Can I just have a rewind on my day please?

I had a rough day.  Icky day.  These are the exact times that I realize I needed to have the tool of the surgery because it prevents me from picking up too much food to make myself feel better.

I started out my day at a 7 a.m. appointment at Kaiser.  It was time for me to see my physical medicine doctor to talk about my back and how well it's (not) doing.  I've been having ongoing, chronic back pain for several years now.  If you have some chronic pain, you know what I'm going through.  If you don't, count your blessings!  It's extremely difficult to feel pain every single day but I do.  I have it in my left leg, too.  After seeing a physical therapist and having a year of acupuncture treatments, it just isn't better.  Based on this morning's examination and previous interventions, the doctor determined that its muscular.  While the physical therapy and stimulation therapy takes the edge off, it's not really helping for day to day functioning.  I even explained to the doctor that weight loss isn't helping.  I'm down 120 pounds from my top weight, let alone 57 pounds since the gastric bypass surgery, and I still have the pain in the same intensity.  So she's going to try a compound cream and muscle relaxer, see how I do for 3-4 weeks.  I'm scheduled to see her for follow up the day before Thanksgiving.  At that point we'll see where I'm at.  I almost cried talking to her, just feeling extremely emotional.  I'm frustrated and the pain doesn't help.  I held it together, though.

When I got to work, I got busy with things I needed to do there.  However, two issues have come up in the last couple days that are upsetting.  While I am not going to go into specifics here because some friends from work read this blog, I will say they are staffing issues and I am not taking mistreatment towards me or similar co-workers lying down.  I am confronting people when necessary so that we can discuss issues going on.  In some ways that helped, in others things got worse because the reality of the situation reared it's ugly head.  I almost cried there, too.  I just was so upset that I got very emotional and was inches away from tears.  Yet again, I pulled it together.  Even if nothing is resolved with my confrontations, at least I know I am doing everything I can to take care of myself while still remaining professional.  On top of that, I'm also feeling emotional where work is concerned because I'm going to be starting my graduate program on November 10th.  While it's exciting for me, it's also very bittersweet because it likely means the beginning of the end of my time with my current school district.  They have rules that forbid me to be able to do school counseling (which is what my master's degree is for) in my district, even though I have 25 years with them.  It's very upsetting and incredibly emotional for me.  I'm a product of my district and have worked there since I was 17 years old.

Later in the afternoon, I had to go to the dentist.  I somehow lost part of a filling on the left side of my mouth.  Every time I drink something cold or eat something on that side, I'm in extreme pain.  As I was driving to the dentist's office, I was still feeling emotional from what happened at work and I remember thinking how badly I wanted something to eat.  As a person who has had a lifetime battle with weight, food is my go-to "drug" of choice to numb out.  Some people choose alcohol, I choose sugar and grease.  Instead, though, I focused on what I needed.  The dentist injected nova cane and drilled into my tooth then filled it.  They put headphones on me so I could blast tunes in my ears to prevent me from hearing what was going on.  Trust me, I heard!  At one point, I had my eyes open and smoke was coming out of my mouth.  I can totally see why people avoid going to the dentist.  Afterwards, I was in a lot of pain.  Half my face was numb, including my lips and jaw.  I was still upset about the first doctor's appointment and things that transpired at work and now I was dealing with numbness and pain.

When I got home, my first response was to want food.  I knew, though, it just wasn't going to solve anything.  I mean, truly, when has it ever?  I need to learn how to deal with life without going to food.  Obviously if I'm hungry and need it for nourishment, that's one thing.  In the moment, the last thing I wanted to do was eat something.  Have you ever tried eating or drinking with half your face numb?  I can just imagine the drool!  I did decide to take my contacts out and just go take a nap, even though it was later in the afternoon.  It was the best thing for me in the moment.  I just needed to rest and let my day go.  The only bad part of that is that it's just past midnight right now and I'm wide awake.  Oh well, you can't win them all.

I just need to keep suiting up, showing up and putting one foot in front of the other.  That's the best I can do because, ultimately, God's the one in charge.  I'm so happy it's officially Friday now.  Happy Halloween!

Dining out and letting go of Twitter

I went out with some friends tonight for dinner.  I believe it was my first time out at a restaurant since the surgery.  They were very supportive and wanted to be sure to go somewhere that I could find something to eat so I suggested a Mexican restaurant.  I knew I could probably order beans or fish.  I settled on grilled fish tacos that came with refried beans and rice.

Before you ask yourself if I'm allowed to eat that food yet, the answer is yes and no.  Don't worry, I made sure to take very good care of myself.  I received my statement from the hospital showing that the cost of the surgery and hospital stay was $85,439.  Thankfully my awesome insurance covered it but I'm not about to screw around with my food.  I gave up a lot to have this surgery and it's a huge commitment for the rest of my life.  I ordered my grilled tacos in corn tortillas that I wasn't planning on eating and asked them to serve them without cabbage since it's a bit early for me to eat veggies, especially veggies that aren't well cooked.  I didn't touch the rice at all.  I ended up having the fish with some salsa on top to keep it moist and then the refried beans.  I ate very slowly and thoroughly.  I took the rest home in a box that is enough for probably four more meals!  I really didn't eat much, but I wanted to err on the side of caution since I was away from and I really didn't want to run to the bathroom to throw up.

Switch of topics.  I have had a Twitter account for quite a while, but I've decided it's time to deactivate.  I just haven't been that active on it and I really don't like the feeds that include posts I'm not interested in from accounts I'm not following.  So if anyone is following me over there, this is the reason I won't have any activity going on there any longer.  I'm very active on Instagram, so that account will keep going.  And, of course, I will be continuing to be active on this blog, MyFitnessPal and Fitbit.  I love the accountability of all these social networking avenues.  It's a great way to have so much wonderful support.  I have found that I really need the support after surgery. You'll  never believe how intense things are after having had major surgery that rearranged my insides and forever effects the way I eat food.

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.

Consultations are now scheduled

Well, it looks like things are really moving forward now!  I received my authorizations today from Kaiser for the gastric bypass consultations, so I immediately called to schedule those appointments.  I was hoping to get them all done before I return to work on August 11th.  With two months off during the summer, it would probably not be great to turn around and take another day off.  Thankfully they were able to get me right in this coming Tuesday.  Hooray!  I will be meeting with a psychiatrist, internist and the surgeon with appointments one right after the other.  While all the surgeons are fantastic, I did specifically request the one I wanted.  I just have heard exceptional things about him and already met him at one of the information sessions.  I have prayed about this and God guides me at every turn.  I just felt that now is my time to ask for what I want.  So here I go!!

Having started this process back in early November, it seriously has felt like this time would never come.  Of course I knew it would eventually, but it feels pretty surreal.  After I meet with the surgeon, it will be a pretty quick turn-around to then schedule the surgery date.  One of my classmates, who has already completed her consultations, got her surgery date scheduled about a week from when she met with the surgeon (we have the same one).  I can imagine my experience will probably be just as quick.  Her date is almost three weeks away, so I'm guessing I'll probably have my surgery around the end of August.  Eeek!

I must admit I'm a little nervous, but I've been really trying to stay in the day about all of this.  The mindfulness class I am participating in, as well as the meditations I am doing at home daily, is really helping me stay focused.  If I project into the future, then I'm not honoring my process and, trust me, this is definitely a process.  When I do have those moments of thinking about the actual surgery and how very different things are going to be for the rest of my life, I start to feel anxiety.  Using the mindfulness techniques, I can stop and take those deep breaths to help bring me back to the present moment.  I know my mind with continue drifting to that day in the operating room, but I also know I have tools to help me with that.  Thankfully it is not my first experience with having a surgery, so I at least know what to expect in terms of that piece.  I'm grateful that I will be returning to work while I wait for the surgery date and the days leading up to that time - it will help me to stay focused on something else.  Of course, as I have more updates, I'll post them on here.  Thank you all for your continued support ;-)

Practicing mindfulness, fitness test and a new spot

I'm not doing great on posting more often.  I need to work on that because it is always so therapeutic when I do writing.  Since last I posted, I have been practicing mindfulness meditations as I mentioned in my last post.  It's amazing how peaceful and in tune with myself I have become just in this short time doing it (mostly) every day.  The guided meditations really help my mind stay focused.  For those that have Kaiser and want to take the workshop, you just need to participate in an intake appointment through the psychiatry department and then you can request the mindfulness group.  I am going through the list of online guided meditations and posting them on the resources page of my blog as I find some that are worthwhile.  I have found some really fantastic ones.  If you'd like to check them out for yourself, click here to go directly to the page with the list.  I love the "Self-Compassion" ones so far.  The speaker has a soothing, kind voice and I feel so relaxed when I am participating in the exercise.  Feeling peaceful with less anxiety is so amazing and, remarkably, doesn't take that long at all.  I even recorded some meditations in my own voice, following a script we were given in class, on my iPhone using the voice memo feature.  When it's time to meditate, I simply use my earplugs, sit in my meditation spot and within seconds, I'm feeling a lot of peace.  I thought it would be hard for me to meditate using some of the practices because I am not Buddhist, but I have found it works for any religion.  I don't need to lose my Christian roots and beliefs to enjoy the practice.  In fact, if anything, it enhances my spiritual center.

On Thursday, I completed my fitness test.  This was the next step in the process leading towards bariatric surgery.  Given that I normally walk much further on a regular basis than was required in the fitness test, I found it to be probably the easiest part of this journey.  It took about 5-7 minutes, that's all.  So now I am waiting for Positive Choice nurses to put orders in for lab work.  In talking to fellow classmates, they will be running 17 different tests so I'm sure they'll be taking plenty of samples from me.  Almost everyone in my pre-op classes are moving forward with surgery, so it's been great to see them posting their status in our Facebook group as they complete their next tact.

I had a routine diabetic follow-up appointment with my primary care doctor this morning.  She is incredibly supportive of my journey towards surgery and told me she was proud of me for not only making this decision but also hanging in there through the classes I was required to take.  She agrees that the gastric bypass (versus the sleeve) is the better choice for me for long-term success, even if I didn't have diabetes.  I was glancing at the computer screen while she was doing some typing and it has me classified as super morbidly obese.  If I ever forget my bottom line, I must remember that because the decision to move forward with surgery has been completely about quality of life.  Of course I can't wait to wear cute clothes, but my health is the most important.  I did tell her I have a little concern about the malabsportion issues and she shared some interesting info about that in terms of complications.  She's been a doctor with Kaiser for over 25 years and she said that ever since they started doing the bypass laprascopically, they have less incidents of complications and dumping.  She has found that curious because they haven't changed anything with the surgery internally, but doing it that way versus an open surgery has produced better results in terms of fewer complications.  While I was in with her, we were looking at my blood sugar numbers and she did a foot exam.  The foot exam is something all diabetics should do to make sure they don't have cuts on their feet that they're not feeling.  As she was looking at my feet, she asked me how long I've had the mole on my left big toe.  My response to her was, "Are you sure it's not just nail polish?"  I had just painted my toes dark blue the other day so I thought maybe I somehow got some there (it's under my toe near the top, so it's hard to see).  She looked at it closely and she confirmed that it was, in fact, a mole.  I did have a body scan when I went to see my dermatologist a few weeks ago, but we didn't check my feet if I remember correctly.  When I came home today, I checked it more closely and it definitely is a mole.  My doctor is very concerned.  She's the one that spotted my first mole that turned into melanoma three years ago so, of course, that concerned me, too.  She has sent a message over to my dermatologist's office so that we can book an appointment.  I feel biopsy number eight coming on.  I'd rather be safe than sorry, so I will definitely do whatever I need.

I see now why the mindfulness meditations are more timely than ever before.  Finding peace in the middle of anxiety, whether it be about the surgery or the biopsy, is incredibly important for me.  Practice mindfulness folks, it really does make a difference.  Maybe it won't change the outcome of situations, but it does change how I choose to deal with it.

Finished my pre-op classes and weekly-weigh in

After complaining about how long the classes were going to be, tonight I finished the six months of pre-op classes required through Kaiser to move forward with bariatric surgery.  I can still remember the time, years ago, when I was talking to a friend at work about wanting to do the surgery but just not having time to wait for classes.  When I think back on it, she was so patient with me.  She had gastric bypass herself a long time ago and I confided in her that I wanted to pursue surgery but I wasn't willing to wait to take classes.  Unless a person chooses to pay out of pocket and go down to Mexico for surgery, it is a very long process.  In fact, I'm still not done with mine.

In terms of my ending weight, the program doctor wants you to lose ten percent of your body weight by the end of the classes or to at least be ten pounds away from that goal.  I weighed in tonight and was so disappointed because I was half a pound from reaching that goal.  Can you believe it?  Half a freaking pound!  I told my classmate sitting next to me and she told me to go to the bathroom and poop.  Ha ha, I busted out laughing.  I raised my hand and asked my facilitator if half a pound would be okay.  Sure, I could have lied since she doesn't check our weight on the scale.  If we haven't met the goal, we would have to go back to the program doctor to be reevaluated.  This could take up to an additional three weeks and he could have told me to work on it longer or even outright denied me.  Of course, we were assured that this never happens.  Anyway, when I asked if that half a pound would be okay, she and the entire class told me to go out, use the bathroom and take off whatever I needed to take off to ensure I would meet that half pound.  They all were completely serious and waited until I left the room to keep talking.  I went down the hall and used the restroom.  I did have a lot of water to drink today, especially before class so it was possible.  When I got back to the scale, which was in a separate but adjoining room, I took off my shoes and even took off my Fitbit.  I seriously considered taking off my top for a second or two, but someone could have walked in on me.  Honestly, I would have stripped down to the bare essentials if I knew no one would walk in from one of the other classes.  However, I'm happy to report that between my visit to the restroom and the removal of what I could take off, I made the weight requirement with a half pound to spare. Yahoooooo!  I swear, I was never happier to see a two pound loss this week than ever before.

Now the next step is for our facilitator to submit our files back to the program director and then she will process them.  That could take up to two weeks, but generally it happens quicker.  Then I will be required to complete a fitness test.  That consists of walking around this building five times.  It's not a very big building at all and, given that I aim to walk 10,000 steps a day as much as possible, that shouldn't be a problem for me.  That is about five miles a day so I'm not particularly worried about that test.  In the meantime, as one of the surgeons has recommended, I am trying to replace one to two of my meals with protein shakes.  Since I'm lactose intolerant, I have to be pretty selective with what I choose to drink.  I've been using Muscle Milk but it doesn't have enough protein in it so I ordered from Bariatric Advantage.  It's the brand that Kaiser recommends and I do get a discount since I'm a member.  It's pricier but if its better for me, I'm in support of that.  All of this shake drinking reminds me of being on Optifast again in some ways.  There is a huge difference, though - I felt very weak and lightheaded when I was doing the Optifast shakes.  I don't feel that way at all using the protein replacement, as long as I get enough of it in.  The smaller I can get for surgery, the better it is for the actual procedure.  I'm excited to continue moving forward.

Two months of whatever I want

My end of the school year craziness at work is over and now I'm on summer break for eight weeks.  Hooray!  It was pretty rough for me at the end, but no one really knows the extent of it because I just keep most of it inside.  It's difficult because I'm not one to just "dump" all of my complaints at work.  I mean, yes, I will complain about situations with kids or perhaps other staff to colleagues but generally not when it comes to the intricacies of my work.  The truth is that no one else is there to do it except me.  When I'm absent, no one picks up my work ... it just sits there waiting for me to come back.  We're all really busy anyway, I'm not unique.  I might have more responsibilities than some, but it's not as if we're just twiddling our thumbs.

Since this is my blog and I'm here to write about what's going on with me, I can talk about some things that I haven't necessarily shared with most people.  I am a part of the counseling department at the high school where I work.  I am not a counselor.  My title is Guidance Technician.  In some respects, I have a lot of crossover in duties with the counselors and there are many times when kids come in to see me instead of their counselor.  They have mentioned that they prefer to see me, even though they know I'm not their counselor.  When I can help them, I will but I will also send them to see their counselor when appropriate.  I do that because of liability issues and also, frankly, because I don't get paid what they are paid.  While it is not about the money, it is about a respect level.  I certainly don't want to be taken advantage of just because I know the answers.  I have struggled with my role a lot because while I am part of the department, I feel like a stepchild.  Some comments have been made recently that have made me feel this more than ever.  I am trying to choose my words carefully right now because I know some friends I work with read this blog regularly so I don't want to go into too many details.  We said goodbye to one of our counselors yesterday as she is headed off to a higher position elsewhere in our district and she has been a good friend.  I was incredibly emotional about this, even though I know we will still remain friends.  It's just hard saying goodbye.  While dealing with those issues, I have been in a world of tremendous physical pain.

At the end of the year, I am in charge of our senior awards ceremony and heavily involved in graduation activities.  Standing on my feet for long periods of time, especially when I'm not wearing sneakers, leaves my body in so much pain that I really can't adequately describe.  When you are 200 pounds overweight, your poor body can only take so much.  For me, the last few days have been about a lot of pain in my lower back, the chronic pain in my legs and on in my feet.  By the time graduation was over, I could only spend a few minutes at a graduation party because my legs and back were on fire.  Even now, a few days later, they still hurt.  Of course I would do it all over again because I love our kids and was so proud to see them graduate.  My body just goes through a lot that it really can't take on a day to day basis.  This year I was back down on the field with our graduates, dressed in my cap and gown with the hood on my back in my college colors.

As I was sitting down on the field, I got nervous in the chairs, sure I was about to break the one I was sitting in.  It's irrational thinking because the chairs are sturdy.  Truly, it's based on a fear of have of being in the stadium and I fall on the ground because I've broken my chair.  This irrational fear is the same one I have with heights and thinking that the bridge I may be standing on just can't support my weight so I'm going to fall.  As you can clearly see from my writing, I have a lot of issues around weight.  As I move forward, closer to the time when I will be going in for my bariatric surgery, there is a lot of hopefulness in me about it helping relieve pain.  This is why it has never been a vanity decision for me, not at all.  I frankly want to be in far less pain than I am in now.  It hurts so much being in this body.

Looking at the positives, since I'm off for two months, I can spend a lot of time working on my health leading up to the surgery.  I am not planning on going on any big trips or taking classes during the summer.  I do want to do some work on my house, but also spend time exercising and practicing habits I've learned in my Kaiser pre-op classes to help me be successful with the surgery.  I'm so grateful for having been through the classes because I just feel so much more prepared than the people I know who have not had the benefit of the classes.  I desperately want to be successful with the surgery and I know that if I keep talking about whatever is on my mind and I follow the rules given to me, I will be successful.  I just pray I continue to remember that along the way.

Pre-op class #11, weekly weigh-in & the dental hygienist from hell

Among the things that I had scheduled today was an appointment at my dentist's office to get a cleaning.  I also somehow have a chipped tooth, so I knew I was going to be there for awhile today.  I'm not one of those people that hates going to the dentist.  I like the feeling of having a really clean mouth and, except for one time, all of my experiences have been good.

Make that two times ...

My dentist has a thriving practice and she is awesome.  The hygienist that was working on me today, however, was new, at least to me.  I was sort of looking forward to my regular person because he's always been very chatty and is gentle on my mouth.  This one was like evil Nurse Ratched.  She had me laying down on the chair and every time she went to grab a dental instrument, she would hold it in the air, inspect it, turning the blade or hook this way and that and then lower it into my unsuspecting mouth.  Mind you, I'm watching all of this from where I'm trapped.  Then she would scrape and scrape and scrape some more.  It was if she was taking a chisel and chipping away at imaginary icicles in my mouth.  Several times I had to raise my hand to ask her to be a bit more gentle.  She sang while she worked, yet I had no idea what it was - something incoherent and evil I think.  Oh, and the absolute worst, she would let too much fluid build up in my mouth before she sucked it out with that straw thingy.  Ewwww!

Bleh.  On to my class and weigh-in.  For this week, I lost a pound.  I was disappointed with it.  Two is a low number to me, so one was almost as if I gained.  I have to keep remembering that this is no race to the finish line and I'm doing everything I am supposed to be doing in terms of what I'm eating.  I do need to kick up my exercise though.  I just don't think I'm getting enough in.  I asked my friend if we could start walking again at lunch starting tomorrow.  We were both excited about that until we found it it's going to rain tomorrow and Wednesday.  Boo.  I do have a gym membership so there's nothing that's preventing me from staying away from a workout indoors.

This week's class was about assessing my new relationship with food since starting the bariatric pre-op classes 11 weeks ago.  Some of the questions I need to ponder this week include:

• What factors in my current lifestyle contribute most to my obesity?
• What do I need to do to commit to lifestyle changes that support my health?
• What weight do I think is my optimal healthy weight?  Have I ever maintained a weight as an adult that was comfortable and felt good to me?  What felt good about that weight and will I be satisfied to be that weight again?
• What style of eating will fit me best?

There were more questions, but those are the ones that jumped out at me the most.  One of the things that amazes me about these classes is that we're not just skimming over surface-level topics.  We are really diving in to the heart of what has brought us to seek bariatric surgery in the first place.  I appreciate that because I want to go deep with all of this, even when it's difficult to face the answers to the questions.

In a discussion with our facilitator, we addressed a concern I had, which was, "What if I don't lose the 10% weight loss that Kaiser wants prior to having the surgery?"  Our facilitator assured me, and my classmates, that people who do not meet the 10% loss will need to see the doctor in charge of the program at Kaiser to review where we're at.  Essentially, all patients move forward to the bariatric center that will be performing the surgery, but the surgeons at that center may request additional weight loss before surgery can occur if they deem it necessary.  The best I can do is try my hardest to reach my goal of losing 37 pounds before finishing this part of the program.  I'm almost halfway there already, so that feels good.  Once we're done with the classes, we will then go for a fitness test and lab work before everything is forwarded to the Pacific Bariatric center.  Then, they will contact us to schedule three appointments on the same day - meeting with a psychologist, internist and then with the surgeon.  During the meeting with the surgeon, we'll then book the surgery date.  The end of the classes is several months away, but we're almost halfway done and I know the time will go even faster as we get closer to summer.

This week I'm going to work on the questions I mentioned above and then I think I'll post them on here.  That keeps me honest.

Water Challenge Day 68:  Drank 179 of 179 ounces

Pre-op class #7, weekly weigh-in and serious contemplation

Boooo, I didn't lose weight this week.  I know that's okay, but I was a bit disappointed.  I'll keep trekking along.  It's hard to believe I already finished my seventh pre-op class ... they seem to be going pretty quickly.  Of course the process from the start of making the decision to having weight loss surgery up to now has been slow, but the anxiousness I had been feeling before is not with me now.  I find it difficult to make this huge, life-altering decision only to be told I would have to wait about nine months for that to happen.  Yet, I have found myself happy that Kaiser put on the brakes so that I could be educated during this time.  

The class last night was an opportunity to learn more about the difference between a gastric bypass and vertical sleeve, the two choices we are given through Kaiser.  Not one to be patient and wait for this particular week to learn more information, I have been doing a lot of research on my own.  I don't take this lightly and so I find a huge desire to be well informed.  The principal at the school where I work has called me a lifelong learner because I approach things like this as a student.  That's not necessarily a bad thing at all.

Bypass or sleeve, which way to go?  Oh, if only you could get in my head right now.  I cannot possibly describe the level of seesawing I feel inside.  In the beginning, I was all about the bypass.  People keep calling it the "gold standard", the one in which other surgeries try to emulate.  That makes sense since it has been around the longest and has a proven track record.  Then, as I was doing more research, I felt sure that I had switched and wanted to pursue the sleeve.  It simply is far less invasive and does not have the malabsportion issues prominent with the bypass.  I believe constipation is a bigger issue, which has to be a large concern for me since I had some major problems when I was on Optifast.  Of course, ninety percent of your stomach is removed, so there's that to consider.  However, after the discussion last night, now I wonder if perhaps the bypass is a better surgery for my situation.  The biggest issue is that I am a diabetic and most people who have that choice of surgery have diabetes resolved.  That's a big deal to me.  Of course, it does happen with the sleeve as well.  If I go with the bypass, I will have to be very committed to taking the supplements for the rest of my life because my body will not naturally be able to produce those essential nutrients any longer.  When I think about my commitment, I think about my brother.  He had a heart transplant years ago and while he does not take nearly as many anti-rejection meds as he did in the beginning, he must take pills every day.  The flip side of that is that he was given a new life, so a few pills in the big scheme of things isn't really a big deal.  He is committed to his new life, so this begs the question:  Am I just as committed?

Can you see now why I'm freakin' confused??  The facilitator did assure me that I will have an opportunity to speak with the surgeon and discuss my choices prior to the surgery so that we can make a decision together.  I have a feeling I will be told the bypass will be the surgery he will support for me because of the diabetes, but I also want to discuss the sleeve as an option.  On paper, it makes more sense to go with the bypass but my poor body has been through so much and to put it through the more invasive surgery as an automatic choice is something I fight. According to our patient manual, the weight loss is about the same with both procedures, although it will be a little slower with the sleeve.  When the possible complications with a bypass are 23 percent as compared to less than five percent with the sleeve, I'm sure you can understand my pause.

There are some questions that I will need to consider as part of all of this.  Instead of rushing through them in class last night, I want to spend some time really working on them this week and honestly searching my soul in terms of what is right for me.  Some of those questions include:

• Why am I contemplating bariatric surgery?
• Which type of surgery do I want and why?
• Have I honestly tried to lose weight non-surgically?  Why will surgery be different for me?
• Have I really considered the risks of surgery before now?  What risk level am I willing to accept?
• Have I considered the hospital portion of this process?
• How will the type of work I do affect my recovery?
• Am I willing to give up some foods for the rest of my life?  Am I willing to take nutritional supplements daily for the rest of my life?
• What level of weight loss will satisfy me?
• What will success be for me?
• How willing am I to commit to managing my food intake for the rest of my life?  How willing am I to deal with the underlying reasons for my past overeating?
• In what ways might I and my friends and family sabotage my program?
• Am I willing to stay on my program for the rest of my life?  What steps can I take to make sure I follow my program?
• Am I willing to minimize or eliminate eating high-sugar and high-fat foods for the rest of my life?  What steps can I take to make sure I remain compliant with all my post-operative instructions?
• Am I willing to remain vigilant regarding my caloric intake for the rest of my life?  What steps can I take to make sure I monitor my food and calorie intake?
• Am I willing to take the time I need to be sure my decision to have surgery is the right decision for me?  What do I need to know in order to make my decision?

Wow.  I can really see that the answers to these questions will be incredibly important for me.  Not

only are the answers important, but my willingness to be honest is equally as important.  This is more than just about which surgery I will choose but ultimately why I am choosing surgery in the first place.  I had a thought last night, fleeting as many of the thoughts I had, about maybe revisiting Optifast again.  I was able to lose 192 pounds through the program.  As fantastic as that was, I think my brain has forgotten all of the issues I had while I was on the shakes, though, especially towards the end.  I don't want to scare those that read my blog who are on the program right now, but I had a lot of medical issues going on after being on it for so long.  Truly, I think I thought about Optifast again because surgery is scary.  I gained a lot of my lost weight back after stopping Optifast and I can't forget that either.  Don't get me wrong, I'm not rethinking having the surgery (although that is okay if I choose to not forgo it in the future).  Surgery is just a tool, albeit a very important one, but I must give those questions serious consideration.  My life will change forever.  Forever.  I owe it to myself to spend some time in serious contemplation and answering those questions with my deepest level of honesty.  Heavy stuff.

Water Challenge Day 46:  Drank 182 of 182 ounces

Now I understand why keeping track of food is so important

When I started the Options program, which is the six months of educational classes before bariatric surgery through Kaiser, I was open to whatever suggestions and "rules" I was going to have to follow.  Basically I was (and still am) willing to do whatever they ask of me because I know it's going to prepare me the best for a different lifestyle after having the surgery.

One of the first things we were told in the classes was that we would have to keep track of all of our food and then show it to our facilitator each week.  I have to admit, I inwardly rolled my eyes and thought to myself, Really?  You're going to make me show you what I'm eating, as if you don't believe me?  Each week when we go to class, we either turn in our written logs or show our app with all of our food, water and exercise documented.  I use the MyFitnessPal app (my screen name is MissKathyJean if you want to follow me there).  I love it because it's super easy to use and I can scan everything using my iPhone.

After doing it for over a month now on a consistent basis, I finally saw why it is so important.  It's one thing to write down the food you are eating or planning to eat but it's quite another to really see it.  Up to now, I had been noticing my daily totals and seeing that I haven't been eating enough.  Today, however, I got a huge jolt when I logged in my lunch.  I wasn't planning today, just sort of opened the fridge to see what might be good.  I decided on some salmon with stir-fry veggies over quinoa.  It was incredibly delicious ... until I logged in my food.  Quinoa - 110 calories for a half cup, 1 tablespoon of extra virgin olive oil - 120 calories, and a slew of veggies - 40 calories.

Then came the salmon - 340 calories.  Shit!  I had to look at the package again to make sure that scanned correctly.  When my dad was here, he bought this package of salmon from Costco because it was portioned individually, which I thought was a great idea.  I remember logging in my salmon the other day when we had grilled them, but I just did a generic salmon and didn't look up the specific details.  By scanning the actual package, not only was it 340 calories, but I discovered one portion was seven ounces, not the three to four that I would hope to aim for.

I really got to see that this exercise of turning in our food every week is not an effort in futility but really about changing bad habits into good ones.  I think it's very important to stay aware of what goes into my mouth or something I'm considering eating.  It brings to mind a commercial I've been seeing on TV a lot lately from a national pizza chain.  They keep talking about this new cheeseburger pizza that they're now selling.  To me, it's not something that looks even remotely appetizing because all I'm imagining right now is how long I'd have to work out to have just one slice of that stuff.  Out of curiosity, I looked it up online.  For just one slice of their original crust large size pizza, which is apparently 1/8th of the entire thing, it's 410 calories, 22 grams of fat, 950 milligrams of sodium and 38 grams of carbs.  Let's be honest - when is the last time you had 1/8th of a pizza??  It's usually like 2-3 slices, if not more.  I went to the lake today and burned almost 800 calories walking around it several times.  If I would have chosen to have that pizza, that exercise would have burned almost two slices.  Doesn't seem worth it to me.

I completely recognize my awareness is because I'm being forced to document all of my food.  Turns out that's a good thing for me after all.  It all adds up.  I'd be frightened to see how many calories I was ingesting on a binge.  I mean, honestly, if I had eaten a half of the pizza I mentioned above, that would be 1640 calories and that's just half.  That is slap you in the face reality right there.

I'm not done with my water for today, so I'll document how much I had tomorrow at the bottom of the post like usual.  I think I'll do that from now on so I'm not feeling as though I can't post before 11 p.m.

Pre-op class #5, weekly weigh-in and meeting my new therapist

This week's Options class was about the benefits of exercise.  I don't know about you, but I would always internally roll my eyes when a doctor or P.E. teacher told me that it would be good for me to get more exercise.  Of course it would but it's much easier to talk about how great exercise is when you don't weigh 200, 300 or 400+ pounds.  Zumba class is a lot more fun when you can actually move around and enjoy yourself.  Even water aerobics hurts when you have osteoarthritis in your knees.

Yesterday I went for a 3 mile walk around my neighborhood, which was fantastic.  It was the same course I used to do when I was 150 pounds lighter, but I have to be honest and say it hurt a lot more yesterday than at other times.  Yet, keeping up with it will make it hurt less and less over time.  It felt great to give that to my body because I know it craves the loving care that exercise gives it.  One of the things I will need to do after surgery is walk a lot to help with recovery and so now is the time to make it a habit.

My weigh-in was good - I lost another two pounds.  I'm starting to see the scale making some progress heading down and that's terrific.  As my dad was leaving my house this morning after visiting for a few days, he asked me to come and visit him in June.  Since I'll still be taking my classes, that means I'll need to fly on a plane since that's quicker than driving 700 miles each way.  It's a pretty great incentive to keep up on the walking so I fit better in that airplane seat!  Sure, I can look to other wonderful benefits, such as improving my circulatory system, improving tension and reducing my appetite, but I also do know it's a great motivator for me to keep up on an exercise regiment knowing that I'll fit better in an airplane seat.

I had my first meeting with my therapist tonight.  My other one retired at the end of January and I felt it was important to keep up with therapy, especially as I walk through gastric bypass surgery.  It's such a major surgery and I need to continue working on the emotional issues that come with food addiction.  It's amazing to me how easily tears can come when I'm having a real, honest conversation with someone and all the walls are down.  I went through two tissues!  It's all good though ... obviously I needed to cry.

One of the things we talked about is my desire to go to food for many things, not just happiness or sadness but everything in between.  It's been my way of living life, almost second nature.  I'm bored - go to food.  I'm angry - go to food.  I'm depressed - go to food.  I'm in love - go to food.  Here's an example:  my dad left today.  While he was here visiting, my food was fabulously healthy, just as it was before he came.  My blood sugar was in control, even a little on the low side.  Yet, after he drove away, all I wanted to do was go in the house and eat.  I wasn't hungry and I wasn't thirsty.  That seems to be my response for a lot of things.  It seems like it's such a learned response that I need to do some serious work to break that pattern to move away from it.  The therapist suggested a great group that Kaiser offers called Mindfulness Meditation.  It will be an opportunity for me to go through guided meditation so that I am more aware of what's going on, which will then lead to new habits instead of going to food.  I'm all for that.  I so badly want to heal and turn things around towards a healthy, positive light.  That doesn't mean the meditation will magically take the desire away, but it's a huge step in the right direction.  The next group doesn't start until March 18th.   However, she did give me something to think about in that regards when I'm faced with a situation that makes me want to overeat in the meantime:

R - recognize what emotional state you are experiencing
A - acknowledge state
I - investigate, be curious
N - non-attachment

So here I am, placing one foot in front of the other making progress towards a different way.  I'm grateful that I have the courage from somewhere deep down inside to do everything that I am to be healthier.  God is so powerful!

Water Challenge Day 35:  Drank 110 of 183 ounces

Trying not to stress about it

It seems like this issue with my inability to sleep with the CPAP machine has been overtaking most of the space in my head.  Last night I decided to sleep sans the machine and I fell asleep in about five minutes.  I remember my head hitting the pillow and then I was out like a light.  The truth is that I sleep so much better without the machine that is supposed to help me sleep better.  Ironic ain't it?  Two reasons keep me trying the machine.  First, it is incredibly dangerous for my heart and overall health to live with unregulated sleep apnea.  The research I have done has more than convinced me that I have to keep trying.  Second, I am going to have the gastric bypass surgery later in the year and if I can't sleep on my back, how am I ever going to recover after surgery?

This issue with surgery recovery has been really weighing on my mind a lot.  I know that, for many people, they no longer have sleep apnea sometime after the surgery.  Imagine, having this incredible surgery to have a healthier and longer life.  You're in the recovery room and all of a sudden you can't breathe because you wake up every time you fall asleep.  And the doctor tells you not to lay on your stomach because your incisions need to heal.  So you're lying there in a dark room, struggling with a CPAP machine that only keeps you up and prevents you from sleeping.  Your eyes hurt from being so tired but you Just.Can't.Sleep.  No matter what you do, you Just.Can't.Sleep.  Tears are falling from your eyes out of frustration in not being able to fall asleep without losing your breath.  This is what I'm going through right now.  I lay there with every good intention that this will be the night that I will fall asleep with the machine, even if it's just 15 minutes.  It never happens.  I'm talking never, ever.  

I decided to be proactive today.  Instead of sitting here in wonder, I decided to send a message to the doctor who approved me for the surgery.  I am seeing a pulmonologist next week, but I don't know if he can answer questions about the specifics on the surgery.  I know I'm being impatient, I completely own that.  Yet, the worry about what will happen after surgery is messing with my head so much that I just had to ask some questions to find out if I should worry or if I can relax a bit.  So here's what I asked the doctor in my message:

"Hi Dr. R,

I am currently participating in the Options program leading to a gastric bypass surgery.  I have a question I'm hoping you can help me with since I don't have a surgeon yet with it being too early in the process.  I was diagnosed with sleep apnea a couple of years ago, tried the CPAP machine but gave up because I just couldn't fall asleep.  However, I have decided to try again because I know how important it is to be on the machine.  I am still having extreme difficulty and cannot sleep on my back or side.  I lose my breath and wake up.  I have an appointment with the sleep clinic to see how I'm doing.  However, in regards to the surgery, is it possible to still have the surgery if I'm a tummy sleeper?  I'm just worried I won't be able to have it if I can't sleep on my back/side.  If you could provide me with some insight, I'd appreciate it.  Thank you."

So I sent it off with bated breath, hoping the doctor would help me feel better or at least alleviate the worry I have going on inside.  Here is his very detailed response:

"The condition or way you sleep should not interfere with surgery.  Thanks."

Okay.  Mr. Personality he is not.  I might look into whether or not I can contact one of the surgeons that actually perform the surgery just to be certain because his response left a lot to be desired.  He does not perform the actual surgery, but does the final approval for Kaiser members in the San Diego area that want to move forward with the surgery.  

These are the things that take up space in my head and make me want to eat when I'm left with more questions than answers.  And I have to admit that I really wanted to eat today.  Instead, I drank water.  Ho hum ... water.  It didn't give me quite the thrill that a scoop of ice cream does, but it shouldn't be doing that anyway.  Sorry I seem to be talking about all the CPAP trials and tribs lately.  It's just all-consuming for me because I'm very tired, physically and emotionally.  It has wiped me out and I feel non-functional lately.  I'm sure I'm handling things better than I think in my head but I'm just exhausted.

Water Challenge Day 23:  Drank 185 of 185 ounces

400 posts later

Two years ago, almost to the day, I started this blog.  I had made the decision to pursue weight loss through Optifast.  It's such a roller coaster of emotions to go through my older posts, remembering what I as going through at the time and how I feel about things today.  I wouldn't erase my journey with Optifast (or Weight Watchers and Jenny Craig) since that time because, truthfully, those things brought me to where I am today and my decision to have gastric bypass surgery.  I have tried so many things to lose weight during my entire life and it's really those things that made me hit my knees and ask God to guide me on this.  I wonder if I am courageous enough to continue on this journey.  I also wonder if I will fail.  The best thing I can do for now is just be honest about how I'm feeling, trust in God to lead me and pray for bravery.  This is my 401st post (can you believe it??) and I've had more than 66,000 hits to my blog.  Obviously I'm not alone in this journey and I'm so grateful for that and for all of you wonderful readers.

Tomorrow I begin my pre-op classes for the surgery at Kaiser.  To say I am ready is seriously the understatement of my life.  I have really come so far in the emotional part of this process already.  When I first even made the decision that I was indeed going to pursue surgery, I felt incredibly scared.  Now that I've done more research, talked to more people who have had it, shared my decision with an incredible support system and have a center for excellence that will be doing it, I find myself more excited than a child on Christmas morning.  Now that's excited!  Of course I will continue sharing my journey here.  I need to post more than ever before as I go through such an incredible journey.  I'll bring back pictures of my progress here once I start accumulating some.  I still have them from my Optifast weight loss, but I don't want to compare myself today to the self that I was while doing Optifast.  This will be a different experience, one that I feel in my heart I will be able to do.  Let's face it - if I was able to survive on nothing but liquids for something like 8-10 months, I know I can do this too.

Water Challenge Day 7:  Drank 190 of 186 ounces

Sleeping and body image

My mother went home after spending four days at my house.  It's nice to have my place to myself again, although I do miss her.  I know that she will be living with me in the future, probably after she retires from her job, so these little visits over are good.  She's alone and, especially as she gets older, I don't want her living by herself.  I really am more amazed each day at hour our relationship just continues to grow and flourish, especially after such an abusive childhood.  This helps me see that really all things are possible.

It looks like my APAP machine (CPAP with auto adjustment features) is in so I'm going tomorrow to get a fitting.  I told the person on the phone that the mask I was given to do the sleep study just isn't working for me and that I'd like to have the nasal pillow.  It was pretty amazing in how easy that conversation went because they told me it wouldn't be a problem.  I'm so grateful to have insurance because the machine along with everything associated is completely free to me.

My biggest problem with sleep is that the only position I can sleep in is on my tummy.  That's normally fine, but that is not going to work after I get the gastric bypass surgery done.  What happens to me is that I'll lay on my back and I'll start to fall asleep, but then I either snore or stop breathing and then I wake up.  I've tried many different positions to make it happen - bigger pillows, smaller pillows, sitting up, laying perfectly flat.  No matter what I do, I just can't get to sleep.  This is a big reason I decided to get on the machine for the sleep apnea so early when my surgery won't be for another eight months or so ... I need the time to adjust.  My dad said he has the same problem but he was able to overcome it eventually with the nasal pillow.  He said it did take time and patience, but it is doable.  Lord help me but I pray that the surgery will aid in getting rid of the sleep apnea altogether.

Speaking of the surgery, I'm feeling really antsy.  It is months away and I just want to get going with it already.  I know a big part of that is that I've been having some really major body image issues coming up lately.  This morning when I was changing my clothes and looking in the mirror, I focused on my thighs.  The excess on my upper thigh feels like a growth to me, even though I know in my head it is not.  I recently watched a program on TLC, Half Ton Killer, and I know I am comparing my body to hers.  It's the story of a woman who weighed over 1,000 pounds and was accused of killing her little nephew by accidentally rolling over on him while babysitting him.

Obviously I don't weigh 1,000 pounds.  I just sat there staring at the screen and looking at the mass of flesh surrounding her, feeling so broken-hearted for her but also feeling as though I am the same way.  There are so many physical limitations that she has that she is now bed-ridden.  I wondered how she could get to that extreme point without doing something about it, but then realized I am in the same situation.  Sure, it's not as drastic as hers, but it seems like I closed my eyes one day and wondered how all the weight piled on without me really recognizing how bad it had gotten.  Obviously I saw what was happening, but I guess it just goes to show me how much of an addiction food is to me, just like alcohol is to the alcoholic.

Whether this was before I went on Optifast or after the weight came back, the devastation is still just as strong.  I just don't want to feel the physical and emotional pain of obesity any more.  I don't want to continue putting my life at risk being this size.  I know there is a process I need to go through with the surgery and the next stage of that will happen in about three weeks with me starting the six-months of classes. I just want it now.  I want to close my eyes and fast forward to the time I can have the surgery done.  It's hard being in this body and not feeling shame when I look in the mirror.

Of course, in the meantime, I do have the opportunity to be proactive and do my best to be as healthy as I can right now.  Kaiser has set a goal for me to lose 37 pounds before the surgery, so I'm doing my best to work on that.  Obviously I have to work on the feelings I have going on.  I'm so glad that I was brave enough to seek out therapy because my head is the source of all the negative emotions around body image.  I think it is vitally important for me to continue working with the therapist throughout this entire process.  Otherwise, I am quite certain I'll repeat patterns that got me here in the first place.  I definitely don't want that to happen.

Feelings of grief I think

Today was incredibly painful for me.  Not physically, but emotionally.  I shared yesterday that I was given some potentially devastating news in terms of my graduate program to do school counseling.  I had so many unanswered questions that I decided to send a message to the personnel department to figure out what's going on.  To do the field work required for my master's degree with my district, I have to do it 24 hours per week over three full-time, 8-hour days for the duration of about a semester or so.  I will have to take a leave of absence during those days from my 40-hour per week job.  I am not permitted to do the hours during the summer.  Then, when the time comes to apply, I will have to quit my job and do counseling in another district for a minimum of two years before I will then be allowed to come back and counsel in the district where I have been working for 24 years.

The biggest problem I have is that I already work in the counseling department of a busy high school.  None of the years I have matter, though, not where this is concerned.  I have given so much to the district where I work.  I'm a product of the district and love the work I do.  All I want is to be able to have the opportunity to become a counselor, but that opportunity is just not there.  Not only that but I will have to quit something that I have been invested in for so long.  I have accrued so much time towards retirement, benefits and more. If I leave, that means I will probably have to also leave my doctor because my insurance will likely be through another provider.  It's just very, very difficult to deal with this.

Thankfully I work with some fantastic friends who helped me to look at the bigger picture.  If counseling is important to me, yes perhaps it may not look like what I thought it would but that might also be a blessing in disguise.  I just won't know until I stick my neck out and take the risk.  They are absolutely right ... the point is to be working with kids.  There are no guarantees with anything and so I have to walk forward in faith.

I do have a strong faith, but being a human being is also hard when we often times have fear.  Right now I have a lot of it.  I shed a lot of tears today over this, but I have been incredibly supported by so many people.  My supervisor reminded me of something that fits in with this situation just perfectly:

Be still and know that I am God.  That means I'm not in charge of the outcome.  In fact, I'm in charge of no part of any of this process.  I am responsible for doing my part, but after that it really is out of my hands.  As the day went on, the tears were less and less.  I went from sort of throwing my hands up in the air to stepping back, taking a breath and saying to myself that this is really going to be okay.  Obviously there are so many other battles to fight out there.  I'm not discounting how I feel, but just to get some perspective.

In other news, I received a call from the Positive Choice clinic to schedule my pre-op classes.  That was super fast!  I just saw the doctor yesterday and they were already calling me.  Unfortunately, I missed the call so I won't be able to schedule until tomorrow morning but at least I'm on my way.

A few weeks ago, I completed a sleep study with Kaiser for the sleep apnea.  I received a report in the mail today regarding the results.  I definitely have obstructive sleep apnea and they are recommending the use of the auto-titrating machine (APAP).  The report showed me averaging less than four hours of sleep per night.  No wonder I feel so flipping tired all of the time!  Because of my medical history with this, they do want me to meet with one of the board certified sleep specialists to discuss my diagnosis and any follow-up care I will need.  So I need to make an appointment in regards to that.  I swear, in the last year or two, I have seen more specialists, nurses and doctors for a lifetime.  These are additional reasons as to why I am pursuing the bariatric surgery.  While it's not a cure for all that ails me, it will most definitely help and that's all I've ever really wanted - to just feel healthier.

My highly stressful day

I had a whirlwind of emotions today and I'm still trying to process them.  I have mentioned before that I'm in the process of applying to graduate school.  My goal is to participate in a master's program that will lead to a school counseling position eventually.  I currently work in the counseling department of a big high school.  I love what I do working with kids, so this is just a natural progression to the next step up for me.  I've actually worked in education since I was 17 years old and now I'm 42, so I definitely have a lot of experience.  Nothing can prepare me more for this than what I'm doing now, getting day to day exposure of what happens in high school counseling department.

So I was talking to a colleague who is currently in a graduate program for the exact same thing.  She's about a year in and mentioned to me today she found out that if I want to eventually become a counselor in our current district, my practicum and field hours must be performed three full days per week.  The program requires a total of 600 hours doing that.  Given that I work full time, 40 hours per week, and I would be participating in a full-time graduate program with classes taken at night, I felt like I was sucker-punched.  A friend of mine called her contact at our district office and the person confirmed that I must do three full 8-hour days or I could possibly petition to do four 6-hour days.  Regardless, it must be a minimum of 24 hours per week and they don't want it split up.  The district's rationalization is that interns don't get to experience the full scope of what happens in a counseling department if their time is split up to just mornings or just afternoons.  I do understand that logic, but I already work in a counseling department!  If I choose to do my hours outside of my district, they basically won't hire me.  One of my friends, who is a current counselor and is supervising two interns right now, told me that her interns said the district won't hire you unless you have counseled elsewhere for two years first.  If I do end up counseling somewhere else, I likely will not be returning to my district unless there's a compelling reason to do so because it will be a huge deal to leave my district in the first place and I probably won't want to leave another place.  Never say never, though.

I was pretty upset at all of this news.  I wasn't even at the point of wanting to cry over it.  I was pissed.  The graduate program itself is completely flexible and will let me complete my hours part time or in any way that works out for my schedule.  The issue is with my district and their strictness with those 24 hours.  Am I supposed to take a leave of absence?  Am I supposed to somehow make up those 24 hours somewhere?  It's not as if I don't have any exposure to kids and everything is theoretical for me ... I work with kids everyday and often do many things that a counselor would do.  Granted, I do not handle crisis counseling because there are legal issues around that, but there are often crossover duties.  I did decide that I'm going to contact the personnel department and talk to them about my concerns.  My friend that told all of this to me today is a teacher, so the way things will work out for her schedule-wise is different than my situation.  Regardless, though, we both have to face the fact that, if we move forward in the programs, we will have a huge cut in pay.  I'm a single person who has no other income than my own, so I'm faced with having to make some very touch decisions to survive on 16 hours per week of pay.  Excuse my language, but fuck!

With all the stress of that churning in my stomach, I had to leave work a little early and then head to my appointment at Kaiser to meet with the program doctor who would be reviewing my test results and discussing whether or not I would be officially accepted into the program for weight loss surgery.  I didn't know what to expect, so I was feeling anxious with butterflies churning in my tummy.  When I checked in at the Positive Choice clinic, I was asked to weigh myself and then have a seat to wait for the doctor.  I have gained a couple of pounds.  I didn't know if that was a true gain or because I had been drinking water all day, which always adds weight.  I got recorded at 371.5, which was pretty difficult for me.  My lowest weight I got down to when I was doing Optifast about a year ago or so was, I think, 220.  As I sat there waiting, I had to remind myself not to beat myself up over the number because I'm there to get healthier, not berate myself.

The doctor came and got me and brought me back to his office.  I looked around and noticed all of his diplomas, awards and news articles about weight loss and surgical options on the walls.  There were drawings of the differences between the different weight loss surgeries as well.  He began by discussing my current BMI, which is calculated to be about 54.  He said the program requirement is to have a BMI of 40 so I more than qualify on that front.  Fantastic Kathy (can't you detect the sarcasm?).  Then he started asking me about my diabetes, whether or not I inject insulin, my osteoarthritis, the pain in my legs and fibromyalgia, my history with high blood pressure, sleep apnea, depression and all the medications I take.  He told me I am an excellent candidate and congratulated me since he is approving me for surgery.

Hoooooray!!!

All the stress of the day went away in that moment.  I am now officially on my way.  He does recommend the gastric bypass surgery for me since that is the one where I can lose the most weight and most of those patients have their diabetes go into remission.  He did explain that my diabetes will never be reversed or go away, but the remission will make it so that I won't appear to be diabetic any longer as long as I follow the program.  When I discussed with him the difference between the gastric bypass and the vertical sleeve, he said the sleeve does not allow for as much weight loss and the not as many patients have remission of their diabetes.  The lap band does not reverse the diabetes at all.

The next step is that one of the nurses will be contacting me in about a week to put me in a class.  Since Carrie and I want to do the class together, I'll be choosing the one that is closer to where I live.  The only bummer is that it doesn't start for another month.  However, unless they have a class starting this month, that's the one I'll do.  The doctor did say that about a month before the six-month pre-op classes are over, I will be contacted by one of the surgeons at Pacific Bariatric to meet with them.  The surgery will happen about a month after I finish the classes.  That will bring me into about mid-August in terms of having the surgery.  The doctor did say that I will be in the hospital for two days to make sure I don't have any complications develop and then I should be back to work within two weeks since I don't have a highly physical job.  He did tell me that, in terms of my weight, we want to aim for me losing about ten percent of my body weight prior to surgery or at least maintaining where I'm at right now.  They don't want me gaining but staying the same is okay, too.  So here I go!

Surprising result

From the lab work that was done on Monday, I thought I was done with all the tests they were going to do with my blood.  Wrong!  I happened to log onto Kaiser's patient website to look at when my next appointments were and found this message that was sent to me before a received an e-mail notification:

"All of your lab results look good, except for your vitamin D.  Your vitamin D level is low (24):  Normal range is 30-100.  A prescription is entered into the computer for you to pick up at any Kaiser pharmacy for vitamin D 50,000 units by mouth to take three times a week (or every other day) for 6 doses.

"You should also be taking over-the-counter vitamin D3, 2000 units daily as a routine supplement.  Continue taking the over-the-counter dose after completing prescription.  You will need to check lab again (vitamin D, PTH, calcium) after treatment.  Orders have been entered for non-fasting lab to be done the week of March 10th.

"You may also find the following website contains helpful information and you may purchase supplements designed for bariatric patients: www.bariatricadvantage.com."

So after reading all of that, the thing that struck me first was the part where she mentioned purchasing supplements for bariatric patients.  I wondered to myself, "Am I a bariatric patient now? Have I been okayed to move forward?"  These are legitimate questions, but probably most people would focus on the deficiency part first and worry about the bariatric label later.  Not me ... impatience rearing it's ugly head.

Back to the vitamin deficiency, I wondered how I could possibly be lacking in vitamin D.  Usually that's for people who don't get enough sunlight.  I do try not to bake in the sun since having melanoma, but I also don't hibernate indoors either.  I know it's winter time, but I live in southern California - there's generally always sunshine of some sort.  I went online to Web MD to see if I could find out what was going on.  What I saw made sense: of the various symptoms, I qualify in two areas - have darker skin and lactose intolerant.

I went to the pharmacy and picked up the prescription.  Pills with 50,000 units of vitamin D seems like a lot, but I'm sure that's just to get my levels back to where they should be.  I always think to myself that I have too many pills to take, but that is incredibly laughable because, after I have the gastric bypass, I will be taking vitamins for the rest of my life.  I am sure I will get rid of most, if not all, of my other pills as my health improves in the future.  I need to do what I need to do to get my level back to normal, so no big deal in the big scheme of things.

What, another change?

Yes! I like to keep things fresh so here's a new look to my blog.  I'm still trying to figure some things out, so there might be some minor changes but I decided that as I move into a new phase (surgery) of my journey to living a healthier life, it was perfect timing.  The woman at the top represents me springing out of this body that hides a fresher, more confident, sexier, much more free Kathy.  I found out yesterday that my melanoma biopsy is benign (YIPEE!!!) and so it's time to celebrate ;-)

Speaking of my surgery, I found out more information in terms of my next steps.  I had an evening workshop to schedule at work with some families in January, so wondered when my gastric bypass pre-op classes would start, provided I move to the next step.  They take six months and I didn't want to schedule a workshop the same night I have those classes.  I thought maybe I should just wait for my appointment with the doctor in charge of the Kaiser clinic since that's just next week.  Yet I realized it would not only be meeting with him but then waiting for the referral to get back to the program director and then finally scheduling something.  Or I could just call the program director and find out details right now.  Yeah, that sounded much better.  That way, I could plan my workshop and also find out when things get rolling on the classes.  Okay, if I'm being completely honest, it was probably more about finding when the classes start because I'm anxious than the workshop I need to do in January.  I just can't wait!

I called and got to speak with the director.  I told her I've gone through the orientation, did all the lab work and will be meeting with the doctor on Tuesday.  She sounded surprised I'd gotten so far so fast.  Well, I guess when you're feeling determined, you'll do whatever it takes to make it happen.  I knew that the choice is up to me in terms of how fast I want to get going. The classes will be starting on Monday, January 20th at 5pm.  My classes will be on Mondays, right after work, so that's perfect.  Even better, I get to do it at the facility closer to my house and I also get to do it with my new friend who is going through the same program.  I can't even express how excited I am about all of this.  I'm also so grateful I will not be doing this alone.  The support system I have going on for this is so much bigger than the one I had for Optifast.  It's been pretty amazing.  I haven't even told that many people outside of those that are very close to me.  I'm sure in time I will share it with more people, but for now I'm holding it close to the vest because this is very personal and I frankly don't want any Negative Nancy's bringing me down.  I had enough of those with Optifast.  As strongly as I felt about that program, I feel even moreso for this one.  After everything I have tried, it feels right for me on some very deep level I can't quite express.  But I think you get it.

A cut for me is a good thing and moving on to the next step

I had an appointment to see my dermatologist yesterday.  I got a call from his office over the Thanksgiving holiday to tell me I was on a waiting list to see him for a routine 6-month melanoma follow-up appointment in February.  I told his nurse that would be fine but to please let him know I have been experiencing pain around my incision site.  I didn't realize that little comment would spark an immediate phone call by the doctor himself (which never happens with my HMO unless it's to tell you bad news) followed by a next-available visit with him.  What's basically been happening is that I have been having significant pain and tingling at the tip of my back scar from the cancer surgery and it had been happening all of a sudden so I was concerned.  He ended up looking at it and prescribing some steroids for me to help with the pain.  While I was there, we did my regular appointment so that  wouldn't need to wait until February.  That entails a full body scan.  It's a less than thrilling appointment because the doctor looks at you from head to toe, literally.  He found two moles that are "concerning" to him in addition to taking a biopsy from my back where a spot had grown in size and changed shape.  So now I have a portion of my back cut out a few inches above the surgery site and it huuuuurts. The way they do it when you get a skin biopsy is they give you a shot of a local numbing agent and then essentially take a blade and shave off the area.  The size he cut off my back is about the size of a thumbnail.  When the shot wears off, you're left with a lot of pain.  So that's been sent off to be evaluated.  Meanwhile, the two moles he found made him very silent when he was looking at them and told me to diligently watch them.  That didn't sound good.  However, I'm trying to stay as positive as possible and be guided by my faith.  I've had two other biopsies that ended up perfectly fine so I'm assuming this one will as well.  As for the other two moles he saw today, I don't want to think about worst case scenarios because, right now, they are just little moles.  With my skin type, I have dark freckles that make it hard to distinguish sometimes between that and a mole.  I do have to say that, with all of my experience in dealing with a dermatologist, I have a great respect for the profession.  When I was younger, I had the misinformed perception that all a dermatologist really did was give botox injections and maybe help with acne.  I couldn't be more wrong!  It was a dermatologist that saved my life - if he had not treated my melanoma as seriously as he did, I wouldn't be here today.  I'm so grateful for my wonderful doctor and his empathy with me.

In other news, I received a message from the Options program that I am moving forward towards the next step of the weight loss surgery process.  I have to go get lab work done now.  That includes give lots of vials of blood samples (someone told me it's over 20 vials but I have a hard time believing that's true), a urine sample, EKG and providing a stool sample.  That last part makes me less than thrilled but, whatever, I gotta do what I gotta do.  I'm really happy I can keep moving forward.  For some reason, I had myself convinced that they would reject me from my answers in the questionnaire.  I know it's silly, especially given I have co-morbidities that make me the perfect candidate for the gastric bypass, but I have to be honest that it was a concern of mine.  I have discovered how very much I want to pursue this surgery that any disappointment along the way, perceived or actual, affects me greatly.  I found a really great group on Facebook that is a great source of support.  If you're interested, search for "Gastric ByPass Surgery Stories".  There are about 5,000 people in the group and the only people that can see your posts are other members, not everyone on your Facebook friends list.  It's a really active group with great before/after pictures, advice and people sharing their experiences.  I have come to really understand how absolutely necessary positive support is for long-term success with the surgery.

I actually do laugh at myself

Yesterday was such a busy day that I meant to post, but it just didn't happen.  I had two important Kaiser appointments.  One was the Lifestyle & Weight Management class.  If you are planning on going through weight loss surgery, one of the classes you are required to take in the beginning is this particular class.  They talk about portion control, planning meals, label reading and more.  You are actually given a sample meal plan to follow if you want to lose weight.  The dietitian brought in some of that rubber food that looks like the real thing but really just demonstrates what sizes are when trying to eat in a healthy manner.  It was a good class and I'm glad I went because I picked up some great tips that I can incorporate into my life beginning now.

The other appointment I had was to go to the pulmonary department and get instructions to start my next sleep study.  It's my third one.  I can't even express how much I'm dreading it because I just can't freakin sleep with the CPAP mask on.  However, I have to get on the machine.  One reason is the weight loss surgery requires it if I have a sleep apnea diagnosis.  The other reason is that, if I can manage it, I actually will sleep better.  At least I pray that is a result.  My problem is that I can't sleep on my back.   I will lay down and then, just as I'm falling asleep, I'll start to snore and then wake myself up.  So I generally resort to sleeping on my tummy.  That usually isn't a problem but, given that the gastric bypass is done on the tummy, I won't be able to sleep on it so I'll have to figure something else out.  If I'm being perfectly honest, my biggest fear around the CPAP machine is that I will be one of those people that just can't sleep with it no matter what.  However, I'm trying to take it a step at a time with that.

So, when I was in with the technician, I asked her if I could please use the nasal canal machine.  It just connects into your nostrils and does not have the gas mask.  Okay, so it's not really a gas mask, but it sure feels and looks like it.  She basically told me that she does not recommend that machine because it has a tendency to slip out of the nose and is a problem.  She asked me to please give another device a try and then go to that one after 6 months if I still want to pursue it.  I told myself that I would at least try what is recommended.  So there were two options - one with a mask covering your nostrils and one with a mask covering both your nostrils and mouth.  Sounds lovely, doesn't it?  I have to give a visual reference.  Below is a photo I had posted before I found of a person with a CPAP mask on that I found hilarious because it reminded me of Hannibal Lecter.

This mask is the one covering both your nose and your mouth.  The advantage of this machine is that you don't have to worry if you ever sleep with your mouth open.  However, my machine just covers my nose.  I have a lovely chin guard to wear that will keep my mouth closed.

Ready for a picture of what I will look like going to bed?  I know you're just dying to see it.

Are you sure you're ready?

This image will be one you won't be able to get out of your head. Ever.

Wait for it ...

Wait for it ...

Boom!

Ha ha!!  Tell me that isn't hilarious!  I purposely tried to look like the man in the other picture with my eyes wide open.  When I showed it to a couple of other people today (I took it last night), we were laughing hysterically in howling laughter.  I just thought to myself, "Oh, that is attractive!"  It just seemed so ridiculous to me.  You can't even see the special chin strap, but that's just like the icing on top of the cake.  At least I'm laughing at myself ;-)

All kidding aside, there were moments when I got very sad as I was getting instructions on how to do the sleep study.  My sleep apnea is in the "severe" category, I believe the worst level there is.  There was a moment when I wanted to put everything back in the bag and run out of the room.  I wondered to myself if this is some sort of punishment towards me for years of having problems with overeating.  Did I do this to myself?  I just felt really, really bad in the moment.  I did remember, though, that this is a process and I am going to be just fine. The gastric bypass will really help with this, maybe even reverse the condition similar to what will likely happen with the diabetes.  I need to remember to breathe and pray that God give me strength through all of this.  I did try the machine last night and, after two hours of attempting sleep, I finally took it off so I could at least get some sort of sleep to be functional today.  I'm going to try again tonight, though.  I'm not giving up.  Besides, the technician said that there are lots of things they could do, even send me to a formal sleep study where they monitor me overnight.  So all is not lost and I don't have to think about it in such a black and white fashion.  I always said my goal was to be transparent here and I wasn't kidding.