see if my insurance covers WLS.  That is a big fat no.  My husbands employer does not have the rider. So that night was spent looking into Mexico as an option. The next morning on my way to work, I realized that open enrollment is coming up.  Let's see if my insurance covers it.  In to HR I went and sure enough, my employer does have this on the insurance!!!!   I started looking into Doctors that are covered on both my current insurance and my future insurance.  Narrowed it down and scheduled to go to both of their seminars. On 10-11, I went to Dr. Gagne's seminar at Butler Memorial Hospital.  Luckily, I got there very early since i went straight from work.  I was the first one there as the Dr and Kelli his coordinator were setting up.  That gave me a 30 minute opportunity to sit and talk to them one on one.  At that point, I realized I didn't need to go to the other seminar, this was who I wanted to be my Dr. and coordinator. On 10-24, I had my first appointment with Dr. Gagne.  Kelli let me know that with my changing insurance, there would be no problem and also that my future insurance had just changed it's medical policy last month and there is no longer a 6 month weigh in period.  Now the only wait I have is for Highmark to kick in!!! So on that note, on November 7, I have appointments with both the dietitian and my pysch evaluation and then go back to Dr. Gagne on 12-12.  

Jenwill630

Jenwill630

 

Too much, too soon.

Changing HOW I eat is so hard.  I mean, I knew it would be hard, but now I'm actually IN it. I should have been working on it earlier, this frantic eating.  Whenever I have food in front of me, it's like I haven't eaten in days, I just frantically shovel food into my mouth.  Now that I'm doing purees (and starting soft foods), the same thing is applying - I go into a frenzy when there's food around!  It is taking almost everything in me to slow down.  In fact, I have had two soft food meals so far in which I over-stuffed myself because I wasn't eating slowly enough.  Ugh, that feeling, nauseated and uncomfortable, but also just so so "hungry".  In fact, I am still feeling the effects over 24 hours later.  I know that it's not real hunger, it's just an automatic reaction to having food around, but it feels so real and keeps me shoving food in my mouth even when I don't want to.  I am hoping that I can improve in this area, that I can quiet my food desperation and appetite, but I know it's going to take work and willpower on my side - something I've always had trouble summoning on my behalf. I have not been doing well with hydration.  My skin is dry and flaking and my mouth and eyes are dry.  But it's hard to drink water because I feel nauseated and it still kinda hurts my stomach.  Waiting 30 minutes before and after food is NOT working out for me - I just can't seem to get enough fluid in!  I don't know what to do. Exercise is also something I'm failing at.  I haven't done any form of exercise since I got back from the hospital.  Like, what am I thinking?  I know this is an important part of my new lifestyle, but I forget (because it wasn't a part of my previous lifestyle) or I just keep telling myself I'm healing and I'm too exhausted from not eating.  Or my skating rink is closed, as if that's my only option for exercise.  So many excuses. Other than these things, I do seem to be doing well.  My incisions are healing nicely, I really haven't had any intolerances to anything.  I'm just falling behind on things and being a bad bariatric patient.  I'm working on it, I need to put more into my efforts.

boringtessa

boringtessa

 

Saving money and kind friends.

Boy, I did not realize how much money I was spending on food.  Now that I've been on liquids for almost 3 weeks, I haven't spent basically anything.   I mean, I was already stocked up on protein and vitamins before the surgery, and I will eventually need to spend money on that.... well, and I will need to start spending money on food this coming Wednesday when I move on to purees.... BUT STILL.  I used to eat out every day (and not cheap fast food, but real restaurants), and it's no wonder I was kinda living paycheck to paycheck.  But, boy, I did eat some delicious things. At any rate, that isn't the only thing I've noticed.  Sitting around at home and at work, HUNGRY, I've been constantly thinking about food.  My relationship with food, my future with food.  Pre-surgery I was telling myself and others that eventually I'll be able to eat everything I want again, just smaller portions.  Now I am realizing that that would be a complete mistake, that eating like that is why I'm so unhealthy in the first place, and I would be undoing the benefit of this "extreme measure" I took to get healthy.  I love to bake, but I'm going to need to be careful now.  I'm coming to terms with the fact that I will probably never eat sugar the same way again - I will need to be extremely careful and use low-calorie options whenever possible and avoid candy (which I used to binge-eat); I'm kinda okay with this... I've been addicted to sugar, but my true love is UMAMI (savory flavor).  So it will be harder for me to avoid fats like butter and olive oil, gravies, fancy cheese, coconut milk (in its role in Indian food).  I am a foodie, and I want big, rich, complicated flavors!  Thankfully, there are tons of calorie-free spices and low calorie condiments, but I'm not a good cook yet - something I will now work on, since I have no choice. So, I am nearly 50 lbs down from my highest weight when I started this journey in June - 14 lbs down since surgery.  The power is off in my town, so I went to the city to a spice shop and treated myself to some delicious, aromatic spices.  A fancy taco seasoning for the refried beans I'm going to eat on Wednesday (when I start purees), some Garam Masala for when I want to make something that tastes like Indian food, and a couple little tasters of spice blends to experiment with.  One of the first non-food rewards... though, maybe it kinda IS a food reward.... but anyways, it doesn't involve calories going into my mouth. Healing-wise, I'm doing very well.  So far, I haven't had anything that disagreed with me, haven't accidentally over-stuffed myself, haven't caused myself much pain.  The worst part right now is the itching and scabs at the incision sites, which I have a compulsion to pick at.  Thankfully there are still steri-strips there as a physical block to my wandering itch-seeking fingers.  I hope to start purees on Wednesday (my 2-week surgiversary), but I might try some very liquidy purees ahead of time.  I'm antsy to get started on real food, but I need to make sure I don't injure my healing stomach. Some friends of mine have been very kind to me - they are elderly people (and very very thin), and they said that they don't know what I'm going through having never struggled with weight, but they care about me and understand that it is going to be a difficult process and wanted to offer me actual money for meeting my goals!  I was floored.  I told them that that wasn't necessary, but thanks for the thought, but I think they might actually do it, saying that it'll be for my upcoming trip to Germany so I can be healthy and active and ready for anything.  What kind, kind friends.  AND My pastor and his wife, those dear people, gave me an incredible, thoughtful gift - a weighted blanket!  I've always wanted one, I find the weight so soothing and comforting both for my body and for my anxious/depressed brain. I have been shown so much kindness lately, it has brought me out of the self-pity and has reminded me to be thankful.  And I am.  I'm also thankful for quick healing and no complications.

boringtessa

boringtessa

 

Going slow, getting bored.

Being an invalid is so boring.  I want to go out and do something, but my body isn't ready at all. Thankfully, I haven't had much pain (other than the gas pains, which, thankfully, I was able to get rid of while still in hospital).  Even in the hospital, my pain was relatively minimal, so I'm doing okay without the pain killers so far.  I've been able to take my psych meds - most can be broken in half, so I only have to crush one of them.  I've started taking my chewable vitamins, and there are no issues with those so far.  All-in-all, It looks like I'm doing well! I'm a bit concerned about getting enough liquids in - I may be trying to push to hard, but every time I take a sip of something, it hurts a little and gurgles.  I've tried hot, cold, and lukewarm, salty, sweet, plain water.  I'm hoping that this will get better because I don't want to end up in the hospital with dehydration.  A bit of me kinda wishes I was still in the hospital for that reason... Not that it was particularly pleasant, but it was nice to know that I wouldn't get dehydrated because I had an IV in.  I don't know why dehydration is such a concern for me, perhaps because I've never been good about getting in my fluids. I haven't felt what I would call real hunger yet, so that is a relief, but I am craving foods that I can't have yet - specifically, refried bean puree spiced with taco seasoning!  I don't know why I'm craving that so much, but I'm just really looking forward to it.  I'm getting very very bored with clear liquids - I'm not enjoying broth like I thought I would, which is a shame. I'm feeling pretty down, probably because I'm so bored.  Watching TV in the middle of the day makes me so uncomfortable!  I'm kinda regretting the decision just a little, but when I remember what the doctor said about how big my liver was and how close I am to having cirrhosis, I know I've made the right choice.  I mean, I know I made the right choice, anyways, but thinking about food is getting me down.  It's not all about food.  I have to remember that, even though my life revolved around food before, it doesn't have to  - I can find other ways to be fulfilled. Looking forward to getting back to roller-skating and eating something with some spices in it!

boringtessa

boringtessa

 

The other side.

Well, I'm back!  The surgery was Wednesday, but they made me stay until today (Friday)... not because I wasn't doing well, but because it is a requirement of the surgeon.  I was actually impressing all the nurses with how well I was recovering.  I was up and walking within a couple hours, absolutely determined to progress.  AND the gas pains were surprising!  It's really unfortunate that there isn't really anything they can do to help with the gas pains except encourage walking, but the drugs did a great job with the incision pain. It was very boring at the hospital - I thought I had loaded my mp3 player with audiobooks, but of course that wasn't working.  There was TV, but there was nothing interesting on it.  I pretty much sat around staring at nothing for hours, ugh.  Eventually, I remembered to text my people to let them know I was alright, and I was able to get some sleeping medication to knock me out.  Everyone at the hospital was so nice and incredibly helpful, I felt like I was being taken great care of. The surgeon said that my liver was HUGE, and that, without weight loss, I'd have cirrhosis within 5 years... yikes!  It is a good thing I was able to have the surgery - just another reason that I NEEDED to do something drastic. I'm getting a little nervous about hydration - 64 oz seems like a lot of liquid now that I can only take in a tiny bit of water at a time.  So far, I haven't been able to get down much liquid at all, it feels a little uncomfortable and gets all gurgly, but I will keep trying. Well, anyways, I'm back and well!

boringtessa

boringtessa

 

Last Days and Second Thoughts.

Surgery is the day after tomorrow!     I'm starting to second-guess myself about the surgery - I know it's pre-surgery nerves, but it's still very real.  I think the thing that is bothering me the most is that I won't be able to eat like I used to.  Like, it's hard for me to imagine being able to be satisfied with just 1/2 cup of food.  I am a total foodie.  The delight of my life has been delicious, high quality food; I believe that the human sense of taste is one of God's kindest gifts, given for our pleasure.  How can I enjoy gourmet meals if I only get a tiny taste?  I know this is silly, I'm just used to bigger portions and eating fast as if I haven't eaten in days... once I am able to feel full quickly (imagine, actually being able to feel full?) and when I'm forced to really slow down and savor a meal, a small portion isn't going to be so bad.  But I am freaking out a little bit.  I just have to tell myself it will be worth it, and it won't be as bad as I think.   At this point, it's hard not to hope (and maybe even expect) that the surgery is going to show results immediately.  I'm not going to walk out of the hospital a thinner person, it's going to take maybe a year to get to goal weight, or maybe I'll never even reach my goal weight.  This has to be okay with me.   An update about the liquid diet - this is my 4th day on full liquids, and I think I'm doing okay.  I can't watch food shows/videos or anything because it's making me crazy and a little depressed, but I am not as hangry as I expected.  I am a bit grumpy, no doubt, but I've been able to stave off hunger pangs with protein drinks, soup, and V8.  The thing I haven't been able to prevent is migraines - I've got the family curse (it runs in my dad's side of the family).  One of my biggest migraine triggers is HUNGER, so I woke up this morning with a migraine; I've been expecting this, and I'm impressed that I haven't had one yet, but it was time for it to pop up.  Thankfully, my migraine medication is okay to take, which is helpful even if I can't take any effective pain killers (no blood thinners).   Alright, so, tomorrow - clear liquids and bowel prep; Wednesday, surgery!!

boringtessa

boringtessa

 

The Beginning of a New Life

So tomorrow is the first day of the rest of my life. Yes, it is Surgery Day! I am absolutely giddy today, mostly just because I am so excited, but maybe a little nervous, too. I can't even say that it seems like it's taken forever to get to this point because I only started the whole process on August 8th. But still, it seems like it's taken forever!  I have a really strong support system, especially in my Mom & Step-Dad. I will be staying with them for at least the first week when I come home, possibly even two weeks. We will see how well I am doing at that point. I know that my kitty, Portia Lin will be anxiously awaiting for my return home. I suppose that is all for now. I need to finish getting ready for my big day tomorrow! Any prayers would be greatly appreciated! Blessings to you all! ~Precious~

LovePrecious

LovePrecious

 

Food funerals and nerves.

The day is coming up!  A week from this Wednesday!  I'm getting nervous, but mostly in a good way.  I've told all my close people, and everyone is supportive so far; I've got a few people praying for me (well, mostly for the surgeon and his team), which is a comfort. I've been having "food funerals", though I'm on the fence about that concept in general... in some ways, it doesn't seem like a good idea to have "one last...." if it means binging on things.  That kinda defeats the purpose of the pre-op diet you were on to develop good habits.  But I've been doing them.  Indian food one last time.  Baking one last cake for myself.  One last ice cream.  I begin my pre-op liquid diet on this coming Friday, so I'm kinda going a little crazy with the last meals, almost on the verge of a binge - though, encouragingly, I've been able to control the urge to binge so far, avoiding situations that would cause that behavior. Speaking of the 5-day pre-op liquid diet, I think the thing I'm getting most nervous about is being HANGRY for those 5 days before the surgery, but I have to remind myself that it will be worth it, and in doing so, I hope I can keep my attitude from being totally rotten.  But BOY do I get hangry.

boringtessa

boringtessa

 

Pre-Op Appointment.

I met with my surgeon today for my pre-op appointment where he showed me what he would be doing, how long it should take, the risks involved, and the diet to follow.  He told me I had lost a total of 32 lbs so far and asked if I wanted to drop out and lose the weight on my own; when I told him I still believe I need the help, he told me he agreed with my decision, and so the countdown begins! There will be a 5-day liquid pre-op diet (no 2-week liver shrink diet like I feared, thank goodness), and then the regular diet progression of clear liquids - full liquids - purees - soft foods.  I'll be "eating" only liquids for a total of almost 3 weeks, and that is what I am looking forward to the least.  That seems like such a long time, and I know it's going to be hard.  I'm going to be drinking a lot of broth and V8 to break up the sweetness of the protein shakes. I need a water bottle to help me meet my hydration requirement, but it's hard for me to find what I want.  I want a stainless steel bottle, it would be nice to have a sippy straw or lid, but I don't want something that can get moldy, but it would be nice to have a filter bottle, otherwise I need something large because I get squeamish about drinking unfiltered water; It might also be nice to have a bottle that reminds you to drink water, but nothing too expensive.  Obviously I can't have all of these in one bottle, so I just don't know.  A silly thing to think so much about, haha, but drinking water is going to be my life for a while. Anyways, I'm getting totally pumped!  Starting to tell a few more people about the surgery, making sure I have a good support base and people praying for me.  So far, everyone has been supportive - I haven't gotten any back-talk from anyone, which is encouraging.  At the moment, I don't care if they are secretly judging me in their hearts, as long as they don't plague me with their opinions.  I know I'm doing the right thing, and I don't want to argue about it or have to justify myself to anyone.  I'm a bit of a sensitive person, so, even though I won't be changing my mind, I get extremely anxious when there's conflict, and I don't need a hit to my morale at this time.  I'm just trying to live my life. Wow, this was a long and boring entry, but writing this stuff out really does help me, I don't expect people to be as interested in it as I am.

boringtessa

boringtessa

 

Approved!

I just got the call this morning - the insurance had approved the surgery!  My surgery date is October 3, 2018, which is a little sooner than I was expecting. I've been losing weight lately - so far I've lost about 30 lbs since when I started the journey.  This brings with it some doubts and waverings... sometimes I think, "Do I really need the surgery?", and for a while I think I'll cancel - I mean, I've been losing weight without it, maybe I can do it myself?  But I know that I need the help, I've tried losing weight many times before without being able to sustain the change.  I need help, and I think that if this chance is presented to me, I should take it.  I know that relying too much on the sleeve to cure my bad habits is not wise or correct, but from what I know about myself, I will be more likely to continue knowing that I have a "help-mate", an actual physical reason to help inspire me.  Losing a bunch of weight very fast will help me realize that it is possible and that it is REAL.  One of my biggest failings is that I will give up or not even try if I can't "visualize" what the end result would be - this has affected my previous weight loss attempts along with many other aspects of my life.  Losing a bunch of weight in a short amount of time will help me get past my hesitations and help me "visualize" success.  And I need to succeed, my health and well-being depend on it. Anyways, I'm very excited!  I am going to seize this opportunity!  I can't wait to make a fresh start!

boringtessa

boringtessa

 

A Little History

I'm a 46 year-old mother/wife with four children. The youngest turning 7 this year. I suffered from gestational diabetes during that pregnancy, but none of the others. Maybe being 39 at the time had something to do with it.  I've been struggling with weight gain since 2011. Although, I haven't really done anything about it. Mostly complain and avoid my reflection. Over time with everyday stresses from work and home, I have been taking Zoloft. I had been considered pre-diabetic for several years, but about a year ago was finally put on diabetic medication: Metformin. Only taking one per day.   Taking it didn't make me feel any different and being in denial, I guess, I felt like I didn't need it. Along with the weight gain, diabetes diagnosis, I've also been dealing with pre-menopausal stuff (maybe?) and my vision seems to be deteriorating. I've gone from occasionally using reading glasses to actually needing them to read more and more. I was also recently diagnosed with IBS, which has become more of a consistent issue that I have to deal with on an almost daily basis. With the increased stress of declining health, Wellbutrin is now part of my medicinal arsenal. I started looking into and considering bariatric surgery in October 2017 and have finally decided the surgery is needed as part of my determination to get healthy again.  

QponL8y

QponL8y

 

Three takeaways coming from beating CIGNA and winning another bariatric surgery appeal

Whether you’re reading this as the patient who needs bariatric surgery, someone who loves that patient, or the provider committed to caring for the patient, there are at least three important lessons coming out of this experience that should be taken away for future benefit. Three takeaways coming from beating CIGNA and winning another bariatric surgery appeal
 

Requirements cleared.

Well, it looks like I've met all my requirements!  Woooo!  I see the surgeon next Thursday, and I'll be ready for him to send all the info off for insurance approval.  This is very exciting!  I hope that he'll set a date for my surgery at that point... I'm going to start slowly buying things I know I'm going to need after my surgery; today I ordered a "fancy" scale (which was an affordable off-brand, but which I have read is accurate) and some leggings (since my pants are already falling off me).  My biggest problem is that I'll really get into something then GO ALL OUT and buy everything I need for it in one go... and then I'm broke for weeks until I build my finances back up.  So I'm working on doing it slowly, just getting one or two things that I can afford within my budget for the week.  I am pretty excited about this - it seems like this surgery is not only going to improve my weight, it may also force me into healthy habits that I wasn't expecting, like practicing self-control and discipline.  I already feel the improvements, I'm making positive changes in my behavior. My mother is also obese and would like to have the surgery, but she is now 66 (in a youthful way, though), and I hear that some doctors won't operate on older folks.  My surgeon does sometimes take older patients, depending on the patient.  I hope my mom gets the help she needs, it would be good for her, a diabetic, to make such a change - I want her to be around a lot longer.

boringtessa

boringtessa

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    • I'm kind of surprised that only about 30% are diagnosed(?) with an ED. I personally think everyone who needs WLS has severe problems with eating/food - if one wants to call that an eating disorder or not doesn't matter in the end.
    • My team is so weird. Full liquids are their own thing, and then purees and soft foods are thrown in together. I'm on that stage, which starts with cottage cheese and yogurt and ends with ground meat and soup/chili. The most "advanced" thing I've eaten was a couple (1 and 3/4 :)) of Ikea meatballs, which sat really heavy, but besides those, I'd say I'm around the middle of the list. Very moist tuna salad is fine, as are scrambled eggs (I mean, those settled weird, but I digested them, so I guess they're OK). I'm thinking of trying thin-cut lunch meat next; that sounds really good to me. All I want in this world is the middle of a cheeseburger--I could let the bread and veggies go; I just want some ground beef, and cheese on it would be excellent--but I know not to push things that far, yet. The reward for going slowly is not getting sick, and that is a very compelling reward. :)
    • Thank you for sharing your experience! I haven't even thought of trying to get my fluids in any form other than plain water or at a temperature other than room temp, but I may have more success there, as you have. I'll give tea a try - thankfully I enjoy my tea unsweetened! You're probably right about the rollerskating - I don't normally fall, but it could definitely happen, especially since I haven't skated for a month. I just love it so much, I'm eager to get going, but it's more important to let my body heal. I could make a point of taking a short walk during my breaks at work. Have you started soft foods yet, or are you still doing full liquids/purees?
    • Just comparing notes, in case it helps... I still can't drink plain water. I'm getting 90% of my hydration with hot tea (mostly decaf--I don't count the caffeinated tea toward my total) and protein shakes. And it is close to 64 ounces per day, but it's not ever very much more than that. Besides hot tea, I can stand to drink protein shakes cold or at room temp. Room temp Powerade Zero is only a little bit harder than a protein shake, but room temp water hurts. Cold beverages also do OK, mostly--it's chilly enough out, now, that I just find myself gravitating toward the hot--and I definitely eat more sugar free popsicles than anyone should (even though it's cold, yes ... they seem to help when I start to feel nauseated from dehydration, though, and also they taste good 😁). I think not going rollerskating (or ice skating?), this soon, might be better than going, unless you're a lot less likely to fall than I am. (Who isn't, though? 😁) We're still pretty early on in the healing process. I do little walks most days, and since I'm still on blood thinners, I figure I also still need to be up and moving a little bit every hour I'm awake. But none of it is especially epic exercise, and I'm not going to beat myself up about that until after I've been cleared to go in the pool and lift weights and get out of breath. (Those first two happen at the 1 month post-op appointment, and the latter, I don't know? I have in my notes, from somewhere, that we're supposed to exercise only at a "moderate" pace until sometime after the 6 week mark, but that's not from my surgeon.) I don't know what to say about the food. I feel so bad if I eat too quickly that it's a pretty good policing mechanism. Like you, though, I wish I'd practiced more. The constant gurgling has gone away, and now I feel hungry 3-4 times per day, like you'd expect. It probably helps that very little of what I'm eating now is so appetizing that I feel rushed to eat it, lol. I think this will all get better with time. I hope you find a way to get your liquids in soon, though! ❤️
    • I'm not going to make it to 64 ounces today. (They sent me home yesterday.) If I really push, I can make it past half way there before bedtime. I never believed people who were like "plain water hurts, but I can do [some more interesting thing]," so karma showed up to put me in my place. I do OK with jello! Hot (really, warm) tea seems to do OK, too. Protein water I can do, but I have to go slowly. Plain water HURTS. I think I'll try my first protein shake (not just protein water) tomorrow. Anyway, I'm glad we're both back out in the non-hospital world and moving forward! ❤️
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