“Don’t be afraid to give up the good to go for the great.” ~ J.D. Rockefeller

One month. Surgery is one month from today. I CANNOT WAIT. Am I afraid? People ask me that all the time. Am I getting nervous? Hell no. I am not afraid or nervous or anxious or worried. I am ready. 

 

In many ways, I feel like this is a decision I have been in the process of making my whole life. When you’re fat, you think about being fat all the time. You are reminded of your size in nearly every moment of your day. From getting dressed in the morning to making decisions about eating to worrying about fitting into spaces, you are confronted by your body and you think, “How did I let this happen?” It confronts you when you are going to school, when you are looking for a job, when you date. You think people are looking at you, judging you, talking about you…all the time. With every rejection, you wonder how much of a role your weight had in it. It becomes something that’s easy to blame so that sometimes you don’t have to face the real reasons why you failed or fell short. While I know my eating and exercising habits are choices I make, they really feel out of my control so much of the time. Choosing surgery was empowering. When I finally made this decision, I was relieved. So, am I scared? Hell no. And I don’t think about being fat all the time anymore. I am embracing my inner thinness :)

I have done the research I need to do. I understand the surgical procedure, the risks, and the benefits. I know and trust my doctor and his team; I am confident in their abilities. I am having the surgery in the best hospital in the world. I am surrounded by people who love and support me and will take good care of me as I recover. And, while I don’t often talk about my faith openly, I believe in God. He knows what the outcome of the surgery will be – this is part of the path He planned for me to take and I trust that He knows what He’s doing.

I’m not worried so you don’t need to worry. The only thing any of you need to worry about is whose job it’s going to be to make sure I dress appropriately once I am thin. I am excited for the rest of my life. My life thus far has been pretty amazing but my weight has always been the one obstacle I wasn’t able to overcome. That’s about to change…in 30 days.

“Food is an important part of a balanced diet.” ~ F. Lebowitz

“What will you be able to eat?” That’s the most frequently asked question these days.  People are shocked when they hear me answer, “Anything I want.” Remember, I said most people don’t know much about weight loss surgery. One of the reasons I chose this specific surgical option, the gastric sleeve, was because I would not be as restricted in my diet as I would be with the other options. I didn’t want never to eat a piece of birthday cake again. I didn’t want to forego my mom’s fried chicken for the rest of my life - those of you who have had it understand why. I wanted to have the flexibility to make those choices myself. There will, however, be weeks, possibly months, of an adjusted diet while I prepare for surgery, heal afterward, and then re-introduce food into my new, smaller stomach. This adventure officially begins on December 5, two weeks before surgery but, as you know from reading about my visits to the dietitian, I have already been making dietary changes.

On December 5, I will begin a two week liquid diet in preparation for the surgery: 800 calories a day, consisting of protein shakes, sugar-free jello, and sugar-free popsicles. The goal of this is to stimulate rapid fat loss from the liver. The liver sits atop the stomach and, since the surgery is done laparoscopically, can get in the way during surgery if it’s too fat. Slimming it down just before the surgery insures that the surgeon can move it out of the way and see what he’s doing while he’s operating. Fortunately, the new medicine I have been taking as a migraine preventative also works as an appetite suppressant so I am not anticipating much difficulty with the liquid diet.

If all goes well, I should only be in the hospital overnight but, while I’m there, I will be given a clear liquid diet. This consists of one ounce of water, unsweetened apple or grape juice, sugar-free jello, or decaf tea each hour. If I tolerate that, then I will advance to two ounces per hour. Doesn’t sound like much but there will be substantial swelling in the stomach and that’s all it will be able to hold.

When I go home, I will remain on a liquid diet for one to two weeks but the choices increase to include milk, strained low-fat cream soups, protein shakes, and yummy-sounding shakes and smoothies for which I have been given recipes. The key is to cram as much protein into my tiny meals as possible. Eating and drinking will become my full-time job for a couple of weeks. I will eat a quarter cup of something from my list every two hours and, in between meals, drink at least a cup of fluid. Protein and hydration are the key.

The third phase is the puree diet. This sounds the least appetizing to me. While I can now start to include meats, cheeses, vegetables, and starches into my diet, they have to be the consistency of baby food. Blech. And, I can’t eat baby food because it typically doesn’t have the amount of protein I need. So, I am really dreading this part, especially since it coincides with my return to work. I can’t even talk about it…

Phase four is soft foods…foods that can be easily cut with a fork. I can do this. Also, I’ll be gradually increasing the size of my portions but protein consumption and hydration will always be key to my diet.

I should be back to a fairly regular diet one to two months after surgery. Eventually, I will be able to eat about one cup of food at each meal. So, several small meals throughout the day, caloric intake between 800 and 1200 calories, minimum of 60 grams of protein, and  6 to 8 cups of water daily. Sounds like what the doctors tell all of us to do for a normal, healthy diet, right? Well, maybe they tell us to eat a few more calories than that but people ask why can’t  I just follow that diet without having the surgery. Trust me. I’ve tried. I literally need to be unable to fit any more food into my stomach. Truly. You may not have ever seen me eat a dozen doughnuts but believe me when I tell you I have done it. More than once. I need to be physically unable to do that ever again. Surgery will make that happen. If I try to eat more than my tiny stomach can hold, it’s coming back out. Just the threat of that makes me want to avoid it.

I think of this surgery as my “do-over.” It’s my chance to get a new stomach and do eating and nutrition the way I know it’s supposed to be done. Monday begins the one month countdown…

"I'd like to think the best of me was still hiding up in my sleeve." ~ J. Mayer

So it’s been a minute since my last blog. I’ve been busy. It’s hard to believe that it is November. Surgery is just a little more than a month away. Wow. For so long, it seemed so far away and now I need to start getting my “ducks in a row.” December 19 will be here before you know it. Now that most of you have wrapped your head around the idea that I’m really going to do this, I have been getting questions about the type of surgery I have chosen, the Vertical Sleeve Gastrectomy. I’ll admit – I didn’t know anything about it before I began this process but, ultimately, it is the choice that makes the most sense for my weight loss goals.

The Clinic basically offers four types of weight loss surgery: the Roux-En-Y Gastric Bypass, the Lap-Band, the Vertical Sleeve Gastrectomy, and Gastric Plication. The Roux-En-Y is the traditional gastric bypass and I knew I didn’t want that surgery because it is the most restrictive. Additionally, it is a more complicated surgery and requires a longer recovery time. I also did not want the Lap-Band. I didn’t like the idea of having a “foreign body” inserted into me and the follow-up necessary to maintain it. It came down to the sleeve and plication. They are very similar procedures, although the sleeve has been performed for a longer period of time. The plication is a relatively new procedure. Ultimately, I learned that my insurance would not cover gastric plication so my decision was made.

The vertical sleeve gastrectomy is a laparoscopic procedure in which the size of the stomach is reduced. Your stomach is normally the shape of the sideways view of a man's big old beer belly. This surgery cuts off the 'beer belly' section leaving just a banana-shaped stomach, or sleeve, in its place. In this process, the section of the stomach that produces ghrelin, the hormone responsible for causing you to feel starved when dieting (and certainly not starving), is also cut off. The new stomach is about 75% smaller than the old stomach. This video shows an animation of the surgery…

http://www.youtube.com/watch?v=IjxFjI69bEI

Patients who have this surgery can expect to lose 50-70% of their excess body weight so it is not intended to be a surgery for people who are morbidly obese. I am about 100 pounds overweight. If I could lose 50 to 70 pounds, AND KEEP IT OFF, I’d be a happy camper. The surgery is a tool, not a cure-all. The better you use the tool, the better results you will have. So, the surgery combined with healthy eating plus exercise can result in even greater weight loss which is ultimately what I am hoping for. I don’t have a set “goal weight.”  I’ll know it when I get there J

And, yes, I do plan to share all of my weight numbers with you…I’m working up to that. I’ve not willingly revealed my true weight to anyone in a very long time so that may have to wait until the very last post before the surgery, or maybe even the very first one after. I’ll get there. This is all about full-disclosure.

“To eat is a necessity, but to eat intelligently is an art.” ~ La Rochefoucauld

My first meeting with Gretchen, the dietitian, was in August. She challenged me to lose 12 pounds before surgery, 10% of my excess weight. We talked about a balanced plate and that I should strive to eat my protein first, my veggies second, and my carbs last (and only if I’m still hungry). This was important to practice because I have to focus on getting enough protein into my tiny new stomach after surgery. OK – I could do that but then she rocked my world. She asked me to replace my daily breakfast cereal with a protein shake. WHAT?! NO CEREAL?! I have eaten cereal for breakfast every day of my life. Frequently, I eat it for dinner too. Sometimes, I even have it for a snack. According to Gretchen, cereal is worthless to me now because it doesn’t have enough protein. I was so sad. She gave me a list of protein shakes and told me to try some and find three that I liked before I came to see her again. As if that wasn’t enough…she then told me I had to also give up pop. POP. That meant DIET PEPSI. This was almost too much. Apparently, the bubbles from carbonation can cause the tiny stomach to stretch back out after surgery so carbonated beverages are a no-no. Wow. Limited carbs at meals. No cereal for breakfast. No pop. What have I done?

I saw Gretchen again in September. I had lost 4 pounds. I had replaced my cereal with protein shakes. I had given up pop. I was afraid of what she might ask me to do next but this time we just talked about vitamins. She asked me to begin taking a multivitamin each day, along with B12, and calcium citrate with vitamin D. I will continue this regimen after the surgery as well. I have never tolerated adult multivitamins well so she told me to try the adult gummy or chewable versions. Those have been fine and I have adjusted my morning routine to include my supplements. My second meeting with Gretchen coincided with my involvement with the BEST Start group and I found that the information from the group and the nutrition sessions really complimented each other which made following the suggestions very helpful.

My final nutrition appointment was in October. It was my very last appointment before my file could be submitted to the insurance company for review. I had lost 5 more pounds, for a total of 9 pounds in 3 months. I had taken my vitamins as required and maintained all of the other dietary changes made during the previous month. In this last visit, we discussed the diet I would need to follow leading up to the surgery, while I am in the hospital, and then during my recovery at home. I will share this in detail another time. At the end of the session, my file was electronically sent to the nurse to be prepared for the insurance company.

All in all, my favorite part of the approval process with visiting with the dietitian. It was the most educational and Gretchen was just so upbeat and positive and sparkly that I had to love her.

A little about insurance requirements…

My insurance policy requires two years of weight history to demonstrate longevity of obesity. This was easy for me to provide because I am involved in an intense love affair with the Cleveland Clinic and all of my doctors are there. My weight is thoroughly documented in their computer system going back several years.

I had to participate in three months of a supervised weight management program. It wasn’t a diet, per se, but the goal was to lose a little weight and begin to implement some good eating habits. This requirement was why I ended up meeting with Gretchen.

My specific insurance policy requires a body mass index of 35 or higher.

All of the appointments I have described thus far in my blog are supposed to be covered by my medical insurance (according to my specific policy), with the exception of the visits with the dietitian, however, I am still trying to sort out two charges for which I am receiving bills. I have to pay for the three visits to Gretchen, which are roughly $90 each. The costs of surgery and the follow up visits will all be covered, except any follow up visits with the dietitian should I need them.

If you don’t know if your insurance policy covers weight loss surgery, also called bariatric surgery, ASK SOMEONE. Even if your insurance covers the surgery, they may not cover all of the appointments leading up to the surgery or after the surgery. They may have different requirements than my insurance company and policy. Every company and policy is different. I have Medical Mutual but even different policies within Medical Mutual are different. PLEASE, ask someone. It could save your life or greatly improve the quality of your life. Don’t be embarrassed to make the phone call. If I can do it, you can do it too.