Thursday, November 21, 2013

My head is spinning

I had my orientation today to begin the weight loss surgery process.  When I got to the location of the class, I wondered if I would run into my old counselor from the Optifast program or if people at the front desk would judge me for having gained weight back.  I was actually feeling the nervous nellies when I walked in because of that.  I know it's all about me, not about them.  Of course everything was fine, as I'm sure it was going to be all along.  I got weighed in and my height was measured.  My weight today was 368.  Depressing.  Of course, I had just eaten and had been drinking water all day long so I'm sure that influenced the weight.  I haven't weighed myself in a bit.  I know that I reported my weight the other day, but that was from the last time I weighed.  However, I am here to be honest with myself so, o-freakin-kay, 368 it is.  Gulp.

The session had about 30 people in attendance.  I looked around at the other people, comparing my body to theirs and vice versa. Why?  I don't have a clue.  Maybe it was to convince myself that I was actually there.  Maybe it was to see if I was the worst one in the room.  The more I think about it, it was probably the latter.  In my mind, I convince myself often that there is no one worse than me.  I can say for sure that wasn't the case when I was in that room today.  There were several people, including women, who were larger.  There were a mix of people who were anxious to be there, to get started in this process, and others that I could tell were not very happy.  I get it, though.

I took copious notes, like the lifelong learner that I am, and wanted to document everything here.  It might be useful to others considering the surgery, but it's mostly for me to remember everything I'm going through and to explain the process to my friends (including all of you!) who read this blog.  Here are my steps, at least how I understand them to be today.

  1. Attend the orientation. 
  2. Complete a program questionnaire and return it to the director.
  3. Within a two-week time period, I will be approved to move forward with the surgery.  This does not mean I have final approval, but it means I can move forward with the process.  If, along the way, there become reasons why they deem I should not be approved, they will let me know.  However, they did say it is pretty rare for someone to be turned away after they are initially approved for reasons other than medical.
  4. Attend a Lifestyle & Weight Management class.
  5. Meet with the doctor overseeing the program to discuss my history, surgical options and have questions answered.  My weight at the meeting with the doctor will be my starting weight.  They want all patients to shoot for a pre-surgery weight loss of about 10% from this date.  Even patients who do not meet the 10% goal are not turned away, although they will have to meet with the doctor again.
  6. Fitness walk to determine whether or not I am ambulatory.  The walk is five laps around the parking lot of Kaiser's Positive Choice center.
  7. Begin the 6-month group educational classes.  The classes usually start about six weeks after attending the orientation (step 1).
  8. After finishing the classes, I then attend an orientation about six weeks later through Scripps Pacific Bariatric.  The surgery is not done through Kaiser itself.  They outsource to Scripps Mercy Hospital's Pacific Bariatric Center.  They are supposed to be excellent at the work they do and focus solely on weight loss surgeries.  This orientation is also an opportunity for family/friends to attend with me to learn more about the process.
  9. Meet with the bariatric surgeon, internist and one other doctor (can't remember the specialty at the moment and, of course, I didn't write that one down!).
  10. Go through a series of tests.  Actually, I will have lab work done throughout the process, I believe on a monthly basis.  
  11. Have the surgery.  The entire process, from the time I attend the orientation until I have the surgery is about nine months, although I can have the surgery up to a year after I complete the 6-month classes.
Some of the interesting facts that I learned today were the difference between the three surgeries.  The gastric bypass is considered the gold standard of weight loss surgeries, the creme de la creme, the mother load.  People who are diabetic and have the bypass most of the time go into remission.  The gastric sleeve used to be an interim procedure, something that was temporary for patients before moving on to the bypass.  In terms of the lapband, there have been real problems.  The program director was sharing with us that, of the last 34 lapband-related procedures Pacific Bariatric has performed, 33 were to remove the lapband because of problems patients were having before performing either the bypass or sleeve.  That's pretty significant.

In terms of the surgery itself, 95% of the patients are able to have laproscopic procedures.  This means that, instead of having a surgery where the chest is opened from the breastplate down to almost the waist, five small incisions are done.  This increases healing time and leads to less complications.  The director shared that most patients are not in pain from the surgery; they just feel uncomfortable.  For those that work in an office and don't have highly physical jobs, some can return to work in 1-2 weeks.  It just depends on each person and how well they do at preparing before the surgery and following the "rules" after the surgery.

In terms of the cost, this surgery is $50,000.  Whoa.  However, if you go through all the steps and have Kaiser insurance, you are only responsible for your co-pay.  For me, that is $5 for medications and $10 for all visits or hospital stays.  Here are all the things that have to be paid for:
  • Lab work to enter the Options program
  • Medical appointment to enter the Options program
  • Lab work prior to bariatric surgery referral
  • Medical appointment prior to bariatric surgery referral (only needed if 10% goal weight not met)
  • Psychological assessment at Pacific Bariatric Surgical Medical Group
  • Internal medicine assessment at PBSMG
  • Bariatric surgical consult at PBSMG
  • Hospital and surgical costs
  • Post-surgical consult(s) with bariatric surgeon at PBSMG
  • Medications prescribed by my bariatric surgeon
This is a LOT to process, isn't it?  Imagine what I was feeling!  Thankfully, after this appointment, I met with my therapist and talked about the entire process with her.  She told me that she could tell how confident and sure I am about this and I've clearly made a decision to move forward.  As we talked about everything, we discussed my next couple of appointments with her.  Here was part of our conversation:

"Kathy, we need to talk about how often you want to keep seeing me and what you will do when I'm gone." 

"Oh, are you going on vacation?"

"When I reti ... Wait a minute, you didn't know I'm retiring at the end of January?  I didn't tell you?"

"No, you didn't."

Dang it.  Just when I got into a groove with her, she's leaving!  I get the feeling she's going to talk to me
about phasing out of therapy and perhaps using it as needed.  I don't know that for sure, but that's the way the conversation went.  My feeling is that I am doing so much better than when I first started seeing her.  Yet, I am going to be going through major, life-altering surgery and there are bound to be emotions that come up not only going into the surgery but dealing with things after the surgery is over.  However, I decided that, instead of getting myself all worked up and worried about what will be coming up, I can just take it one step at a time.  I can breathe, in and out, and just put one foot in front of the other, handling the next indicated thing and nothing more past that.  Otherwise, I could get myself worried and projecting too much.  I don't need to put any added stress onto my shoulders, that's for sure.


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