Wednesday, October 31, 2007

Bariatrics, Part 2

So I did it. I had my surgery on October 9th. Instead of a Roux-en-Y, I went with an Adjustable Gastric Band (Lap-Band) for several reasons. After seeing the surgeon initially, I did some more research and talked to a few people including my shrink and my primary care physician, then emailed the surgeon to let him know I'd chosen the band.

I chose the band because it's less invasive, in that there's no cutting and re-routing of one's innards. It's just a little silicone and titanium device that stays inside forever and reminds you that you can no longer overeat. I believe the band will work for me. It's not like I can't lose weight without it. I can and I have. I can diet. I can and actually like to exercise. After I saw Dr. Schweitzer (the surgeon), I joined Curves and went faithfully. I have and use a home treadmill. It's just that I get too hungry to last for many weeks on a diet. While I like sweets, I didn't want to give them up forever and be punished by "dumping" for indulging in a very occasional scoop of ice cream or slice of cheesecake. I just need a little helper sitting on the outside of my tummy reminding me that I can no longer indulge in seconds of a really great tuna casserole or meatloaf, and in fact, need to keep the first portion child-sized. Works for me.

So ... between the time I saw Dr. S. on June 11 and my surgery day, I dropped 7 pounds. The picture was taken the weekend before surgery. It's going to be my benchmark picture. I'll have Kevin take one each month, same dress, same door, same child with me. That way, you can see her grow while you see me shrink.

Since surgery, I've dropped 23 pounds. I attribute the rapid loss in part to giving up sugar, including my nasty Pepsi habit, and white flour. Now that I've been detoxed from sugar, it's a lot easier to avoid it. The post-op diet is protein-rich, similar to South Beach. I also have to keep the (non-caloric) fluids going all day. Between the two, I've probably peed off most of the 23 pounds. My calves and feet are no longer swollen. My legs look downright skinny. My shoes were the first diet casualty in that most of the ones bought more recently have been wide width to accommodate my swollen feet. I bought a comfortable pair of size 9 mediums yesterday. My bras have also been a casualty. I'm temporarily, until the swelling in my midsection goes down, unable to wear underwires. Good thing I bought sports bras the weekend before the surgery. And the best news of all is that I'm off Metformin!! My blood glucose has been inching towards normal since the diet change, and the liquid Metformin I ordered is too gross to drink. I asked my primary if I could just skip it, and she agreed.

I had my first follow-up with the surgeon's office and his CNP Pat -- you usually don't see The Man, as he's a busy, busy guy -- two days ago. She was very happy with me, especially when it came to what the scale shows. I have my first fill, if I need one (seem to still have restriction from surgery), on November 27. I'm still on the pureed diet (the first week was full liquids), but I get to start working regular soft foods into my diet next Tuesday at 4 weeks out. I also get to go back to Curves then.

So, here are the weight stats so far:

June 11 (consultation) 299
October 9 (surgery) 292.2
October 31 (today) 269.2

Yes, I do rock!!!

My surgical experience was an interesting one. Had a few minor complications. Here's my post about it from my Obesity Help blog. I wrote this on October 13th:

It's amazing what a couple of nights at home in your own bed can do. The earlier part of this week seems like a bad dream now. Thankfully, all is well, but things were a bit dicier a few days back.

Everything started pretty uneventfully. When I got to
Johns Hopkins Bayview on Tuesday morning, they had me ready to go within an hour, and since the OR was free, they got started an hour early. It was the usual stuff. The anesthesia team came by and asked lots of questions -- amazingly enough, the anesthesiologist is in the process of adopting from China!!! -- and got me prepped. Dr. S. came by with the informed consent, and I started to see why lots of reviewers say he has a wicked sense of humor. The nurse anesthestists were trying to start an IV at the time he showed up. I have notoriously small, rolly-polly veins. They were on their 3rd attempt when Dr. S. came in and he chided them about that. Accommodating soul that I try to be, I told him that 3 tries was NOTHING, that it took 6 tries for the IV they inserted before my nose job. "Don't tell them that!!! You're just encouraging them!" he said, with a little false-consternation on his face. It was priceless. We both had a good laugh. Dr. S. went over the informed consent and told me I could expect to lose 50% of my excess weight, "statistically speaking," or something to that effect. I looked him in the eye and said, "I am not a statistic." He broke into a big grin at that point, and then, after Kevin kissed me good-bye, they rolled me back.

I remember being settled on the table and Ron, one of the nurses, pushing a wedge under my knees and shoulders to keep my back comfortable. (Dr. S. had asked me about my back problems in front of them earlier.) The next thing I remember, there were several masked faces circled around my head and Ron was shaking my shoulder and telling me I'd sailed through the surgery without any problem and it was 1:00 and they were going to transfer me to recovery. I remember being wheeled into there.

I woke up again at 2:30 in a little bit of pain and the nurse told me they were having trouble with my oxygen saturation levels. I was hovering around 87/88 with oxygen canulas in my nose, and they wanted the mid-90's. The nurse encouraged me to keep pushing the button for pain meds until the pain was gone, then they gave me an incentive spirometer to get me breathing more deeply. I kept bugging them to call Kevin and let him know how I was. I didn't want him to worry and had seen how nervous he had gotten when his dad had surgery a couple of months ago and ended up in recovery for several hours. Finally, at about 6 p.m., they were able to transfer me to my room. A good thing, too. Had I not been able to get my numbers up, I might have spent the night in the SICU.

Once in my room, Kevin came by to see me, then I learned I'd get nothing by mouth for another 12 hours. I desperately wanted chicken broth!!! And Jello!!! And water!!!!They brought me water and a little sponge on a stick like we had to use to clean my dad's mouth out during his final illness when he couldn't eat. (He had had neurological problems and they didn't trust his swallowing reflex.) My mom has cried and cried over having to use that little sponge on Daddy when he so desperately wanted to eat something. Well, I got a 12-hour taste of what Daddy experienced, and oh my! As the song goes, I wish I didn't know now what I didn't know then. Just to think about my dad living like that for the last four months of his life tears me up.

I had a roommate. Said roommate was suffering severe diabetes complications and was clearly in a great deal of pain. She told me she'd already lost a leg and was losing toes on the other foot. Since she wasn't obese or even appreciably overweight, I asked her if it was type 1 and she told me, no, she had type 2. Yikes!!! I saw what the future without weight loss surgery might have been and it wasn't pretty. However, to this lady, I was also obviously a child of a lesser god because she kept the frickin' TV on ALL night. And the light on her side. I could not sleep. Meanwhile, the nurses kept coming in and telling me to breathe because my pulse oxygen level was really low. Finally, dawn broke and I got to eat and ate some yogurt and drank Crystal Light and water. Kevin showed up about 10 to pick me up and they told him I wasn't going anywhere. I hadn't been able to pee yet and they'd removed the Foley. Kevin got pretty upset about that because they'd told him the day before that I'd be ready to go by 10. Hell, I was upset, too. I made him go home. Meanwhile, I read over my release instructions and realized I wouldn't be driving for 3 weeks instead of one. I started freaking over that, because all the carpooling, etc. arrangement I'd made were for naught. I worried about what Madeline would think about my spending another night. I worried about Kevin being anxious over my not coming home. Worse yet, I was just exhausted by the roommate's behavior the night before. Now, every time they came in to check on me, the roommate would try to get the nurse over to her side for some minor complaint.

So, here I was, thoroughly stressed out and feeling worse and worse, and I finally just started crying. My meltdown got everyone's attention, and all of the sudden, my half of the room was filled with nurses, CNP's, residents, etc. Dr. S's main resident came to see me, too. Together we all figured out what to do. One of the CNP's told me that there was no way I'd be allowed to go home that day. In response, I told her she was going to have to call my husband and work things out with him, because he was upset and afraid. She did and was successful in her mission. As for all the other crap I was sitting there crying about about (work, carpool obligations, etc.), they told me everyone would just have to understand, so I could stop worrying right now. And amazingly, I did. (And everyone involved has been more than understanding.) One of the CNP's came back and told me Dr. S was concerned about things other than my lack of pee despite a dose of Lasix (did I have congestive heart failure?). First, I was burping a lot (so, had the band slipped already?). Second, my heart rate was speeding up and my blood gasses were still not good (did I have a blood clot or pneumonia?). Bottom line: I would have to spend another night and have some tests, and the *%(^! Foley catheter would have to go back in.

As the nurses were reinstalling the Foley -- fortunately, it wasn't really that bad, compared to having my nose packed after sinus surgery -- Dr. S. peeked into my room and told me how sorry he was to put me through THAT again, and that he had to eliminate all the possible complications, so I would spend some time being tested that afternoon. He told me he expected that everything would be all right, but he had to check to be sure. Pat, his CNP, also came up and talked with me about fills and held my hand a bit. They put another IV in (Ana the nurse gets a gold star for getting it on the FIRST try!) and x-rayed my lungs. We went downstairs and did an upper GI and a CT scan of my heart and lungs with contrast. Fortunately, everything was okay.

The roommate was transferred out some time that afternoon. Phew! At 5 or so, Kevin and Connie (my mother-in-law) walked into my room and asked if I'd like to see Madeline. Amber, the tech, came with a wheelchair to get me and wheeled me out to the lobby on the 6th floor, where my family was waiting. Kevin had really wanted Madeline to see that I was okay and asked the hospital to make it possible for her to see me beause she was too young to be allowed back in the rooms. He said when she got home from school on Wednesday and learned that I wasn't going to be home that night, she was inconsolable. Bayview gets high marks just for making the visit possible.

I went back to my room and had dinner, then the respiratory therapist came to see me and I went to sleep. At 4:30 a.m., they brought in my new roommate, a woman from the ER with mystery chest pains. She soon found out I was on Vicodin and started bugging the nurses for pain meds. They wouldn't give them to her and she threatened to check herself out. Meanwhile, she talked nonstop on her cellphone and watched TV all night and into the day.

On Thursday morning, they took out the Foley, gave me more Lasix and I performed the requisite toileting activity. I also got up and walked around a lot. By 10, they received the final reports from the studies and let me know they'd be cutting me loose that day. When Georgeanne, the CNP, gave the high sign, I called Kevin and he was there within the hour and I was safely home by 2:30. To the very end, the nurses kept checking my oxygen levels and kept making me walk around. In the process, we discovered that one machine they were using tested everyone's oxygen levels as low, including the level for the nurse who was testing me. So, I suspect that that the blood gas problem might have been part machine failure.

However, there was a real problem. My chest xray showed that my lungs were "wet," as though an infection was in the works. I think had this been the case on my pre-op x-ray they would have postponed the surgery. I was exposed to a sick kid last weekend. Thankfully, the fall-out was minor, though I now have a nasty chest cold.

Things have gotten better and better since then. Bayview sent a home health nurse today, and she felt I was doing well. I'm more chipper and alert than I was after the gallbladder surgery, though every bit as sore, particularly at my port incision below my left breast. But I have no fever, my incisions look great and my blood sugar levels are PERFECT without meds.

So that's the whole ugly story.