Friday, August 29, 2014

Feeling a bit unladylike

My gastric bypass surgery was a week ago.  It seems like much longer than that, but I suppose that's also because I've been trying to adjust to an entirely new way of doing things.  The weight is flying off my body and that's been insane.  In just these seven days, I've lost 23 pounds.  That's pretty mind-blowing!  I feel like a newborn in so many ways.  My little pouch is very sensitive.  I can only take tiny baby sips when drinking something.  In fact, I was drinking water yesterday with my mother and I accidentally gulped my water down.  I remember taking one swallow and then the next without a break in between.  As soon as I did it, I gasped and remembered I wasn't supposed to do that.  I told my mom and we sat there, waiting for something to happen.  Nothing did, so we eventually let it go.  That's when the very manlike burps came out of my mouth for the next hour.  Buuuuuurp.  I sometimes accompanied them with hiccups.  Have you ever had to burp and hiccup at the same time?  Not fun.  My belly felt like huge bubbles were trapped and I had pain in my chest.  Even later in the night, they kept coming as I laid on my side and tried to breathe.  Then the farting came to the surface, too.  That made me start to laugh, which didn't make things any easier.  I swear, I need to write a book someday about the things I'm experiencing!  At least I can laugh about it now.

I did see my surgeon yesterday because I was experiencing some swelling around my ankles and he wanted to see me to be on the safe side.  I was full of questions for him:  Should I be feeling this? What about that?  He was so understanding of me and reminded me that I have just been through major surgery and I'm going to need to give my body time to heal.  Oh yes, I think that was another way of saying, "Kathy, you just need to be patient."  I don't do well with that, in case you haven't figured it out yet. My steri-strips are starting to fall off the incisions and so I'm fascinated with feeling how these new cuts on my body feel under my fingers.  The thing with laparascopic surgery is that your mind is fooled into thinking nothing major really happened inside because there are just five little cuts.  

Something major did occur, though.  For the first time in a long time, I am listening to my body and doing everything I can to take care of it.  That means I have to be on a schedule in terms of when I take my medications because I can only take one pill per hour.  That means I absolutely must keep myself hydrated and make it my top priority.  Above all, that means that I have to be very aware of what I'm doing.  I can't go all day long without eating something any more and I definitely can't be lax in what I'm doing to take care of myself.  In many ways, my new pouch is like a baby.  I have to treat it as well as I would a newborn.

Wednesday, August 27, 2014

Are you okay, Kat?

I know it's time for a major update!  After a three night stay in the hospital following my surgery, I was discharged to go home yesterday morning.  Thankfully my doctor did his rounds nice and early so I was able to leave there by 10:20 a.m.  He reviewed my list of medications with me.  Because my blood sugar numbers ended up great in the hospital, I have already been taken off my diabetes oral medication and injected insulin.  I'm still monitoring my blood sugar levels to turn in when I visit my primary care doctor in about 3 weeks, but things look great.  My blood pressure medicine has also been cut in half.  For so early after the surgery, this has been incredibly encouraging.  Some new meds were added, but that was to be expected due to the malabsorptive nature of the surgery.

My post-op care included all of the following until I meet with the doctor on Tuesday for a follow-up appointment:

  • Continue on a clear liquid diet through Tuesday evening, limited to water, Crystal Light, broth, Popsicles, Diet Snapple, and Gatorade Zero.  Must drink a minimum of 30 ounces per day with no more than 2-3 ounces per hour.
  • On Wednesday, add in one pre-made or powdered protein shake with about 30 grams of protein.  Continue with the clear liquids, but do not add more than the one protein shake until meeting with the doctor next week.
  • Begin taking medications, dosages indicated by the doctor on Tuesday.  However, because I may only sip my liquids, I must take only one per hour.  This means I have to space meds out through the entire day.
  • Walk frequently to prevent blot clots from forming.
  • No driving a car until cleared by the doctor and no longer taking pain medication.
  • No lifting 15 pounds or more.

While I was in the hospital, I was a walking champ.  I wasn't trying to be Miss Overachiever (no, seriously!) but I ended up that way.  On my last full day there, I did 42 laps around that floor of the hospital, complete with my rolling IV cart.  I was donning a tshirt, sweats and every chord known to man in the medical world hooked up to my heart, chest, tummy, wrist and more.  It was a real challenge to even go to the bathroom, but I rocked it.  I was just feeling so good ... that was until I walked outside of the hospital.  My mom and one of my friends were there to take me home, but first we all decided to walk across the street to the doctor's office to pick up some paperwork for my mom.  She is staying with me for two weeks to take care of me and she needed some FMLA paperwork signed by the doctor.  We looked on my phone and the distance to the doctor's office from the hospital was 14 feet so I thought it would be fine.  What I forgot was that the floor in the hospital was indoors, an even platform with no steps and a very controlled environment.  Walking across the street to the doc's office winded me by the time we got back.

On the ride home, I forgot the suggestion so many people had given me to be sure to bring a pillow to put over my tummy so it would be a less painful experience getting home.  Let me tell you, I felt every single bump.  My friend was driving the car and she missed an exit so she jerked the car to the left and that pulled at my seat belt.  I'm sure you can just imagine the pain I felt in that moment!  Thankfully the seat belt was not laying directly on any of the incisions, but it hurt no matter what.

Finally, when I got home, I just laid with my kitties on my own bed.  Ahhh ... it was such a nice feeling to be outside of that hospital.  Now, it seemed for the time being, the biggest challenge for me was to continue to sip my drinks and pick up prescriptions from the pharmacy ordered by the doctor.  I must have either drank some water too fast or drank too much of it because when I was in the middle of the pharmacy, I almost threw up.  Seriously, right there while I was talking to the pharmacist.  I'm not even mentioning the gas pains, which were horrible because of all the gas they pump into your body during the surgery.  At times, I felt like I couldn't breathe or I would have sharp pains on my sides.  The nurses assured me those were gas pains.  It was incredibly uncomfortable.

When it was time for me to take a shower, I went into my bathroom, took off all my clothes and then looked at myself in the mirror.  I have five tiny incisions on my tummy as well as some bruising.  It's not bad overall, but they are definitely reminders of some major work being done inside my body.  In that moment, I got so emotional.  I got under the water in the shower, let the drops run over my head and then I just wept in the corner.  I thought to myself, "My God, I can never take another sip of anything without possibly throwing up," coupled with, "You know you did this, don't you Kathy?  If your eating wasn't so out of control, you wouldn't have resorted to major surgery where they rearrange your freaking intestines in order for you to lose weight and maybe have a normal life."

Now, please understand, these are not my true feelings.  The enormity of everything just got to me.  I can never eat like I did before without hurting myself.  I have a lovely new tool that will help me have a healthy, good quality of life.  In the process, though, there will be mourning.  I don't regret this surgery, but it is an adjustment that I just can't adequately describe.  It's not an easier path by any means, but it's one that's designed to help me and I have to be willing to accept that help, even if it's not on my terms.

Since I had that shower, things have been feeling good.  I do have some pain, but it's pretty manageable.  Having my mom with me has been wonderful, but every time I start coughing or take a moment to breathe deeply because I'm feeling pain or burping rises up, she asks, "Are you okay, Kat?"  I'm talking every single time.  Every one.  I have explained to her that there will be times that I will cough and it will sound bad.  I might even throw up or feel like I'm having a heart attack.  That's my body's way of telling me it doesn't like something.  As a case in point, I was having a Popsicle earlier today and I put too much of it in my mouth to swallow before it melted all over my fingers.  My pouch didn't like that at all, so I could feel a sort of bubble sensation in my chest and I started coughing violently.  I even excused myself from the room so I could do my hacking in the bathroom.  "Are you okay, Kat?"  Of course she says it out of love and concern, but she doesn't understand the logistics of the surgery very much so she's asking me that question any time I make a peep out of my body that doesn't seem to be normal to her.  I am reminding myself, though, that even though she doesn't understand the surgery, she loves me and doesn't want me in any sort of pain.

Tomorrow is another new day with a fresh start.  And a fresh batch of one ounce cups to at least get in my 30 ounces for the day.  I am having five friends coming to visit tomorrow at different times, so I'm looking forward to that so much.  I'm sure I'll be lifting my shirt a lot to show them my tummy with the incisions and bruises.  Never before in my life have I showed so many people my tummy and not blinked twice about it.  It reminds me of those women who get breast implants put in and want to show everyone their new boobs.  So proud!

Sunday, August 24, 2014

I wonder what "full" feels like

I'm ready to escape on out of this hospital!  The staff has been great and they have taken good care of me, but I have cabin fever.

Another surgeon from Pacific Bariatric was doing rounds this morning so I didn't get to see my doctor for a check-up.  However, this surgeon was just as great and pretty funny.  Turns out he is the father of one of the teachers I work with at the high school.  He said I was doing wonderful so I asked him if I could go home today.  He cut me off with a very emphatic "NO!" Well, I did have to try.  He said I should be able to go home tomorrow though.  I was released to take a shower and start having liquids.  I have to say that was one of the best showers I've ever had.  After not showering for two days and having had surgery, I just felt yucky.

My experience with liquids has been interesting. I walked 10 laps around the floor early this morning (34 total for the day) so the head nurse said I could have a Popsicle.  Oh boy, oh boy, oh boy!!!  It was sugar-free, totally allowed and delicious.  

Later on, I was told that I could have up to two one-ounce cups per hour of fluid. I was started off with Crystal Light.  I took tiny baby sips and that seemed to go well.  Later on, I had chicken broth and it was good, too.  I requested more Crystal Light so the nurse brought me some more with ice chips in the cup.  I gently spooned enough to go in the one-ounce cups.  

The first one was great and, though it took me a long time to finish, I did a good job.  When I worked on the second one, I must have put too much liquid in my mouth because I feel sick to my stomach right now.  I don't know if this is the full feeling they said I would experience, but it feels like a tummy ache.  It is going to take time and practice for me to get used to this new pouch.  I can't gulp like I used to or have too much.  When I look down at my tummy and see the five tiny incisions where the surgeon operated, it doesn't feel real somehow.  The uncomfortability does, though.

I also had visits from a physical therapist and dietician today.  The physical therapist talked to me about how to get in and out of bed.  Sounds like an easy thing to do but when you have had major surgery on your stomach, you have to be able to rise out of bed without hurting yourself.  The dietician was a great source of information.  She talked to me about specific questions I had upon returning home from the hospital and which protein shakes might work best for me given my lactose intolerance.

Each day is going to be full of learning for me, but that's okay.  I want to maximize this incredible opportunity before me.  Oh, I almost forgot some really fantastic news ... I think my diabetes is going into remission!  The first few readings were high after surgery because of the dextrose in my IV bags but it is leveling out.  I just had a reading of 102, so I'm hopeful about that. More to come on that front.

How things are going after surgery

Hi everyone!  I'm in the hospital right now, writing this post through the Blogger app on my phone so we'll see how it goes.

The day of surgery on Friday, I was feeling calm as I got up at 3:15 a.m. to get ready.  It was so surreal that after months and months of preparation, the day was finally here.  My mom was asleep in my guest room, so I tried to shower quietly until I needed to wake her up to do the same. In those moments alone, it was feeling like a rebirth to me in some ways.  I scrubbed my body thoroughly, as per the surgeon's instructions, and it was like I was washing away the parts that I could let go of - the person who was a slave to food, whose body was breaking down day by day.  It actually was a very cleansing shower.

I had a great medical team working on me.  They did a great job of checking on me to see how I was doing prior to surgery and easing me into anesthesia.  The surgery took three hours, but apparently I did a really good job.  I woke up in recovery in sooo much pain though.  My back felt like it was on blazing fire.  Thank God my mother was able to do deep tissue massages on me.  In fact, if she wasn't there, I would have probably been in tears from all the pain.  She kept me very strong.  They also put a lot of gas into my body so that made things feel heavy and painful.  Despite all that, I was able to push through the pain, knowing God was watching over me and holding my hand through the entire process.

Day number two was amazing!  The pain was nowhere near as strong and it felt like a night and day difference.  I walked around the hospital floor 19 times, which is the equivalent of over a mile.  The nurses told me I was the first person ever to be excited to begin walking ... they usually have to tell people to start walking. I was allowed to walk at 4pm the day of surgery and boy was I chomping at the bit!  I am in pain right now, but I'm pushing through and happily pressing my pain pump.  Meanwhile, I am able to have an ounce of ice chips every hour.  Tomorrow I will be allowed to take a shower and have liquids.  

I have a lot of gratitude and praise God all the way through.  I know I'll feel better as the days continue to pass.

Thursday, August 21, 2014

Surgery eve

Well, tomorrow is the big day!  It's been such a long road that has felt very arduous at times, brief at others. I had my pre-op appointment today and I must say that I have never experienced more calm than I did today.  When my mother and I drove up to the hospital, I had absolutely no butterflies in my stomach, unlike the first time I was there to hear the surgeon give an informational talk. I walked in the hospital, almost feeling like a hostess with my mother ... "Here's the chapel, here's the elevator, here's the cafeteria."  When we arrived in the surgery check-in area, I was calm as I waited for my turn and answered all the nurse's questions.  It just felt really good, for lack of a better word.  I am hungry right now, I'm not gonna lie.  I am only allowed clear fluids today and so it's been really hard.  My blood sugar dipped a little low, so I have to monitor that carefully.  At 11 p.m. tonight, I will not be allowed to have any more fluids.  We are due at the hospital at 5:15 tomorrow morning and then I go in for surgery at 7:15.  Since I am having the gastric bypass done, my surgery will take about two hours.  I'd love any and all prayers!  I need to head off and pack my back for the hospital stay, but I'll post again as soon as I'm able after the surgery.

Sunday, August 17, 2014

Three restaurants in two days

I just need to put this out there and tell you that I have to be careful.  Now that I'm in the last few days before the surgery, people have been wanting to spend time with me and we've been doing it at restaurants.  No one is dragging me there, I'm going of my own free will.  I want to spend the time with them, but part of me also wonders if I want to spend the time with those foods as a sort of goodbye party.  We very well could have gone to Starbucks to get iced tea.  Between yesterday and today, I've been to three separate restaurants.  Last night it was a buffet with my mom, breakfast with one dear friend this morning and lunch with another this afternoon.  I actually didn't do as horribly as I could have.  I didn't even have dessert at the buffet and, trust me, I wanted it.  They had a whole section on delectable desserts.  I kept telling myself, "It'll be your last time to have these things for a very long time, if ever."  Since I'm having the gastric bypass, my body will likely reject any sugary types of foods.  Then I got to a point when I was sitting there with my mom where I knew I didn't really want it.  I don't have to gorge myself.  The only real splurge I had between the three meals was a lovely strawberry margarita.

Margaritas are my downfall at Mexican restaurants.  It's not the alcohol as much, I'm guessing, as the sugar.  After I had it, I could feel my blood sugar going up and I definitely didn't like that.  Oh the power of food.  I feel so much better when I have good tasting food that is nourishing for my body.  I don't want to sit in any regret and I definitely don't want to gain any weight before the surgery on Friday.  So, okay, I'm owning it by being honest on here.

Despite the food part, I have enjoyed spending time with people that mean a lot to me.  Those moments are so precious and taken for granted far too often.  The friends from my pre-op class are having a get-together tomorrow evening and I want to do everything I can to get myself there.  I have so much work to do before my last day on Wednesday, but it's also very important for me to spend time with them as well.  Not only have they become dear friends, but they know exactly what I'm going through because they are going through the same thing.  Between this week and next, five of us are going to have our surgeries, with more to follow afterwards.  It's such a surreal feeling to know these months of build up are finally coming up to the main event.  I am so ready to do it and can't wait for Friday.

Telling other people about my surgery

In the last nine months since I started my journey towards surgery, besides my family, I pretty much only told people in the office at the high school where I work and very close friends.  I wasn't trying to keep it a secret, but I also did not want naysayers to come out of the woodwork.  People have this uncanny ability to tell you their opinions of how wrong you're doing something, unsolicited or not.  Trust me, when it comes to weight loss methods, a lot of people believe you're just not trying hard enough or that you're lazy or some other such thing I have heard a million times before.  They don't think things through very much before it comes out of their mouths.  Clearly weight loss surgery is not the first thing a person does to try to get healthier.  For me, it has been a million diets and desperate attempts to drop the weight.  Most people are well-meaning, but I wanted to focus on my process and not worry about possible negativity coming my way.  Since I'm less than a week away from my surgery date, I decided to share the news on my Facebook page to let everyone know what's going on.  Here's what I wrote:
Friends and family,
I have some important news to share with you so Facebook will help me do it all at once if I haven't had the chance to tell you in person.  If you have known me for a long period of time, you have known that I have struggled with my weight since childhood.  I have tried so many different ways to lose it, some successful for a period of time, but it would inevitably come back on.  Along with it have come diabetes, high blood pressure and other ailments.  My body is constantly in pain, even if you can't tell from the outside.  Finally, with much contemplation over a period of years and prayer, I began the process of pursing weight loss surgery this past November.  After many tests and six months of classes, I'm thrilled to share that I will be having gastric bypass surgery this Friday.  While many in society believe it is the "easy way out", I can assure you all it is not.  It takes a lot of commitment and sacrifice on my part to undergo such an invasive procedure that will affect the rest of my life but one that leads to a great quality of life and wonderful health.  My last day of work will be Wednesday, but I have a great sub coming in to handle things while I'm away.  This is major surgery so I will be out for awhile.  I have pre-op stuff on Thursday and then the surgery at 7:15 a.m. Friday morning.  The procedure is being performed by an excellent surgeon who is part of a center of excellence, Pacific Bariatric.  I will be at Scripps Mercy for three nights, so visitors are welcome!  Thanks for your love, support and prayer.
What happened after that was something beautiful.  I received so many lovely comments and personal messages.  As I read each one, my eyes filled with tears and I felt pure joy inside.  I received message after message of support, love and encouragement.  I even had three people tell me privately that they also have had bariatric surgery recently.  I didn't know they had done that.  I am so blessed to have such wonderful people in my life who clearly love me more than I knew.  I mean I knew, but I didn't really know.  I sit here feeling such peace around all of this, which is sooo unlike me.  Not too long ago, I was feeling very anxious and nervous.  Now I'm the polar opposite.  People have told me that is because I'm ready.  Who knows, maybe I am.  Right this minute, I feel truly touched by God for placing such amazing people in my life.  He is so good!

Friday, August 15, 2014

One week to go, information overload

In a week from today, I will be in recovery from having gastric bypass surgery.  That fact really hasn't hit me yet.  I have really been taking things day to day, which is the healthiest thing I can do for myself, but also because it feels like that's the most I can manage right now.  When I received the news about my surgery date, of course I was elated and shared it with others.  Then I had to get down to the business of preparing myself for being out of work for up to six weeks.  That's the amount of time the surgeons release us, although we can go back to work if they deem we are ready sooner.  For me personally, if I need the six weeks, then by God I am taking that time.  I am not going to rush my body before it is ready to go back to normal activities just because I can.  This is major surgery and I'm certainly not going to minimize that nor have shame in taking the time I need.  

In the midst of preparing things at work for a substitute to come in, I have also been trying to read up on the things I will need to do leading up to the surgery and afterwards.  During the six months of pre-op classes, Kaiser prepared us very well.  I must say, being on the other side of the experience, I am grateful they were so thorough.  Before starting the classes, I really had a hard time with the fact that I would be required to attend six months of classes.  I felt like I had made the decision so let's get on with surgery already.  Yet, they touched on so many issues to help prepare patients like me for a different lifestyle.  This is, by far, not an "easy way out", as some believe it is who judge from the outside looking in.  In fact, our facilitator of the group told us several times this is a more difficult journey, yet one that will give us a better quality of life.  I am also taking in the information the surgeon's office has given me.  At the consultation, I was handed a CD with a file on guidelines leading up to the surgery and afterwards.  This document has a lot of very good information, but it is a lot to take in when I couple it with the information given to me from Kaiser.

Not all of the advice from Kaiser coincides with that from Pacific Bariatric, my surgeon's office, and vice versa.  For example, Kaiser advises us to choose clear liquid protein supplements the first three days after returning home from surgery, such as Isopure Perfect Zero Carb or Syntrax Nectar Whey.  However, the surgeon's office states we should have clear liquids and a liquid protein supplement, but a clear liquid protein supplement is not necessarily stated outright.  So, do I stick with a clear liquid protein supplement or just a regular one?  I have decided that for those first three days, I will go ahead and get some ready-made clear Isopure so that I'm satisfying both recommendations.  When I was going through the classes at Kaiser, I remember being told that the surgeon's office wasn't going to give us much information, but I wonder now if they just didn't know what we were going to be given. Kaiser is heavily involved up to the point where we meet with the surgeon and then they step back, working in conjunction with Pacific Bariatric but allowing those doctors to take primary lead.

Regardless, it is a huge amount of information from both sides.  Being the detail-oriented person I am (yeah, alright, anal retentive to some degree), I'm doing the best I can at studying everything.  I feel like I'm back in school and I'll be tested before I can be released from the hospital.  

How long do you have to be on clear liquids?  
When can you eat chicken again ?
Are you allowed to drink caffeine?
How often do you have to take your vitamins and calcium?
Why can't you chew gum?
How long is it before you can start eating fruit?

Oh my gosh, there are so many rules!  Obviously I don't want to make mistakes when it comes to things I need to be doing to take care of my body after surgery, so I need to know this well.  Thankfully I am not traveling this road alone.  My classmates and I have been very good friends and we're all supporting each other routinely.  I lean on them so much to keep me grounded.  I also have an incredible support system among my family, friends, co-workers, therapist and, of course, all of you.  Between this blog, Twitter, Facebook gastric bypass groups and Instagram, I have a huge community of support.  I am incredibly blessed to know God is taking such good care of me and arming me with all the tools and resources I need on this journey.  Even with the information overload, I'm still doing well.  I'm looking forward to the surgery and the much improved health afterwards.  As I sit here and write this, my back and leg are in pain, yet it calms me to know that perhaps very soon into the future, I will start feeling less pain as the weight (I pray) continues to come off.  I'm really looking forward to that.

Monday, August 11, 2014

I have a surgery date!!

As I posted in my last update, I have been impatiently waiting for that phone to ring to schedule my gastric bypass surgery.  I went back to work today after a two month summer break.  It was nice to get away from my head and focus on other things.  The only problem is that I seemed to think about it more!  I had my cell phone in my pocket everywhere I walked today when I was in the office ... to the copy machine, bathroom, health office.  I admit it - I was obsessed.  Finally, at about 1:30 p.m., after I knew Pacific Bariatric staff were back from lunch, I just couldn't stand it another minute and decided to call.  What, you're surprised?  LOL

When I got on the phone, I was very casual with them, "Hi, I'm just calling to see if we were ready to schedule my surgery!"  Be light and breezy, Kathy.  The surgeon had given them the slip that morning to schedule me.  When the person helping me asked me if I wanted a specific date or just the next available surgery date, I figured it would be weeks so I asked for the next available.  She told me that she would call over to the hospital to check on availability, but that it looked like they had next Friday open.  WTF, next Friday??  Wow.  So, long story short, here I am, booked to have my surgery on Friday, August 22nd at 7:30 a.m. I have to check in at 5:30 a.m. which means I will be getting up that morning at about 4:15.  As if I'm actually going to sleep!

When I got off the phone, I was in a state of shock I think.  It registered with me, but it wasn't really registering with me.  That's less than two weeks away.  I got up from my desk and proceeded to tell my bosses and co-workers in the office.  Amazingly, I wasn't anywhere as anxious as I imagined I would be at that moment. I was feeling nervous, sure, just like anyone else would be in my position.  I believe strongly that my faith, strong support system, this blog and mindfulness classes have really help me stay in the moment as much as possible.  I need to remember to breathe and put one foot in front of the other.  Of course I will be continuing to write about it all here.  If you are a praying person, I ask that you send whatever prayers you can for me to give me strength as I walk through something I thought I would never be brave enough to walk towards.  Stay tuned for more.

Saturday, August 9, 2014

(IM) Patiently waiting for my surgery date

I know that God uses a lot of opportunities to help me learn and grow as a person, even when I'm kicking and screaming.  When I had the consultations on Tuesday, my surgeon told me that I would probably hear back in a few days but no later than a week to schedule the gastric bypass surgery.  Of course I'm antsy, just like every other person that has gone before me.  On Friday, I just couldn't stand waiting one more second.  I doubted they would be ready to schedule by then, but I just had to try.  I'm returning to work on Monday after two months of summer vacation and it would be nice to know something going back.  Unfortunately it's a bit too soon.  I was told that the surgeon is reviewing the internist and psychiatrist reports and then will turn in a slip to the scheduler, who will then be calling me.  They believe it will be by the end of the day on Monday.  If anything, I'm glad the surgeon is being thorough in reviewing the other reports instead of working on automatic and pushing things through.  At least I'll be preoccupied being back at work because, even if I get my date on Monday, I'm still going to have to wait until the actual surgery date.  That means more waiting so at least work will keep my mind busy.

My foot is healing nicely from the biopsies done on Monday.  It has been really hard not pushing myself and just walking through the pain.  Each day has brought more healing and the holes are slowly starting to close up.  I was feeling a little worried because of the cuts since I'm diabetic, but I'm taking good care of it and following doctor's orders.  I still don't know if I'm going to move forward in doing anything more with what happened with the doctor.  On one hand, his explanation seems possible and I did have two biopsy results (from the two cuts).  On the other hand, it just seems fishy.  Up to this point, this doctor has taken very good care of me with the skin cancer and he's done many biopsies on me with no problems.  I suppose the problem with all of this was not telling me what he was doing with the second cut and the poor job on bandaging up the area.  It's getting better, so that coupled with the benign results is the biggest thing right now.  After nine biopsies with the skin cancer and one other type of biopsy done, at least that word doesn't scare me any longer.  I feel like a pro now.

Thursday, August 7, 2014

Biopsy results and following the rules

I received a call from my dermatologist today with the results of the two biopsies done from my foot.  I am happy to report the areas in question were benign, so the cancer has not returned.  Hallelujah!  I do have a lot of pain in my foot, but there was a deep sample taken so I know it will feel better soon.  I'm trying to stay off of it as much as possible.  It's hard for me because I'm recording really low numbers on my Fitbit.  I try to aim for 10,000 steps a day most of the time and right now I'm at 1,347 steps for the day at almost 11 p.m.  Ho hum.  It will get better, though.  In the meantime I need to just practice patience.

Since seeing the surgeon the other day, I've been kicking things into high gear in terms of following the instructions given to me in preparation for surgery.  I decided when I got home and starting tearing in to all of the reading material that I need to do everything I can to have the right mind-set going into surgery and to prepare my body.  While I will be having the gastric bypass done laparascopically, it is major surgery internally.  Anything I can do to make the surgery easier on me and on the surgical team is what I aim to do.  If I was able to stay on Optifast and no "regular" food for eight or nine months, I can do this, too.  The surgical materials talked about some changes I can make, if I have not already started, to help decrease the risk of death, pulmonary emboli, wound infection, pneumonia and other complications.  Of course that is all very serious.  Some of the very important things I pulled from the reading include:

  • Begin exercising now.  Walking at least 30 minutes to 1 hour daily at a brisk pace will help strengthen your heart and lungs for surgery.  Daily exercises to strengthen and build muscles will help you during your recovery.
  • Deep breathing exercises two times per day enhances lung capacity in preparation for general anesthesia.
  • Begin a multivitamin and mineral supplement daily.
  • Take 1,000 mg of vitamin C per day.  This will strengthen the immune system and aid the healing process.
  • Increase protein intake by adding a high protein bar or high protein drink once or twice a day as a meal replacement.  This will promote muscle formation and allow your body to begin weight loss by burning fat.
  • Increase your daily water intake to include a glass of water with each meal.  Tea and coffee do not count.
  • Eliminate caffeine.  Waiting until the time of hospitalization may cause withdrawal symptoms.  Caffeine is also found in most sodas, chocolate and tea.  These should be eliminated from your diet.
  • Eliminate sodas and carbonated beverages.
  • Begin a high-protein, low-fat, low-carb diet.  Eliminate bread and pasta to help shrink your liver for surgery.
  • Begin lifestyle changes and prepare for success:
    • Schedule routine eating times and only eat in designated areas.
    • Avoid eating while doing other activities.
    • Use a cocktail fork or child-size flatware along with a small plate to help reduce portions.
    • Practice leaving food on your plate at the end of the meal.
  • Go to a bariatric support group.
  • Make sure you continue losing weight otherwise your surgery may be cancelled.
My healthy low-fat, low-carb
dinner ... delish!
Whew, what a list.  Obviously this is for my benefit to ensure I have not only a successful surgery and recovery but healthy life afterwards.  Thankfully I have already started incorporating most of these suggestions.  If you're on MyFitnessPal with me, you'll even see my meals have been including protein meal replacement drinks and I'm continuing to do that.  When I made my dinner tonight, I decided to turn off the TV and the computer so that I could focus on my meal.  The only thing I had on in the background was meditation-type music from Pandora.  It was an interesting experience.  I easily have forgotten how mindless eating can be when I'm doing it for the wrong reasons.  Eating when I'm bored, tired or watching TV is very different than when I am doing it for nourishment.  

Clearly I want to do the very best I can to be successful.  There have been so many attempts to lose weight in my life and I don't want this surgery to be in vain.  If I go in with a positive attitude and doing everything that I can on my end, it won't be.  I know it is a tool and that I will need to do a lot of work, but I am honoring myself in this process as much as possible.  I have to be honest with myself when it comes to my triggers and emotions around food.  In one of the gastric bypass groups I belong to on Facebook, someone asked what people did for their "final meal" before surgery.  Reading what people wrote was so shocking to me because most went all out.  If I go all out, I know myself well enough to admit that there is no stopping point, especially if I rationalize it will be the last time I could have something for a very long time or maybe forever.  I'm the kind of overeater that has no boundaries.  Good Lord, I got up to 420 pounds when I had started Optifast a couple of years ago.  If I had that last meal, it would include every sweet food I could get my hands on and probably send me into a diabetic coma.  I'm not exaggerating on that ... I've had high blood sugar readings before so I know I could do it again.

Instead, I am walking forward with as much peace as possible.  I'm being kind and gentle to my body.  I'm trying my hardest to listen to the doctor and follow his advice.  I certainly don't know what this surgery is going to be like for my body but I do know the pre-op suggestions and rules are for my benefit.  If I can do my part to make sure I don't develop complications and pain, then you know I'm going to do it.  

Wednesday, August 6, 2014

Dermatologist update and my surgical consultations

I received a phone call from my dermatologist in response to the message I sent him after the biopsy was done the other day.  I just wanted an explanation of what happened from his point of view.  He stated that he first removed the mole that was on my foot and put it in the container full of liquid, as is the normal process when biopsies are completed.  Upon visual inspection of that mole, he thought it did not appear as dark as it had before removing it.  He looked back at my foot.  At this point, it was swollen because he had already injected the numbing agent.  He did, however, notice the pigment was a little darker in an adjacent area.  He said the skin tone of a darker person is atypical, but there was a color change so he had to be sure since I have a history of melanoma.  One of the things you look for with skin cancer is a change in the color of the skin.  Without talking to me about it, he decided to take a sample of that second area.  He said he had to cut deeper because there was a little bit of a callous on my toe.  He chose not to tell me before he went in for the second sample because he did not want to alarm me or my friend.  He apologized for how things transpired and for the insufficient bandaging.  He said he had thought about it all night and was very concerned.  He gave me his personal desk number at Kaiser and said to reach out to him directly if I have problems with healing.  I expressed to him my appreciation for his apology but also explained to him that if only he had told me he was going in for the second sample, all of this anger and confusion could have been avoided.  He understood and apologized again.  

Do I believe him?  My gut says yes, but I need to sit with this before I decide if I want to do anything further.  The pain in my foot was pretty bad yesterday but at least I can step down on it today.  I do have a lot of gauze wrapped around it to help cushion the area as much as possible and I'm elevating it quite a bit.  This was not a good experience but at least, for now, it's done.  I should hear back in a few days on the results.

On to better news!  I had all three consultations for my surgery with the psychiatrist, internist and surgeon so I wanted to write about those experiences.  A friend from my pre-op classes offered to take me, which was such an amazing blessing.  Not only did she know exactly where to go, but she dropped me off right in front of the buildings so I wouldn't have to walk too much on my foot.

The first appointment was the psychological evaluation.  This doctor's practice was in a portion of her home.  She was very friendly and that helped me feel at ease.  She wanted to get a feel for my mental state going into surgery, so she asked a series of questions designed to build a report on my present state.  She asked me questions about what it was like for me growing up, what my family dynamic was like then and now, the physical health of my parents, my happiness level and my support system, among other things.  She did have me elaborate quite a bit on some areas, such as being teased in school and how that impacted my self-esteem or some of the details about when I was raped as a teen.  It was a nicely flowing conversation and she said she felt no pause in recommending me to move forward.

We finished early and decided to head over to the second appointment, which was with the internist. That was a good call because he took me in practically right away.  I was weighed and my height was measured before I went back into the examination room.  I had gained weight since the classes ended and I'm working to get it off, but it was disappointing.  However, I had to just say to myself, "Okay, this is where you're at and just move on from here."  It is what it is and everything happens for a reason.  Once in the room, the nurse had me remove my shirt and bra and then put on a hospital gown with the opening in the back.  She then performed an EKG to ensure my heart was healthy for surgery.  The doctor then came in to review those results and went over some of my responses from the questionnaire I completed back in May.  He said my heart looked really good and he has no pause whatsoever to recommend me for surgery.  In fact, he told me that I am the exact person this surgery was designed for.  After surgery, my diabetes will most likely go right into remission and my sleep apnea will be significantly improved if not gone altogether.  Most of the medication I am taking I will no longer need to take and the pain I feel in my body will most likely get significantly better in time.  It was an incredibly positive experience.

The last appointment was with the surgeon I chose in the Pacific Bariatric group to perform my surgery.  All of the surgeons have a great reputation since this facility is a center of excellence, but I have spoken with several people who actually had this particular surgeon and they raved about him.  Beyond that, I felt a connection with him after attending an information session where he spoke.  They weighed me again and measured my height using the Tanita Body Composition Analyzer.  It actually gave me a print-out of my stats.  My BMI is currently 51.3 and my body fat percentage is 52.1.  That was pretty sobering but I also reminded myself that the reason I am here is to do something about it.  I can only imagine how different things are going to look in a year from now.  I was given a CD with a lot of information to read about preparing for the surgery and what things will look like post-op.  The doctor was very kind with me and answered absolutely every question I had.  He also said I was an excellent candidate for this surgery.  He did do a physical exam where he listened to my heart and lungs while also looking at my abdominal region.  He took his finger and showed me on my skin where the five incisions would be since I'll be having my operation done laparoscopically.  In terms of the next step, he talked to me about my vitamin, eating and exercising regimen.  He said the most important thing from now until surgery is that I work on doing things to shrink my liver as much as possible to prevent problems during the surgery.  So he wants to make sure I'm replacing 1 or 2 of my meals with protein shakes and that I stop eating bread, pasta and sweets because the carbs effect the liver.  He did tell me that all three doctors, including himself, would be filing their reports that evening and then I should be receiving a call from their scheduler to pick a surgery date within a few days, but no longer than a week.  A couple of my classmates did not have a positive experience in their consultations with this surgeon yesterday after my appointment, but mine was highly positive and I like him.  I pray the best for them but I feel very comfortable with him and completely satisfied that I chose him as my surgeon.

My friend and I went to lunch after that.  We talked about the fact that this is feeling very real now.  It was one thing to go through the six months of pre-op classes, but being seen by the doctors elevated all of that.  It is very likely that I will be having this surgery before this month ends.  Eeeek!  That is so surreal to me.  I have been working on this since November so it has not been quick at all but I feel I'm as ready as I'll ever be.  So now I wait for that phone call.  Will I be obsessively checking my phone for any missed calls?  Probably.

Tuesday, August 5, 2014

Two for the price of one

I had a biopsy done today and to say it was a negative experience would be an understatement.  I'm going to try to go into as many details as possible so that I can not only share with you what happened but so that I can document what happened.  I don't want to eat over this, hence this is why I'm posting all of this here.

In a previous medical appointment, my primary care physician was doing a foot exam with me and noted that there was a mole near the tip of the big toe on my left foot.  She advised that I follow up with my dermatologist since I have a history of melanoma.  

A friend offered to come with me to the dermatology appointment for moral support.  I thought that would be great since I was feeling a little nervous about this one.  Mind you, I've had quite a few biopsies before from this same doctor.  They are not pleasant, but I knew exactly what to expect.  The doctor would examine the suspicious area and then determine if a biopsy would be advised.  If so, he would call a nurse into the room to assist him.  We asked the doctor if my friend could stay and he stated that he normally had family and friends wait outside the room unless I would like her to stay.  I did tell him that I would prefer she stay, which he seemed to accept.

He had me laying on the table on my right side so that my feet were toward him.  It was incredibly awkward because my head was pointing down into a part of the bed that was lower than the rest.  I took a pillow and folded it in half to give me a little better leverage.  My friend sat on the edge of the bed close to me so that we could chat while the doctor was injecting the Lidocaine and performing the biopsy.  The doctor had plenty of room on his end to perform the proper procedures without any restrictions.  As he injected the numbing agent, I felt pain.  After a little bit, I felt an incredibly extreme amount of pain on my foot as he was cutting into my foot and removing skin.  I mean, it was pain that was beyond what I would have expected.  I anticipated a little pain because the mole was little, but nothing like that.  As my friend was trying to distract me from the pain, I had to stop talking and I inhaled deeply to fight through the discomfort.  She reminded me to breathe because I was trying to keep it all in to avoid feeling the pain.  Then I felt another pain.  It felt like he was digging deeply into me.

The doctor pronounced that he was done and that I handled it well.  They were going to put on a simple band-aid and that's when my friend really chimed in.  From her vantage point, she could see more than I could.  She asked if that one little bandage that was put on would be sufficient.  We were assured it would be.  We were given extra bandages to change the dressing at home and then informed that the visit had ended.  I requested the doctor call me with the results instead of sending them to me through the mail since I have an appointment tomorrow with the surgeon.  He left the room.  I put my flip flop back on, careful to avoid my big toe and then stepped down onto the shoe.  The next thing we knew, there was blood all over it.  I took it off and rinsed it in the sink while my friend went and got  help.  The nurse looked at my foot and there was blood all over my big toe, almost gushing.  She ran to get the doctor to show him what was going on.  

My friend was able to see that the doctor had, in fact, done two incision.  I did make the comment that I had cut the bottom of that toe the other day, but it's clear that he had definitely cut off skin in two separate areas.  The nurse was trying to stop the bleeding and, meanwhile, I didn't know quite what was going on because I couldn't see the bottom of my foot.  My friend took a picture and this is what I finally got to see.

At this stage, the nurse had cleaned up all the blood and we were waiting for more dressing to be put on it.  As you can see from the top of the toe, there is a little skin shaved off where the mole was removed (I'll call that area Section A).  But if you look in more detail at the center of my toe, the doctor had removed a crater of skin and went pretty deeply (I'll call that area Section B).  What my friend and I think happened was that the doctor had started cutting into the skin in Section B and likely realized he was cutting into the wrong area.  Then, we theorize, he went to Section A and performed the biopsy.  My friend even saw him with scissors in his hand at one point, which I don't recall he has ever done before.  We started asking him questions and he basically went into an explanation that sometimes the skin is "nicked" during procedures.  I'm sorry, that's no nick!  He did apologize, but he didn't specify for what.  He also said he was able to get a "broad" sample for further investigation.  I was eventually handed a hand-held mirror so that I could see the bottom of my foot and was utterly shocked at what I saw.  The doctor went into further explanation, utilizing some medical jargon, and then eventually left the room, apologizing as he did so.

We were then left with the nurse who explained to me that she had never worked with this doctor before and was just as upset with what happened as my friend was.  Was I upset?  Frankly, I was a little stunned and wanted to just leave.  The nurse bandaged me up with something stronger and tighter around my toe.  Before ending our time together, she reprinted my visit summary sheet and included information for me to escalate this to the next step if I so choose.  She was incredibly professional.  She was just as dumbfounded as we were as to what the doctor had just done.

As we attempted to leave, the bandage fell off after I walked a few feet.  So we went back to the exam room and a second nurse decided on a different bandaging system.  After three attempts, that one worked the best.  The doctor popped his head in the door and asked if everything was alright for probably the 10th time.  He even had the audacity to attempt to fist-bump me and my friend on one of his visits back in the room.  He probably shook my hand 4 or 5 times and even called me after I got home to see how I was doing and to see if I had any questions.

At that point, not everything had completely registered in my mind.  I had a houseful of guests with my classmates from the pre-op program visiting for a get-together.  They were all so supportive as I recounted my tale, with the help of the friend who sat by my side today.  The biggest concern with this, aside from the fact that he ripped deep skin out of my toe when he shouldn't have, is that I am a diabetic.  One of the things they teach us as diabetics is that the last thing you want is a cut on your foot because some diabetics have a hard time healing.  The lack of ability to heal, provided you are so afflicted, can possibly lead to foot amputation.  Obviously I am concerned because I am an insulin-dependent diabetic.  I don't take cuts on my foot lightly.  And I really don't take cuts on my foot that were done in error lightly at all.  

After all my guests left for the evening and I was attempting to walk on my foot without hobbling, I was met with excruciating pain and the anger finally hit me.  This doctor, whom has performed numerous other biopsies on me before, really fucked up.  I mean, he really, really fucked up.  Excuse my language, but I really can't sugar-coat this.  He made a huge mistake.  An "I'm sorry" is not good enough.  I sat down and wrote him an online message through Kaiser's system, requesting an explanation of why he did what he did.  Regardless of what he says to me, I will be escalating this and filing a formal complaint.  I don't have anything against this doctor, but what he did was absolutely wrong.  I hope everything will be okay in my situation, but what if it is not for the next person that needs a biopsy done from this doctor?  

The good news is that I'm not eating over this.  I'm choosing to take care of myself.  I have consultations with the psychiatrist, internist and surgeon tomorrow.  One of my friends has offered to take me and I graciously accepted her offer.  It will help me with not having to walk as far on my bad foot and, really, the moral support is just what I need.  Ugh, what a freaking day!