Now, Life After Surgery

Went to a monthly follow-up meeting last night, and Dr. Courtney Holbrook, who ran the session, gave me two  writing assignments.  This is The Second.

For this assignment, Dr. H asked us to write about what our life was like After surgery, to help us remember why we decided to have it. She suggested answering questions like these to focus my attention on the prospects and possibilities of change.

Describe how you have changed.  Major change so far is dietary compliance with my pouch, my "tool" that has replaced my former stomach. I eat three meals each day, focusing on protein first. About 1200 calories per day, emphasizing meat protein sources (mainly chicken and fish) and veggies.  And some fruit.  Much less carbs than I ate before surgery (BS), and less fats.  And smaller servings, no grazing.  No sweets, either.  The only real sweet thing I've eaten in four months was a partial piece of wedding cake at grandson Erick's wedding to Evangeline.  And I felt guilty for 3 days.

What are your dreams and how are you achieving them?  I'm not much of a dreamer.  There are a number of things I'd like to do on my Bucket List, and the major change offered by the surgery is to improve the odds of me being here to do them.

What is it like to live in your new body?  Pretty much like the old body.  I've lost 70 pounds, but I don't yet feel really different  Much of the weight loss has been from my arms and legs, and so my torso feels unchanged.  Now, in honesty, my pants sizes have dropped from a tight 46 to a loose 42. And today I'm wearing a loose comfortable shirt that I couldn't button two months ago.  But I haven't really made an emotional adjustment to a "new body."  Yet.

How do you define health for yourself?  Not being blind.  Not having my feet cut off.

What are you looking forward to?  Pretty much the same things I looked forward to BS.  Family life, friends, spending time with my wife, children, grandkids, and great-granddaughter.  Still working on my bucket list, and would love to take a tour that would travel over the route of the Lewis and Clark route to the west coast.  I'm hoping to organize a family reunion next year to celebrate the life of a great-grandfather who pioneered settlements in eastern Utah.  And I may go back to my writing job.

What interests that you had wished for when you were overweight are you pursuing now?  Uh, I still feel like I'm overweight.  Ask me again after I lose another 35-40 pounds! :-)

Life Before Surgery?

Went to a monthly follow-up meeting last night, and Dr. Courtney Holbrook, who ran the session, gave me two  writing assignments.  This is The First.

For this assignment, Dr. H asked us to write about what our life was before surgery, to help us remember why we decided to have it.  For me, the answer was simple: diabetes.  I had fought this affliction for over 20 years, and despite reasonable care and close compliance, I was starting to see my end game, and it wasn't pretty.  My eyes were damaged, and I am restricted from night driving.  I had a stroke in 2006, followed by heart surgery.  And I was feeling effects of diabetes in my feet and legs.

Some of my friends and contemporaries have had much more serious issues.  Three of them have had leg/foot operations, and two have had parts of a foot amputated.  Because these are dear friends, it was easy to see myself in their shoes, and predict that another few years would leave me with amputations and blindness.

I had wanted to receive bariatric surgery five years or so ago, but my then-primary care physician vetoed it.  "Absolutely not," he said.  "That is dangerous, unproven surgery and I'll never approve it."  I eventually found a new PCP, but never trusted him enough to discuss this.  Fortunately, my insurance provided an alternative to requiring a PCP approval.

120 Interesting Days

Okay, it happened.  Surgery April 20.  Weighed 274 pounds, felt like crap.  Checked into St. Vincents hospital on 20th, and surgery performed by Dr. Ben-Mier that afternoon.  Was in hospital about 4 days total, dealing with issues of blood pressure, heart rate, etc.  They took me off insulin the day of surgery, which I thought was wonderful.

Now, four months later, where am I?  Today...
     ...I weigh 204, showing a weight loss of 70 pounds.
     ...I am still off Insulin, and my fasting blood glucose yesterday was an excellent 96.
     ...I am taking about one eighth as much blood pressure medicine as BS (Before Surgery.)
     ...I'm taking half as much heart rate medicine.
     ...I can walk 1.4 miles in less than 30 minutes without stopping to catch my breath.
     ...Curiously, I am not exercising as much as I need to.  This is a bit of a mystery to me.
     ...My arms and legs look to have carried me through a famine.  The ol' weightlifter has stick arms now.
     ...I'm troubled by intermittent bouts of dizziness.  Today at Costco, almost fell into my shopping cart.  Several other people pitched in to keep me upright.  This happens embarrassingly often, like maybe once a week now.  WTF???

Last-minute flap

Some excitement last week, followed by a reprieve of sorts.  My surgery still scheduled for the 20th, but early in the week, they told me I had flunked a blood test and needed clearance from a nephrologist.  A Kidney doc.  Now I don't have the greatest relationship with my kidney doc.  When I called mine for a rush appointment, they told me the earliest I could get one was in June.
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(Why do I have a poor relationship?  Well, it feels like they mainly give gloomy warnings rather than useful therapies... grave warnings about how I'm killing myself with  diabetes... blood pressure... etc. It sometimes feels like the kidney docs are all operating a cosmic Ghoul Pool and the one who comes closest to guessing my departure date gets to wear the coveted black cloak for a week.  Or something.)
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Since my regular kidney doc couldn't see me for two months, I called around and got an appointment with a young guy  I'd never heard of.  To my shock, he was a good guy, told me I was doing a good job managing things, and the surgery would provide an enormous step forward in my health and lifestyle.  And wrote me the needed letter, larded with wonderful phrases like "Stable over last four years" and  "...no contraindications .."  I could have kissed him.  And that was my reprieve.


Bottom line:  surgery still on track for April 20.>
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Countdown to Surgery

April 20 is my scheduled date for Surgery.  Went in yesterday for the pre-op testing.  Started at 7:15 at the hospital, and finished about 2:00.  Wound up with a graduating class of four guys, and we went through together.  I gather this is an oddity; many of the nurses there to train us said they had never seen an all-guy group before.  Here are some of the things covered:

• Housekeeping details, like insurance, ID, co-pays, and release forms. Ah, yes, the release and consent forms.
• Lung-function tests.  Blow in the little machine.  Blow fast.  Blow slow.  Over and over again.  I passed, but had to promise to use a little torture machine (spirometer?) 100 times a day to keep lungs strong.
• Blood work and EKG.  Detailed medical history.  No surprises here.
• Met with MD for instructions on meds.  What to keep taking; what to stop (like aspirin) and what to reduce (like insulin.).  Good meeting, many questions answered.
• Nurse came in to review details of meds.  What to crush;  how to open capsules.  Why not to take whole pills (they can get caught in the surgically altered pouch) and how to swallow crushed pills (sprinkle powder on applesauce.)
• Dietitians Dina and Erin brought us order forms for high-protein snacks and drinks, along with samples.   I guess folks complain about taste, so they wanted to give us a preview.  Yummm.  Also diet log forms and day-by-day menus for post-surgical noshing.

At least one blogger gives the date of her surgery as the date she was reborn.  I need to take some picturea of myself, showing my fantastic physique (ha!) to document how I looked on my rebirth date.  These will become my "before" photos, and I'll post them for your amusement.

Gastric Bypass now Recommended Treatment for Diabetes

In an earlier post, I mentioned how friend Greg was cured of diabetes by having gastric bypass surgery.  And how that was my main reason for having it.


Watching ABC News last night, I was surprised, but delighted, to hear that GB is now a "recommended treatment" for diabetes.  They replayed that news item this morning, with Dr. Richard Besser weighing in and noting that the very act of the surgery can cure diabetes.  That you man not need to lose a lot of weight (although we all plan to), but that undergoing the surgery provides an immediate cure, often before you leave the hospital. 


How about that?


http://abcnews.go.com/Health/diabetes-organization-recommends-surgery-treatment-option/story?id=13241219

Insurance and Doctors

Earlier I promised to tell you what my insurance company required before they would approve weight-reduction surgery.  Four things:
First, a letter of approval from my primary-care physician, PCP.
Next, a similar letter from my cardiologist.
Then, an evaluation from a psychologist based on at least 3 interviews and 2 personality analyses.
Finally, an educational program with a dietitian three months long, with four visits, dietary instruction, logging of food consumed, teaching and training, with acceptable weight loss during this time.


We'll review all of these over the next week or so.


I had wanted this surgery several years ago, and started then to meet these requirements.  But when I talked to my then-PCP about approving it, he stunned me with the vigor of his refusal.  "Absolutely not!" he said.  That surgery is unproven, and for you, unnecessary.  There is an element of danger in any surgery, and you are not heavy enough to justify the risk.  I will never approve this for you.


Though disappointed, I accepted his counsel and dropped my plans.  And then was stunned again, several years later, to find he was leaving his PCP practice to join the Bariatric Center of a major hospital.  He was going, I realized, to specialize in that "unproven, unnecessary" program with "an element of danger."  How about that?


He and I have never spoken since that day.  And I left with this intent:  Dammit, I would have weight-reduction surgery, and I would not be talked out of it.