HOOPS: Weight Loss Seminar

So I went to the required weight loss seminar yesterday.  I'm so lucky to have one of the best Bariatric Centers in the world right here.
The very first step in this process is to attend a weight loss seminar. I didn't get why but it's mostly because part of the insurance requirement to pay for surgery is to that you fully understand what weight loss surgery is (the person doing your psych eval has to sign off on this).  I signed up for the seminar online.  I waited for the one held by the surgeon I want (there are a few at the center but this guy is the director...and the best).  I'm glad I waited a few weeks because when I got there they told us that you have to go to the seminar of the person doing your surgery.
The day after I registered for the seminar online I got a call from the receptionist.  She asked me some questions to make sure I qualify for surgery. You either have to have a BMI of 40 or above....or a BMI of 35 or above with a co-morbidity (like diabetes). I have a BMI of 47 and diabetes and high blood pressure. So I was in like Flynn. The one time in my life that has worked to my advantage!  The receptionist also wanted to know about my health insurance. I don't have it yet but will next month so I'm good. 
The receptionist told me she would mail me a packet with info about the center.  As promised it arrived a few days later (in a descreet unlabeled envelope which was nice).  It had directions to the seminar and a thank you letter for signing up.  It also had this packet that my PCP is supposed to fill out so I can bring it with my to my consult with the surgeon.  It basically is a long long form saying what diets I have ever tried my entire life and how much weight I lost on them.  It also has a bunch of questions about my general health. The only question I'm scared of is where it asks if I am "generally compliant with treatment"....hmmm...not always. I forget or just don't take my diabetes and high blood pressure meds...and go off diet a lot. Like a lot a lot. So I have a month to get back on track.
The packet said that I could bring one support person with me. This is a free seminar so space was limited. I had Gander meet me there after work. He is such a good husband! He is so supportive through all of this.  We got there and got a folder full of info on WLS and their center. We also got a free pen! Which I was super excited about! Until I saw that it had "Bariatric Surgery Center" written on it...so I won't be using it ever.  We had to get there at 5:30pm to register and the seminar was supposed to start at 6pm.  I was sooo nervous so I got there at 5pm...then a lady got up front at 6:04 and explained what was in the packet...which I already knew because I had spent the last half hour sitting there reading the whole thing.  It was really helpful information. It outlined every step in the process including attending the seminar so we could all check that off our list. Then she said the surgeon would be there shortly...which turned into a half hour. Sigh.
When he did get there he had a slide show about the center. He showed us that the waiting room chairs and exam tables and scales and OR table are all extra big and sturdy and comfy for fat people...which I was oddly comforted by. Then he showed us a bunch of statistics about the center and why it's so great (which I already kinda knew).  Then he went on for way way way way tooooo long about the anatomy of the digestive system and how you get fat...you eat more calories then you burn. And how you lose weight....burn more calories than you eat. Seriously? Yeh...we know. We are considering weight loss surgery...its not usually the first thing you try. I think we all know how this stuff works.  So I spent a lot of this time yawning and looking at the clock.  But then it got good. Honestly the seminar could have started here and been just fine.
He went into the 3 different options in the order of most commonly performed there: Gastric Bypass, Sleeve Gastrectomy, Gastric Band.  The surgeon did a great great job explaining the differences in not only what happens to your insides (with slides!) but also the differences in hospital stay, average weight loss, upkeep, size of stomach, method (restriction vs malabsorbtion), operating time, time away from work, post surgery care, post surgery diet, and more.  He also went into the risks associated with the surgery.
At the end there was time to ask questions and he spent about an hour answering questions. We didn't leave til 9pm. But it was so worth it. I got all my questions answered and trust my surgeon 100%.  I was surprised that (despite my vorascious web browsing and blog stalking) I learned a lot about this process that I didn't know before.
I have really been wondering how long all the pre-approval and hoop jumping is going to take. Basically (as long as your insurance covers it) it really depends on your nutritionist.  You have to go to a bariatric nutritionist at the center and basically eat the way you would on maintenance after your surgery.  There are two visits that are mandatory (30days apart) and after that the nutritionist decides how many more monthly appointments you need. You have to keep a food journal and stuff like that. You don't have to lose weight during this time (unless your insurance requires it) but you can't gain weight. If you're gaining they take it as a sign that you aren't willing to make the lifestyle change required to make surgery successful.  Some one asked what would happen if some one has never dieted before.  The answer was that they would probably have to do 6 months of nutrition.  She also said the fastest some one would have the surgery is 3-4 months and the longest is a year. I get insurance in January...so best case scenario would be april...worst case would be January 2015. 
I asked if he oversews--he doesn't. He says there is no need and it slows healing. 
I asked how big he makes the sleeve. He said 11mm...about the size of a cigar....which is much smaller than "a small banana" which he described it as earlier. I asked if that's the same for every patient--it is.
I asked if he agrees that the sleeve truly isn't a "new" procedure.  He agreed that it has been done for years as part the first part of a two part procedure for very obese patients who would eventually get the duodenal switch.  But it is newer in the sense that it's being done as a stand alone procedure.  This cleared up a misunderstanding I had...I thought it was the first part of a gastric bypass...but it was the first part of the duodenal switch.
I asked why, if the sleeve is the second most common surgery done at the center, why was there so little information about it in their literature and none on their website. His anwer was that since it is newer, insurance companies just started approving it in 2007.  Ummmmmm seriously? You haven't updated your website and literature? That has been the only frustrating part of dealing with the center right now.  The website doesn't even mention the sleeve. I wouldn't have even known it was an option if I hadn't stumbled upon it in my internet searches.  Then I had to google my surgeon to see if he even did them.  Not good!
The most amazing thing I learned was about stretching out the stomach.  You can't. The new stomach does not stretch.  He said he has seen tons of patients who come to him who say they need another surgery because another surgeon did their WLS years ago and they have gained all their weight back and insist their pouch is stretched out. Every time he does xrays and it's the exact same size. They have just learned to get around it by grazing all day on calorie dense food.  All the surgery does is slow you down but you can still eat toooo much.
I also learned that the lower your BMI, the less difference there is between surgeries in the percentage of excess weight you're likely to lose.  If you are around 40 BMI or less you can expect 80% loss of excess weight. Great news!!!!
Another important thing is that your best way to minimize risks is to be in the best possible shape. My blood sugar and pressure has to be in control even if its by medication. Also if I exercise and eat right my heart and lungs will be in better shape.
Well I was all excited to have all my questions answered!

Who Needs Sleep?

I told two people that I am having weight-loss surgery.  Cart before the horse?  Yes, yes, yes.  But I just feel so sure about this.  I told two people that are very very close to me.  My aunt (who is basically a parent) and one of my oldest dearest friends.  I am the kind of person who can keep a secret as long as it's not mine. 

If I do have this surgery, I don't want every one to know about it. I wonder if I can get away with no one knowing about it.  Can I just take a two week vacation from work and go to Jamaica or something?  Let people think my shrinking and liquid diet is due to a horrible foreign virus?  Or tape worm?  I know I'm getting ahead of myself, but these are just things that I can't stop thinking about.

I have the weight loss seminar with my surgeon on Thursday night.  I have so many questions!  I have read on blogs from other people who have had VSG that sometimes surgeons "oversew" and sometimes they don't.  Also, I have read that the size of the sleeve varies by surgeon's preference.  I want to find out if my surgeon just does a standard size for everyone that he thinks is the best, and if so, how does it rate?  Small, average, large?  Or does he decide what size is best for me in particular?  I know that there are support groups for people who have had WLS and I really hope that I can get some info at the seminar so I can start going to those.  I would really like to hear about some real life experiences.

They say that people who have the sleeve usually lose 50-80% of their EXCESS body weight.  At first this kind of bummed me out.  I weigh 265 lb.  My "pie-in-the-sky-it's-never-gonna-actually-happyen-but-you-can-dream" weight has always been 150 lb.  So, in my book, I have 115 lb of excess weight.  Best case scenario if I lost 80% of that it would be 92 lb lost. That would bring me to 173.  Not bad.  But I was looking up what my "ideal body weight" is considered by medical professionals.  I'm 5'2" and 32 years old.  I should weigh 104-130 lbs to be considered a "healthy weight".

With those numbers in mind, if 130 lb is the highest "healthy weight" for, me then my excess weight is 135 lb making 80% loss of excess weight 108 lb.  That means that I could be down to 157 lb  (if you go by the 104 as my ideal weight, then with an 80% loss of excess weight, I would end up losing 129 lb and be 136).  HA!!!  That would take more than VSG.....I'm pretty sure it would take pixie dust!

Every day that goes by convinces me more and more and more that this is the RIGHT move.  This weekend was so typical and so awful. I am really embarrassed to even put this in print, but here goes.  Friday at work I was just so exhausted.  I spend all week just thinking "only X more days til the weekend".  I spend all day at work thinking "only a few more hours and you can go home and go to sleep".  I get home from work at 6:30 pm and I am asleep by 8:30 pm.  I throw food together, eat dinner, lay on the couch and watch TV until I go to sleep, so that I can wake up the next day and do it again.  What kind of life is that??  This week was particularly bad because on Friday we had a Baby Shower for a girl at work, which I organized.  At the end of the day there was a ton of cake left. A LOT of cake.  And I really did try to have other people take it home....it didn't work. It was either me take it home or throw it away.  Since you already know that I'm 5'2" and weigh 265 lbs, I'm sure you already know what happened.

It did not get thrown away.  I ate the rest of the cake by myself.  We went to a friend's house on Saturday night, so that was "active" but the rest of the time was spent in exhaustion.  Dreading taking a shower because there are no clean clothes because I have no energy to clean!  All Sunday I slept.  I woke up at 10am, could not stay awake so I napped from 11-1pm.  Then at around 2pm I was still so tired I felt drugged.  So I slept again from 2-5pm.  I woke up and watched TV, went grocery shopping, came home, had some canned clam chowder for dinner and....fell asleep at 10pm watching TV. 

Great life, huh?  I don't care what any one says.  This is because of my weight.  I am too tired and too discouraged to do anything.  I'm so scared of surgery because I'm terrified of anesthesia.  I'm scared I won't wake up.  But am I really awake right now???  This is the right decision.  It will at least give me a fighting chance.

Why WLS?

I am one of those girls who look at people who have had weight-loss surgery as cheaters, imposters, easy-way-outers.  When they post photos of their weight-loss, to me it feels like a student drawing an extra line on an “F” paper to make it look like an “A”.  Not real.  I may smile and tell them they look great, and in my head I’m thinking, “You’re going to stretch that sucker out and gain it all back.”  And “This is why you’re fat in the first place, because you won’t just eat right and exercise!” I am not proud of this, but it’s the truth. 

So why am I getting it done?  Because I can’t do this anymore.  

Every other time I thought of getting bariatric surgery, it was no more than a fleeting thought.  I am a big wimp when it comes to anything medical.  I hate getting my teeth cleaned.  I pass out when I get my blood drawn.  So the thought of signing up to have someone cut me open didn’t really appeal to me.  And really for what?  So you can’t eat so much….well, how about you skip the surgery and just don’t eat so much??  So that’s what I would do.  And it would work great! Every time!  I can drop 30 pounds no problem.  Almost as easily as I gain it back.  Which I do. Every time. Every.Time. 

I don’t mind eating healthy.  But I have a problem with food.  An addiction.  And that is truly the scariest part of this whole thing for me.  Will I have this surgery and just do what I have done all along?  Lose and then gain?  Only this time instead of 30 pounds, it will be 130 pounds?  Will I stretch that sucker right out?  What’s to stop me from doing just that?  Right now I know I’m full and I tell myself to stop eating…but I don’t.  So what makes me think I will stop eating when I’m full after the surgery?  Or worse than stretching it, what if I bust the staples because I won’t stop eating?  

What scares me even more is not having the chance to bust the staples…because what if I don’t even make it out of surgery?  What if something horrible happens during or after and I die?  That’s a huge fear of mine.  And even though the chances are slim….there is still a chance.  

So why am I getting it done?  Because I can’t do this anymore.

This is not a life.  I am truly miserable.  I am so miserable that I push every other wonderful thing (and there are a lot of them) into the background.  I am so sad and depressed.  I am not a good wife because I have zero energy to clean, cook, play.  I am not a mother because I have obesity related health problems.  Sometimes I look at the life I have created and want to erase myself from it.  I want a do-over.  So if I die in this surgery or because of it, then at least I died in an attempt to be a better wife, mother, friend, human. 

Right now I don’t have health insurance but we are enrolling in it so it will be effective in January.  It’s going to be so expensive.  About $550 a month total for both of us.  About $350 of that is just for me. That comes out to $4200 a year.  So as long as I get the surgery, that is really a bargain.  (I will still have at least another $1000 in copays I’m sure, but that’s still not bad.)  I just hope I can get it done this year and don’t run into any road blocks.  

I am taking the first step next Thursday, November 21^st and going to a seminar.  I am really lucky that one of the BEST surgeons in the world for bariatric surgery is in my area.  He has been on Oprah and teaches other surgeons all around the world how to improve their methods.  So, really I have the best person to do the surgery.  That also played a huge role in my decision to do it.  My plan is to try to schedule an appointment for January 2^nd (the first day they are open in 2014 when my insurance will be active).  I want to get the ball rolling.  

In the meantime, I am going to make sure I have the best chances for a safe surgery by being in the best health possible.  I have been exercising.  I want to have a strong heart and lungs.  Well, here we go.  I can’t wait!  For the first time in a long time, I feel HOPE…hope that I have a chance at something better than THIS.