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Baba Wawa

Pre Op
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Blog Entries posted by Baba Wawa

  1. Baba Wawa
    Had my follow up with gastroenterologist yesterday. He's done all he can, medically. I'm seeing a top doctor in this type of problem at a local university hospital. There are only a few options available, even surgically:
    1. Remove band, evaluate gastro-esophageal junction, hiatal hernia repair, vagus nerve damage/injury.
    2. Remove band, take down HH repair and redo it along with Heller Myotomy.
    3. Remove band, implant feeding tube for 3-6 months to rest the esophagus.
    4. Remove band, remove esophagus with reconstructive surgery (horrible option)
     
    The achalasia is "end stage" based on the manometry, but since pseudo achalasia is gaining prevalence in the banded population, I might get lucky and just end up with #1. Fingers crossed.
     
    My motility was 0%
     
    My appointments at the university start on May 17.
     
    Wish me luck
     
  2. Baba Wawa

    Fear

    By Baba Wawa,

    Procrastination is the fear of success. People procrastinate because they are afraid of the success that they know will result if they move ahead now. Because success is heavy, carries a responsibility with it, it is much easier to procrastinate and live on the 'someday I'll' philosophy.” Denis Waitley
     
     
     
    I've often asked myself "What is it you're afraid of?" This is a scary question, because once asked, there is an implied responsibility to change something in our lives. Identifying what scares us can be difficult. One tool my counselor gave me was that after every response, I was to ask myself "Why" until I got to the point I had identified the root cause. In business we called this "drilling down" and it can truly be gut wrenching and painful.
     
    An example of a root cause analysis might go like this:
    *Why can't I lose weight? I eat more calories than I expend. Why? I'm always hungry. Why? I don't even think about how I feel. Why? I feel uncomfortable and want to eat when I think about how I feel. Why? I don't know how to change. Why? I haven't learned how to change the way I eat. Why? I'm afraid I will fail.
     
    Root cause: fear of learning how to eat properly and take personal responsibility for success or failure.
     
    This "personal responsibilty" issue is a big one. Many of us have been victims of abuse, neglect, crimes, etc. When we continue to live in the "victim suit", we give our abuser our power. We do this because we haven't faced the reality that someone we trusted and loved hurt us. Facing that reality can be more painful than living as a victim, or so we think. When we face the facts and hold our abuser responsible, there is a big shift in power and responsibility. We take ownership of our actions, feelings and well being and we give the guilt and responsibility for the abuse back where it belongs, with the person who hurt us. Sitting in a chair and telling a therapist that your mother didn't protect you from a predatory male in your family can be one of the most painful truths to acknowledge. The person who was responsible for nurturing, protecting, putting you ahead of herself, did not. I know, I've done it, it hurt like hell.
     
    Once we acknowledge our truth, whatever it is, we take back the power to change our lives. We first work on the thoughts, the negative self-talk. Practice telling yourself that you are worth it, you are powerful, you will change one thing at a time. Maybe, this week, you give up one carb loaded treat you think you enjoy (I say think, because often we don't really enjoy them...it's a habit, not a pleasure). Next is the action step: Just do it! Throw it away if you have it in the house, then buy something healthy to eat as a substitute. Maybe you're the type of person who does it cold turkey...rid the house of ALL processed foods and beverages. Think of the power you take in doing this! Imagine yourself eating healthy nutritious foods and taking control of your own life. Action steps are the key in this process. WE CANNOT CHANGE ANYTHING WITHOUT A VERB. I think I can turns into I will when we add the action step.
     
    My band journey, though not as long-lived as I would have liked, has been this type of process. I WANTED to lose weight, but I took no ACTION that would result in me losing weight. When I went on Medicare Disability, the opportunity to make this change became available and I jumped on it. I started calling different hospitals and WLS clinics to see if they accepted Medicare...that was a tough one. Finally, a really kind person at the University Hospital directed me to another local hospital who she knew took medicare for lapband or RNY. When I called to make an appointment, they got me in within a week. I took action. I took the power. I took personal responsibilty for my success.
     
    I wouldn't say my weight loss journey was easy...it's had it challenges. My band was the perfect tool for me, keeping me free of hunger for 4-6 hours after a very small meal. Even empty, I'm rarely hungry. Losing my band and not being able to revise is extremely scary...I need to ask myself WHY.
     
    Here we go again....
  3. Baba Wawa
    I was doing better...medication for IBSc is working, I was able to eat without issue and Friday night without warning I found myself having a hard time. My daughter made lasagna, I took a small piece, didn't eat the noodles, so probably had a half cup of sauce, cheese and lean chicken Italian sausage. I stopped eating because I realized I was uncomfortable. Not full, not stuck, just slightly uncomfortable and a bit nauseous. After about a half hour, up it all came. By then I was in real pain...a burning feeling and I started having pain at my port area. Since then, I've had continuous discomfort and I'm on a soft/liquid diet.
    I emailed my band doctor and requested an appointment to discuss my options for removal/revision. I feel defeated...I really thought I was going to get to keep my band.
  4. Baba Wawa
    I really appreciate all my band has done for me. Not that it's been easy, I did the work, stayed focused and exercised discipline. Unfortunately, my heart (and GI tract) are telling me its time to quit fighting and wave the white flag. Time to see my band surgeon and seriously discuss my options for removal/revision.
    I've lost 90 lb, but my digestive system just isn't working correctly, 9 months after having all fill removed. Time to make the call and determine the next step.
  5. Baba Wawa
    So, you're going to have weight loss surgery. If you've never had surgery, the experience might be a bit more traumatic than it was for those of us who've had multiple surgeries of varying types.
     
    Here's what to expect:Usually, the first thing is the IV. The IV tech will start a line with saline, to insure you're hydrated and there's a vehicle, so to speak to carry the drugs you'll be given before, during and after your surgery. It doesn't really hurt...I've had them in the back of the hand and inside the elbow. Each bag of saline is about a liter (over two pounds) and this weight will show on your scale for some time. Don't freak out about this...
     
    Usually the anesthesiologist will come in and introduce themselves, ask some questions and tell you what they're going to do in the OR. This person is fully responsible for keeping you alive during surgery. They ventilate you, regulate your BP; this is the most important person to you in the OR.The surgeon usually comes by too, to reassure you, ask a few questions, before going into the OR.
     
    Once you go to OR, they'll usually have you scoot onto the table off the gurney, make sure your comfortable and then proceed with anesthesia. First, you'll be given 100% oxygen and told to take some deep breaths. Take as deep of breaths as you can, since this O2 is what sustains you while being intubated. Once you've taken the breaths, you get another drug to make you "sleep" followed by a drug that basically paralyzes your abdominal and breathing muscles (pretty much all muscles, but the heart). You'll quickly be intubated and put on a ventilator for life support. The entire process is completed in less than a minute.
     
    When you wake up, you'll be very groggy, want to go back to sleep and you may be uncomfortable. Tell the recovery nurse if you're hurting. You might be nauseous from anesthesia. Tell the nurse. Anti nausea drugs can be given thru the IV. After your vitals are stable and you're alert, you'll go to another room to recover. Sometimes, if you're doing great or if your hospital has this protocol, you'll be discharged straight from the day surgery recovery without being moved to a room.
     
    For the trip home, you should have loose fitting pajama bottoms, a warm top, robe or sweatshirt, socks and slippers. You'll also want a pillow to put under the seatbelt in the car. You'll want a barf bag too, just in case for a day or two.
     
    Once home, you'll be most comfortable in a recliner, though I slept in my bed the first night, on my side facing the edge of the bed. Practice getting in and out of bed without using your abs before surgery. It will hurt, it won't kill you. I've had open abdominal surgery and lap surgery, while still painful, cannot hold a candle to open abdominal surgery. You will live.
     
    To get up do the following:
    Roll onto your side
    Use your elbow to push upHave someone rotate your legs and feet to floor
    Push off with your hand to get fully upright...wait a minute to make sure you're not dizzy
    Stand with assistance. Wait a minute to ensure you're not going to faint.
    Reverse to get into bed.
    Always, for the first couple of days, have someone with you whenever you get up or down and while walking.
     
    I cannot emphasize enough that your discharge orders and doctor's diet, hydration and exercise orders should be followed EXACTLY. If you have a question, call your doctor. Don't post here. If you get a fever or can't drink water at all, call your doctor immediately. Nausea should subside within 8-24 hours. If it doesn't and you need a medication for it, call your doctor. Do not post here until after you've called the doctor and please state that you have called so we don't all tell you to call your doctor.
     
    Another thing...definitions:
    Clear liquid means you can see through it
    Full liquid is things like runny cream of wheat, puréed cream soups, protein shakes. NO LUMPS.
    Mushies or Purees is the consistency of baby food. No chunks., no lumps. Smooth is your friend.
    As you progress to solids, remember that babies don't go from puréed baby food to a NY steak in one day. Hopefully you practiced your new eating habits for a couple of months pre op to establish them as your new lifestyle. Transitioning from purees to solids is a gradual thing. Add a little finely ground turkey to a puréed food at first. Add ONE new food per day. After you tolerate ground meat, poached eggs, tuna salad, egg salad, etc, you can try cutting your food into 1/4" pieces and chewing 15-25 times per bite.
     
    Initially you won't get many calories in...500-700 calories, focusing on protein. You'll gradually get up to 900-1000 or more depending on your needs, per your nutritionist or doctor. Drink your water as directed too.The first weeks post op aren't for losing weight. You might not lose anything, but most people will lose the IV weight and a pound or two a week. Once you're on solids, your weight will go up a pound or two...filling the intestinal pipeline . This is normal.
     
    Fills are not the goal with the band...they are another tool to use when your weight loss levels out and/or you're hungry less than 4 hours after eating a meal of 1/2 cup to 1 cup of dense protein and low glycemic veggies/fruits. Go easy on the fills. Being over tight is the #1 identifiable cause of band erosion and slips.Many with the band are so focused on getting fills, they don't realize until they have a little unfill, that their band can work better with less fill.
     
    You can go out to eat with your band. Sharing works great. I ask for a small plate and put my food onto it immediately. I cut up everything before taking a bite. I eat very slowly and if my companion is having a glass of wine, I'll have one too, to sip as I eat. I don't do this at home, most of the time. Alcohol was not permitted for 3 months post op by my doctor. You'll get a little more tipsy on less due to abstaining for months. Your band has no affect on alcohol absorption. You probably shouldn't drink on an empty stomach, ever, band or not.
     
    I hope this is informative and helpful!
  6. Baba Wawa

    Who Am I?

    By Baba Wawa,

    Who I am now isn't so important as how I came to be this person, wife, mother, grandmother, sister. The history is what formed me, challenged me to overcome, compelled me to do better than those who came before me.
     
    I was born near the mid-point of the last century, in a large western US city. My parents married because they had conceived me when my mom was 16. My birth father was 19. As it turned out, he was a violent paranoid schizophrenic and a pedophile. My mom was later Dx with Borderline Personality disorder. I won't go into detail, suffice it to say that my earliest memories are horrific. My two younger brothers and I suffered the abuse and neglect until I was 9 1/2 years old, when a neighbor girl was assaulted by my birth father, he was arrested and sent to a state psychiatric hospital for treatment. I was taken in to protective custody for four days, while my mother was investigated and cleared of complicity in my abuse. He was not allowed within 300 miles of me, upon his release, 4 years later. When I was 14, he committed suicide.
     
    My mom had remarried in 1960 to a wonderful man I refer to as Dad. He earned my trust, respect and love. They had two more little boys in the two years following their marriage. My Dad died of sleep apnea in 1978, we were all devastated and heartbroken...it was the undoing of my mom and my dearest brother. My mom turned to scotch for comfort, inviting my 17 year old brother to be her drinking partner. My mom died 8 miserable years later of pancreatic cancer. Those 8 years were awful, watching my mom decline, my brothers suffer. She raged constantly, told me often that I had no idea of her pain, her suffering. She made life a living hell for her family and circle of friends. She was diagnosed and died in 12 short weeks later.
    My brother died 14 years later, the victim of a predatory female who took advantage of his alcoholism, a recent injury, subbed his Rx pain Meds with extra strength Tylenol. Took him 3 weeks to die of liver failure, on our dad's birthday. My heart was broken. This brother was the first male I had in my life who loved me unconditionally. He was born when I was 11 and he was like a son to me. He was my husband's best buddy, my kids favorite uncle, everybody loved him. Yes, he was an alcoholic, very high functioning, but losing him was the saddest event of my life to date.
     
    My brother has been gone for 12 years...I think of him every day. I remember my little grandkids running up to the car when I'd arrive at their house, all four of them would climb in the car hugging me, asking me "...is you sad? Did your Brubbie die? Sorry *****, usses loves you! ". They did this for months, until I finally told them I felt better because they healed my broken heart. I have 8 grandkids 6 teens, 2 in their twenties. The youngest 4 are all the same age, 3 identical girls and a boy. I am blessed.
     
    Of my four siblings, two have passed. The oldest, died at age 51 as a transient. He inherited the mental illness genes and I never saw him after my mother's death. The next oldest lives in NM, his mind ravaged by years of alcohol and drug abuse. We have minimal contact thru FB. The youngest has never been able to form healthy relationships with anyone...I see him once per year when he comes to visit. He misses his big brother too. He tells me that his true home is wherever I am. I wish my mom had let me take him when he was 15 and she went on her 8 year binge.
     
    So...this is my emotional history, in a nutshell. The other stuff doesn't matter, except to say that my family is healthy, successful and happy. We celebrate often, mourn together when the time comes and love and support each other faithfully. My kids have all been married to their HS sweethearts for over 20 years each. We have done better than the generation before us...the bar was low on my side, but my husband and his family were great role models. I'm thankful every day for their love, support and example. I miss them painfully.
  7. Baba Wawa

    History

    By Baba Wawa,

    May 2010 Realize Band implanted, hiatal hernia repair, uneventful recovery
    Aug 2010 fill 3 cc
    March 2011 fill .5 cc
    Summer 2011 began to have epigastric pain at night.
    Sept 2011 stomach virus
    Sept 2011 pain upper right quadrant, duration 2-5 hours increasing, then subside quickly
    Oct 2011 barium swallow, band fine, slow esophageal emptying
    Oct 2011 upper abdominal ultrasound positive for gallstones
    Oct 2011 gallbladder removal
    Feb-May 2012 increasing GERD symptoms, nighttime epigastric pain radiating to shoulder, neck, jaw, back. Palpitations gradually increasing in frequency
    May 2012 had cardiac work up, stress test, echocardiogram, negative for heart disease. BP was elevated, so new drug Rx, resolved palpitations/hypertension. Epigastric pain persisted.
    June 2012 upper GI with barium shows stoma at band is nearly closed. Barium drips through, but no stream. Barium is backed up into esophagus. PA removes all saline (3.5 cc confirmed, clear, no sign of infection). Under flouro, barium is still in esophagus, emptying slowly. PA and Radiologist are concerned, but decide after I drink 8 oz water to schedule me for follow up 5 @ weeks.
    July 2012 follow up, lost 4 lb. still having problems eating anything fibrous, but able to eat, at least. Barium swallow shows smaller than expected stream thru band, but also shows slow esophogeal motility, but not so slow as to require follow up. PA states that since I'm tolerating food, losing and have a bit of a motility issue, she won't fill me, but cautions me to stay on the band diet and if I'm able to eat everything and quantity increases over 1 cup, to come in for another evaluation.
    Oct-Dec 2012 In early October, became very intolerant to most foods and started having nighttime pain again, GERD symptoms. Symptoms subsided for two weeks, then returned. Taking PPIs for GERD, probiotics and experiencing extreme constipation. BMs only every 8-10 days. Bloated miserable, having pain, feeling like food is stuck. November, saw GI doctor and he ordered EGD, soft low fiber diet. December EGD negative for Hpylori, celiac, erosion, Barrett's. Prescribed Amitiza for constipation. Antispasmodic for GI spasms.
    Symptoms improved.
    Feb symptoms (intolerance of meals, feeling stuck, etc) returned. Consult with GI doc, schedules GES. Results normal gastric emptying times, but abnormal esophageal retention. GI doctor follow up in 2 weeks.
    March 2013: barium swallow:Dx achalasia, severe esophageal dilation due to LES failure to open in response to swallowing. Discussed options for removal/revision and further testing.
    April 2013: esophageal manometry test to determine if achalasia is primary or secondary. If secondary, band IS the problem and it will have to come out. If primary, surgery may exacerbate the condition.
    Update: GI doctor has done all he can for me. I'm scheduled in late May for evaluation with one of the top esophageal surgeons in the nation to discuss band removal, redoing my HH repair and looking to see if my vagus nerve has been damaged.
     
    High weight 290 lb
    Surgery weight 281.5
    Band emptying weight 225
    Current weight 202
    Goal weight 170
     
    At all times my PCP, Gastroenterologist, Cardiologist and Bariatric Surgeon were in communication. Procedures, records and test findings were shared.
     
    Preexisting IBSd. Hypertension, hyperlipidemia, sleep apnea, GERD.
    Sacroiliac Joint Dysfunction/Spinal Stenosis
    Left knee osteoarthritis-replacement recommended
     
    Still taking all medications I was taking pre-band + amitiza, antispasmodic and additional hypertensive drug
  8. Baba Wawa
    This describes a high pressure system with banding. It's not good for our esophagus. It was published on a competing website, so left off that portion of the link. I also posted a link to his blog, which this is a part.
     
    articles/choice-of-bariatric-procedure-a-philosophy-obtained-in-20-years-of-bariatric-practice-2/ Dr Michael Roslin
     
    http://nwhsurgicalweightloss.org/blog/choice-of-bariatric-procedure-part-1-a-philosophy-obtained-in-20-years-of-bariatric-practice/
     
    Excerpt:
    Most importantly, the band does not impact any of the hunger signals that we have been able to study. I also question its mechanism of action. The band functions to create a high pressure zone just past the esophagus, the tube that transports food from the mouth to stomach. As the pressure is raised, the esophagus has to work harder. Until the pressure reaches a certain point, the patient feels little restriction. Once too high, the pressure has an adverse impact on the muscular esophagus. This results in patients having heartburn or dysphagia when the band is too tight, and then feeling no restriction when loosened. Proponents of banding believe that there is an ideal point, or green zone. My experience has shown that this exists for some people. For others, the band can be frustrating to both patient and provider.
  9. Baba Wawa
    I copied and pasted, below, some of my early posts from the first few months after band surgery. I was so enthusiastic and on board with my new lifestyle. I was fully committed to learning everything I needed to know in order to succeed. I did not want to hear anything from anyone who was saying their band didn't work out. There were people who posted that they followed band rules and lost their band due to slips, erosion or esophageal dilation. I countered that very few complications are band caused. I suggested that perhaps they over ate, ate too fast...you get the picture. I was wrong to do that.
     
    It's true that early in our band journey we NEED to hear positive reinforcement that we made the "right" decision. That's why you won't see me post negative information on a post from someone who is doing well, newly banded or had decided to band and isn't asking for help deciding.
     
    If I posted in a way that seemed insensitive or overtly negative anywhere but on the complications forum, I apologize. I try to avoid that, but I'm human. I believed, as many of you do, that if I did all the right things, I'd keep my band for the rest of my life. I cannot convey the disappointment and even grief I'm feeling over the impending loss of my band. I'm also feeling a lot of anxiety about post removal. That might be bleeding thru in my posts. I'm in constant discomfort, unable to eat much of anything and generally not feeling very well at the moment.
     
    My point in this post is to encourage everyone who has WLS to listen, sympathize and file away posts about band complications. As I've stated in more than one post, the information might help you save your band one day. I don't want to scare anyone. I just want to share my experience within a community that might benefit from it one day.
     
    Don't be afraid to read my message. It can't hurt you.
     
    This was 2 months post op:
    Tonight I am going to a play with friends...I subscribe and we go out about every two months Nov-July. Yesterday I figured I should try on some of my smaller (size 24) clothes to see what I should wear. NONE OF THEM FIT! THEY ARE ALL TOO BIG! I am between a 20-22 so all the 24-26 and 3x are going to the donation pile or to my ebay collection. I went to the Talbot's outlet and bought two pairs of 22 WP shorts, very nice for $27 including tax. I now have one pair of jeans, a pair of capris and two shorts that I can wear.
    We always go to Maui in October and was trying on my dresses that I take with me and got into some of my Blue Ginger dresses I haven't been able to wear for a long time...some of the others are way too big....
    Any way enough rambling on! Happy day for me!
     
    My first fill:
    I got my first fill today and it went very well...no pain and so far so good with water. I lost 5 lb in almost 5 weeks and due to travel plans in September and October opted to go ahead and get it now.
    My surgeon's office does them under flouro and it took about 10 min to do...port was flat on the abdominal wall and very easy to access. It did feel weird as she was numbing me up, but other than that couldn't feel it. I am hoping to up my loss to about 1.75 lb per week or 7-8 lbs per month with this fill...
    whew...glad to have that under my belt!
     
    A post on accountability:
    This morning it occurred to me that I have not lost any weight since the 30th of August. My first impulse was to post something on the forum regarding a stall, frustrated, etc, but then I got to thinking about it HONESTLY. I have not logged my food since the middle of July! I looked back and I remember thinking that this is so easy, I don't have to log every bite! WRONG! I lost consistently (even without a fill) 1-1.5 lbs per week while logging. Since I stopped logging I have lost a total of 6 lbs in 6 weeks, but nothing for the last two weeks. I don't think I am eating as much as I am burning, but how do I know??? This could be the 20% stall, but without documentation of my intake, I cannot really tell. My highest weight was 290 about 2 years ago. 20% of 290 is 58 and I am down 51 lbs from that weight so it is close enough to be called that, but most likely it is what I am eating, rather than how much.
    I have been eating more carbs...
    There have been numerous social events, so I have been drinking a bit of wine...
    And I have had some dessert...
    here and there...
    So now I recommit to journalling my food intake so I can assess why I am stalled and what to do to change it WITH SOME CERTAINTY....
    I have lost an inch or so since the stall started, so it isn't really a stall, but a great opportunity to refocus my efforts towards meeting my goal of 1.5 lbs per week on average.
    I do have restriction and I need to do a better job of utilizing it to my advantage.
     
    Me, defending the band:
    Many folks who are anti-band will use a study that was published in 2003 and followed lap-band patients from 1997-2002...that would be like car and driver only reviewing cars made from 1920-1970 and holding them to today's standards of road-worthiness...
    The bands in use today are much more "user-friendly" and the surgeons who "install" them know a lot more about the causes of complications like those cited in the early study and MOST complications are caused by overstuffing the pouch and eating around the band (grazing, sliders etc) as well as over zealous docs who overfill bands.
    Go to the WLS failure forum, complications forum or regrets forum and read about the issues the people who have chosen many different surgeries experience, then you can be satisfied with your decision, whatever it may be.
    I also question why certain individuals feel the need to hang out here and tout their surgery. If they were as knowledgeable as they claim, they would be publishing a book on their surgery, pointing out the benefits vs the risks, and it would speak for itself.
    Here is an example of a study on VSG and it's failure rate...I found this doing a quick search and now it is out there and will be quoted by the VSG haters to support their position....
    The exact failure rate of sleeve gastrectomy is unknown. Using the Spanish National Registry for bariatric surgery, Sanchez-Santos et al[7] reviewed 540 patients who had undergone SG either as a primary or staged procedure over a six-year period. The authors reported excellent overall outcomes; however, 15 percent of the subjects were considered failures based on weight recidivism in the first three years, with 3.3 percent of patients submitting to a second bariatric procedure. Younger age, lower body mass index (BMI), and thinner bougie size were attributed to improved sustainable outcomes. Similarly, Himpens, in an article by Deitel et al,[8] presented his early five-year results after sleeve gastrectomy at the First International Consensus Summit for Sleeve Gastrectomy in 2007. In 46 such patients, he reported a disappointing 37 and 23 percent inadequate weight loss and second procedure rates, respectively.
     
    More recent unpublished presentations by Himpens indicate failure rates as high as 30 percent in five years.[9] Studying the Austrian experience with SG as a stand-alone operation, Felberbauer et al[10] reported a seven-percent failure rate at three years based on a cutoff of 25 percent excess weight loss (EWL). Applying the traditional 50-percent EWL criteria, the failure rate increased to 25 percent.[10]
     
    Me supporting a struggling poster:
    Good for you Tanya....that is why the forums are here, to share and hopefully keep us from getting too complacent and not utilizing our chosen tool. The side note that I have been meaning to post since the day after I wrote this is that though I haven't lost pounds, I have lost a full size, so it isn't about just the weight.
    Perhaps it is time for a fill or a talk with your nutritionist to help you to get back on track...
    Congratulations on your recommittal and I will look for you to post your success!!
     
     
     

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