Saturday June 11th 2011 - How I got fat revisited

I am waiting impatiently for my insurance approval. I should get it this week and then I will schedule the surgery. I can't wait. I am going to workout like I did in the summer of 2009. In the mean time I reflect...

When I was in high school I was at my ideal weight (175 pounds). After graduation in 1983 in Lakewood Colorado, I got a job in warehousing in Hayward California. For the first three years I worked on the swing shift between 5:00pm to 2:30am. I was a forklift order puller. It was a very physically strenuous job and it went way past my bedtime so two significant things occurred. The men of my shift ate like mad men and then turned around and drank gallons of coffee and no doze.

Anyway, this is the point where I started losing control of my metabolism. Binging and then voluntary malnourishment. I worked for that company for seven years and received promotions almost annually. When I left that environment I was a warehouse manager and had not worked a physically strenuous job for at least five years, but I still ate like I did when I was 19 and strong. So eight years after graduation I weighed 245 pounds.

I fought the weight while I worked as General Manager at a different warehousing company in Oakland California and got back down to 235, but then my dad committed suicide and we moved to Buffalo New York and I was not handling his death well. When we left Buffalo to Denver for graduate school in 1998, I weighed 285. When I finished working as CEO of a dot com in 2001 I stressed out and reached 310 or so.

After that I consistently dieted and lost lots of weight, but then I gained it back as usual. When I got super sick in 2007 I was admitted into the hospital at 456 pounds. In the hospital I lost almost 50 pounds of water weight through IV lasixs. Then I had a serious bipolar episode that lasted for two months and I lost another 50 pounds through literal starvation and reached back to 350. I stayed there for a while and then I went vegan in 2009 and began working out about 20 hours per week and I lost 35 pounds in 8 months. Then I started gaining weight even though I was still vegan. I got discouraged and slid back to regular eating and ballooned to 360. Then I got more discouraged, tried a few trendy diets and gained back enough weight that I know sit back at 400.

I relish the thought of never seeing 400, then 380, then 350, then 300, then 250 once I have lost them. I will not gain the weight back. Some people start stuffing their faces with cheating foods and start gaining weight after a year or so with the lap band. But my weight loss will literally extend my life and make it possible to get a liver transplant. No, I will loss the weight. I will be 190 pounds within two years and I will live everyday thankful to have part of my life back. I can't weight to shop off the normal sized racks.

Wednesday June 8th 2011 - More information on the progress and cost of surgery

Before I bore you with my accounting, I would like to update you on the calendar expectations. My insurance file has been sent to the insurance and Eileen from the surgeons office thinks we could have an approval within a week. Possibly Monday.

Once I have insurance approval I can schedule a date for the surgery. Yea! If my approval comes in quickly, I could have a date as soon as after the Fourth of July. Hopefully before I go on a working vacation in Santa Fe New Mexico. I believe that would be one the week of the 25th or so. Unless there are some unforeseen complications, this should be an outpatient one-day surgery.

Now for the money:

• The insurance splits my benefit of $7500 as $4500 for the hospital and $3000 for the surgeon.
• The hospital requires either $6500. They require this amount to be paid one week before surgery. If they do not need all of the money, I will get a refund. Then again, if things get complicated, I might need all of that money.
• The surgeon has a contracted rate of $1800 so there will be money left in the benefit for the post-surgery appointments (the first three are covered in the initial $1800). They will use the benefit until it is gone and then I will have to pay out of pocket, but the $1200 will go pretty far.
• Since I am paying the anesthesiologist in advance, I will only need $1050.
• Since I am paying the surgical assistant in advance, I will only need $270.

The surgery is total costs  $15,320 USD. After the hospital rebate it could be ultimately $14,000. I am going to need $7,820 by the week before surgery so basically by the end of the month.

I have the 2500 Euro ($3,500) from France and potentially $2,800 from the sale of the two Cemetery plots. Roughly I have $6,300 leaving a difference of  $1,520. If I had to I could put that remainder on a credit card.

Then again, maybe I'll get a surgical loan for $5,000 and stash the extra $1,000 or so in savings.

Bottom line: I can afford this and I am ready for this. I need this. I could potentially have the surgery done by this time next month. One more month of being this weight! If I work as hard as I did when I became vegan and exercised like I was on Biggest Loser, I could have lost as much as 110 pounds by January 1st 2012! And by this time next year, considering a slow down in weight loss, I could have lost as much as 160 pounds in the first year! Then I will only have 50 pounds to my target weight of 190 pounds. That would be awesome. Ideal weight within the next two years!!!

Tuesday June 7th, 2011 - Cousin Vicki's card; finances; and book idea

First, an update on the finances of the bariatric surgery (Realize Band). I don't have all the answers yet, but some of my questions have kind of sort of been addressed. According to the hospital, my insurance has a contracted rate for the hospital fee of either $9,000USD for BMI's of 45 or less and $11,000 for BMI's above 45. She thought I might qualify for the lesser amount, but I seriously doubt a BMI of 59 is "borderline."

My insurance is Anthem Blue Cross Blue Shield and it specifically has a $7,500 weight loss benefit. So, the hospital gets $4,500 and the surgeon gets $3,000.

Lets just deal with the hospital for a moment since I know this variable. Assuming that the hospital's contracted rate with Anthem is $11,000, less the insurance benefit of $4,500, then I need to have $6,500 just for the hospital.

I do know that I can pay the anesthesiologist $1,080 in advance and save more than $800. There is someone else that I can pay $280 in advance and save another $600. So, as far as I know I need $1,360 for these other services. The surgeon gets $3,000 from the insurance, but I have no idea what that will cover. It has to include his services and the post surgery appointments so I doubt that $3,000 will cut it. For now let's assume I need $7,860 out of pocket. Due to family financial surprises I will probably only have $6,000 plus $2,000 if I used my credit cards. I'm thinking it would be safe to assume that I will need a medical loan of $5,000 so I can be prepared for any other surprises.

I'll know more by the end of the week. I do know that the surgeon's office is submitting my file to the insurance on Wednesday. I have no idea why it took that long, but at least its in. I don't know how long it takes for insurance approval and then I do not know how far out their surgery schedule is. I'm still hoping for August. I won't need the money until the week before my surgery date. Okay, that's the finances.

Quick note on my book idea: I will be finished with my current fiction novel by this August (see www.NightinPositano.com). I think I am going to write my next book more autobiographical and basically make a book that follows the same trek as I have recorded here since June 2009.

Finally, the card from my cousin Vicky regarding my liver cirrhosis:

"They say what doesn't kill you makes you stronger. Well, what if you didn't sign up for extra-strength training? What if you'd rather catch a break once in awhile? 
At some point you'd think you'd be entitled to a free pass or two. Avoid that crisis. Delete those problems. 
It's not that you're not strong or that you don't have what it takes to get through this. You are, you do, and you will. But you've built enough character already, and it's time for things to lighten up a little!
I know it's not my call, but if I were in charge of life's wheel of fortune, you'd get a free spin. And I'll be right there cheering you on!" (written by Linda Barnes).

Saturday June 4th 2011 - Bariatric impatience like a child

As it stands this morning I still do not know how much my Realize Band surgery is going to cost nor do I have a date for the surgery. I know that I have the patience of a child. Usually I am the opposite of procrastination. I try to react and respond to situations or requests as quickly as possible. If you send me an email, you can expect a reply within 1 to 12 hours depending on my email access. I like to be very prompt with paying bills and especially, being on time for any appointment even if it is social.

So it irks me that I have had to leave three messages with the surgeon's assistant. She's the only one that can tell me my insurance progress. Additionally, the financial lady from the hospital didn't return my call, but she may have a better excuse seeing as she might have just returned from vacation.

Part of my frustration is family finances. I've dropped a good $5000 in my bariatric savings and I keep having to dip into it to pay urgent bills. Take for example my middle son's Jeep. It had some kind of Jeep death wobble and it cost me $500. Then on Monday I have to register my youngest for summer school. He failed US Government which drives me crazy sine I have to advanced degrees in politics. The summer school costs $300. If it's not one thing it's another.

I really shouldn't be stressing. I've always had a knack for pulling money out of my butt when I needed it. Eh, I probably shouldn't take credit. God's always given me just what I need. Usually not more, but He always pulls through when I need it.

I guess it goes back to the unknown. If they tell me I need $10000 on top of my insurances $7500 then I would be fine. I would have a goal and I would reach it. The problem is timing. I do not want to slow the process down. I have another $5000 coming in from Europe this week and it is earmarked for the surgery. I just need to know how much I will need. In the end I could just get a medical loan, but I would like to avoid that if I could.

Thursday June 2nd 2011 - Alternative Pain Management

The liver doctor said that the pain in my enlarged spleen probably wouldn't be reduced even after weight loss. My primary care physician (PCP) gave me some oxycodone, but its fairly addictive so he probably won't refill it more than once or twice. So that leaves me with nothing really. Vicodin has too much Acetaminophen (Tylenol). He did say I could take up to 1mg of Tylenol a day. That won't even touch my pain and I'm not convinced that it won't promote more inflammation.

However, both doctors said that medical marijuana won't hurt me and it would probably be effective. In the State of Colorado medical marijuana is legal with a permit. In order to get a permit all you have to do is go to a doctor that is willing to write an affirmative consultation and then file with the state for certification. Even though the state has been cracking down on the medical marijuana industry, it is still relatively easy to get a permit.

Perhaps if I didn't have three impressionable young men I might consider it, but I do and I don't think its the right thing for me right now. I reserve the right to change my mind. Even if I did use medical marijuana, I wouldn't smoke it. To be honest, I don't like smoking anything. It makes my lungs feel congested. If I ever tried marijuana as pain management, I would use edibles like brownies or... I don't really know what's available, but I've heard that there are a lot of options. Probably my biggest hesitation is the fact that, while it is legal at the state level, it is still a federal crime.

At the time of this writing, my spleen is about a 6 on the 1 through 10 pain meter. Not enough to cry out, but still distracting. Maybe its more scary than painful. Every time it hurts like this I know that the blood flow through the liver is slowing enough to bloat and enlarge my spleen. That's scary. I'm afraid of bursting my spleen and needing a splenectomy.

Wednesday June 1st, 2011 - An email to friends and family

Hello Family and friends,

Last week I received the results from my liver biopsy to check on the progress of my nonalcoholic steatohepatitis (Nash). I have stage four grade one liver cirrhosis. Stage four is the highest measure of liver scarring and beyond repair; however, grade one is the second level of inflammation which is good news. 

In general, I feel okay today except the grade one inflammation and subsequent blood flow disruption is just bad enough to cause mild to severe pain in my enlarged spleen and I have chronic swelling of the abdomen and legs. It may also be the cause of my chronically low platelet count. For these I am medicated. I am a bit fatigued and I don't always feel so good, but nothing major. I have to continue seeing my oncologist because my leukemia has not been excluded and the liver disease dramatically increases my cancer risk.

My mission is to stay at grade one as long as possible. In order to do this I must have bariatric surgery (Realize Band). I was already running down the lap-band path so I am just waiting for the final financial requirements and a date for surgery. Hopefully, I will have the surgery this summer. The extreme change in diet that is required for the lap-band surgery pretty much mirrors the requirements of the liver diet. And, of course, I need to continue exercising, but I can't put myself in danger of an abdominal injury. Obviously, I can't ever even take a sip of alcohol which really isn't such a big deal for me. Work isn't a big deal since I am writing from home full time now.

Cheri and I are focusing on the bariatric surgery right now so I can become a better candidate for a transplant when the time comes. In no way am I giving up or flipping out. It's not good news, but it's not the worst news and I can survive this.  

Thanks for your support,
Christopher 

Friday May 27th, 2011 - More Fat Means Less Life

Research from The National Institutes of Health published in the New England Journal of Medicine, reports that your risk of premature death increases 31% with every five-point increase in the body-mass index (BMI).

In real terms this means that...

• A BMI of 25.0 to 29.9 increased death risk by 13%
• A BMI of 30.0 to 34.9 increased death risk by 44%
• A BMI of 35.0 to 39.9 increased death risk by 88%
• A BMI of 40.0 to 49.9 increased death risk by 251%

To calculate your BMI go to http://www.nhlbisupport.com/bmi/

The following conditions significantly increase your risk:

• Fatty liver 
• High blood pressure (hypertension)
• High LDL cholesterol ("bad" cholesterol)
• Low HDL cholesterol ("good" cholesterol)
• High triglycerides
• High blood glucose (sugar) Diabetes
• Family history of premature heart disease
• Physical inactivity
• Cigarette smoking

And, of course, cirrhosis of the liver can be lethal. Actually, it is. So I need a transplant asap.

Thursday May 26th 2011 - Perhaps I am in denial

I try not to think about it. I generally feel okay especially after Dr Goldstein gave me some oxycodone. The pain from my spleen is somewhat mitigated to a level of tolerance. Sometimes you don't realize how much pain you have until its taken away.

So, I have stage four cirrhosis. My liver is basically an irreparable mass of scar tissue. If I understand the grading system, then grade one (0 to 3) then I have some blockage in my liver, but not completely blocked. I believe that grade three is liver failure. The minor blockage would explain why my spleen is enlarged and it could even explain my chronically low platelets. If I sit and think about the dying organ and visualize the damaged liver sitting right here. Right under my skin. Right under my right ribcage. I can touch the spot. When I touch the skin over my spleen, it actually feels bruised.

But, I feel fine. I went to lunch with my friend, went shopping, and wrote on the book and I felt fine. Other than being fat, I feel healthy so it is disquieting to think that my liver is so close to failure. To look at me, you couldn't tell that I was sick. I'm not all crumpled up or pale or yellow. I look fine. So it is weird.

Even though I read my pathology report, it still seems very abstract. I asked my fourteen year old if he was freaked out and he said, "Not really. I mean we've been through the medical scares and hospitalizations so many times I just don't think about it. Besides, you seem fine."

Jokingly, he asked me if I had a bucket list. To which I responded no. I've always thought that if someone was critical then they should go see the world or go to strip clubs or rob banks. I don't know. Live like there is no tomorrow because there isn't, but now that I am sort of there, I really just want to live everyday with my family and friends. If I died next week I wouldn't have any regrets. I've lived a nice life. I've traveled the world and I have experienced far more than the average Joe. I've been rich; I've been poor. I have no desire to jump out of planes or bridges with a bungee cord. No; if this is it, then I want to spend it with my family.

Of course I'm not going anywhere soon. I just meant hypothetically. I plan on doing whatever it takes to stay alive and well. I'll have the Realize Band surgery and get thin so I don't wreck the next liver. I hope I get the liver of a playboy bunny. Owe, that might be yucky. All joking aside, I can't possibly be dying because I feel too alive. And I'm happy today. It was a good day and I think its going to be a nice weekend. I hope I get to see Hangover II.

I have to stay healthy because I have way too much to do in the next few years and I want to see my boys marry and give my little beautiful granddaughters. Grandson's will be cool too, but I've always wanted a little girl to spoil.

Was this post too weird? Probably. I'm a bit... I don't know. I'm a bit something. I don't want to die, but I'm really not afraid of it. I just don't want to leave my family behind. And I promised my mother-in-law that I would go back to church. I never really left, but I'll go. I don't think you could be on too many prayer chains and I do believe in prayer. Gotta go cook dinner. Lemon skinless chicken and my favorite salad with dehydrated cherry's, blue cheese chunks, spinach, a tangy sweet dressing and almonds. Yumm. Plus I picked up a fresh loaf of whole wheat bread. Oddly enough, my appetite has gone down. Maybe it was the hypnotherapy??? 

I guess if you sit and think about dying then you would just go crazy and who wants to live like that. Unless I am truly  

Wednesday May 25th, 2011 - Stage four cirrhosis of the liver

I have mentioned many times that I have been told that I have nonalcoholic steatohepatitis (NASH), but the only way to tell if it has progressed to a critical stage is to do a liver biopsy. They have biopsied every organ and bone in my body hunting for cancer. My leukemic symptoms include chronically low platelets, swelling, and an enlarged spleen. Coincidentally those are the same symptoms for advanced liver disease. Now I don't know whether I have leukemia or not, but I do know for sure that I have stage 4 grade one cirrhosis of the liver. There is no stage 5. This is it. Ironically my late father was an alcoholic and he died at 50 with a healthy liver.

While there is no cure for stage four and it is not repairable except by transplant, I am going to continue my trek towards the gastric realize band procedure. If I am to extend my life, then I must lose all of my excess body fat immediately. At the very least it will make me healthier for a transplant. I received the bad news on Monday evening. I tried to schedule a follow up and I don't think the scheduler understood the critical nature of the follow up so she made an appointment without talking to me for June 21. Like I'm going to wait that long. Hellz no!

The dietary changes dictated by the bariatric surgery include many of the same elements as a liver friendly diet. But, I will still have to add more to that. For one thing, I have to call all of my providers to double check the safety of my current meds and I can never ever take Tylenol or even sip a drink of wine, beer, or any alcoholic beverage. I can never take Vicodin. I'm supposed to lay off red meat, processed foods, and other stuff I have yet to learn about. I am going to go to a new nutritionist as soon as possible. 

The following is the technical definition of NASH and cirrhosis: 

Nonalcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.

Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

According to the National Institutes of Health, cirrhosis is the 12th leading cause of death by disease.

Other than fatigue and pain in my spleen, I don't have any of the severe visible symptoms, but I will eventually. I hope that I can get on a transplant list now before I reach critical. Obviously, my family is upset, but I don't think they understand the seriousness of the situation. For now, it's life as usual. 

Sunday May 22, 2011 - Financing the Realize Band procedure

I still don't have a concrete number for the surgery. It has a lot to do with deductibles, co-pays, insurance allowances, and the various piecemeal bills like the anesthesiologist. My insurance pays $7500 and I swear I was told last time that the hospital wanted $4,000 in an account in case they need it. I don't know right now because the only finance person with the hospital that specializes in this kind of surgery is on vacation.

Much of the cost depends on your insurance and its agreed fee structure with the providers, but this was the best general answer:

"The price of lap band surgery will depend upon many factors.   Lap Band prices and how to finance it is something that everyone considering the procedure needs to sit down and think about before the surgery.

The price of surgery is complex because you need to include not merely the price of the surgery itself but the associated costs which will vary widely according to where your surgery is carried out and by whom. Costs must include such things as pre-surgical tests, fees for your surgeon and hospital charges, anesthesia fees and much more. Additionally, there will be various post-surgery charges for services like follow-up medical visits, psychological support and nutritional counseling.

If the surgery is done in the US, then you could expect to pay anywhere between $17,000 and $30,000 for your surgery and post-operative care providing you do not encounter any complications. While significant complications are uncommon they do arise every now and again and the cost can then rise considerably."

Now I've managed to bring together as much as $9000, but I still want to be prepared for a surgery loan so I paid down all my credit cards to less than 10% of the available credit and had my friend's wife work on getting some of the dead wood off of my credit report. I'm very anxious about the cost of the surgery and I suppose I'll stay that way until the hospital lady gets back from vacation. I hope its this week.

Thursday May 19, 2011 - Almost there...

Opps. I didn't report on the nutrition appointment or the support group. Last Monday, the 9th, I met with the nutritionist. She gave me the run down on what to eat and when to eat it. Surprisingly, it's more about texture and protein than it is about calories.

The basic philosophy is that you need well chewed food that won't get stuck in the new small lap band pouch. In addition, you don't want to eat greasy or buttery or finely milled foods like cream of wheat because they will just slide right through the new opening and defeat the whole purpose. Keeping good high protein foods in the pouch for as long of a time as possible means that you can't lubricate the stomach with liquids for 15 minutes before eating and you don't want to wash it down with liquids for at least an hour after eating. Absolutely no liquids during the meal.

Things I will have to avoid: bread, steak, and salad. No matter how much you chew them, they will reconstitute in the stomach and cause you to throw up or necessitate an ER visit. I'll go through the ABC's of staged eating in another post.

The support group was awesome. There isn't too many places where you can feel comfortable being over weight. Most of the participants already had the surgery and they looked pretty healthy and happy, but they are more than compassionate towards other obese people. Actually, I think most of them are still fat in the head. They haven't gotten used to being normal sized yet. Very nice welcoming people. We broke up into smaller groups depending on the type of surgery you had. I was with the realize band group. They were all women.

There was a 65 year old woman that had the surgery in December 2010. She has already lost 65 pounds and she hasn't even stuck to the liquids rule. Initially, her daughter had to push her to her first support group in January 2011 in a wheel chair because her knees are in such bad shape. Last month she walked in with a cane. At this meeting she walked gingerly without a cane. It was magical.

The other women were in different stages of post op and they shared their eating tips to make it all bearable. They had all lost an amazing amount of weight and their various obese conditions had decreased if not disappeared completely.

TODAY: Today I had my annual physical which is the last missing pre-qualifier for insurance approval for the surgery. My platelets were back down to 90,000 units and I was lower on Vitamin D than last year and I have been taking 2000 u.. somethings a day. He thought is had to do with the absorptive comparison between the gel caps and tablets so I'll switch vitamins and take 4-5,000 units. He still called me diabetic, but my numbers are way too low for that diagnosis, but I left it alone because it will be just one more reason for the insurance to approve the procedure. I don't think I am going to have much of a problem there anyway.

Next step: Insurance approval will take several weeks and then several more weeks until I have the surgery. I'm still thinking I will have the surgery in August. With God's help I have been able to catch up on all my bills and paid down my credit cards and fixed my car and ect... and I have $3500 USD coming in from Paris and another $2800 from the sale of two of the four burial plots I had for sale. I am also waiting for a smaller check of $750 giving me a total bariatric war chest of $7,050. If I am able to sell two more plots than I will have just over $10,000. I have yet to receive an estimated cost but I am sure I have more than I will need. I will probably put some away for plastic surgery to remove flappy skin when I have lost the weight. See? It will all work out. I am sooo excited. I have several overseas trips to make in 2012 and I hope to be thin enough to sit comfortably in coach. YEAAAA!

Monday May 9th 2011 - One step closer

This morning I went to my cardiologist and passed the exam with flying colors. Dr. Levene will write the bariatric endorsement and send it to Dr. Tillquist. Tonight I am going to the mandatory lap-band nutrition class. It costs $100 cash (Instructor preference). It lasts one and a half hours. Afterwards there is a support group that I will hang out for. I like hearing people's stories. Maybe I should take notes and include them here.

Tomorrow morning I get my blood draw for next week's physical. So I have the nutrition class, pulmonary, cardiologist, psychological eval, sleep apnea, and even a bonus gastrointestinal liver biopsy (GI not required for bariatric surgery). Throw in 12 months of medical notes from my primary care physician and my physical and I will have jumped through all of the hoops. After the surgeons office receives all of the documents, then they will give me a firm price including my insurance contribution. I may call the office and get a new estimate. I'm sticking with $4,000 for my contribution. I hope the final price is lower. 

May 7th 2011 - Transvenous liver biopsy

On Thursday I had my liver biopsy. A Transvenous liver biopsy is used when a person’s blood clots slowly or if he or she is obese or when excess fluid is present in the abdomen, a condition called ascites. I have all of the above.

During the procedure, patients lie on their back on an x-ray table and a local anesthetic is applied to one side of the neck. If needed, an IV tube is used to give sedatives and pain medication. 

A small incision is made in the neck and a specially designed hollow tube called a sheath is inserted into the jugular vein. The doctor threads the sheath down the jugular vein, along the side of the heart, and into one of the hepatic veins, which are located in the liver. To see the veins, the doctor injects liquid contrast material into the sheath. The contrast material lights up when x rayed, highlighting the blood vessels and showing the location of the sheath.

The doctor threads a biopsy needle through the sheath and into the liver and a liver sample is quickly withdrawn. Several samples may be collected, requiring multiple needle insertions. The sheath is carefully withdrawn and the incision is closed with a bandage. They took six biopsies from me and a series of pressure test (I really don't know what the pressure tests were all about.).

Step by step: I went into the "surgical prep" room about an hour before the procedure. The nurse setup my IV and gathered virtually every fact about my life-time medical history. At precisely 1:30pm they took me to an operating room with the biggest x-ray machine I have ever seen. It was like a 10 foot diameter swiveling arm thing. There was also a bank of 40" flat screens. I thought I would be able to watch, but they put an open ended pup tent on my head so that they operating area remained sterile. 

The anesthesiologist gave me some pain medication and 10cc's of some sedative through my IV. The surgeon gave me local around the insertion spot on my neck and then they began. 

I felt a lot of pressure on my neck and then an odd kind of pressure in my torso as the lead was fed down to my liver. I had an odd bend in my vein and it hurt when they tried to work through it. My blood pressure went through the roof and I lost count of how many painkiller shots they were putting into my IV. Ultimately, they took the six biopsies. I think I was in there for about an hour or so.

Then I went to post op where I had a ham sandwich waiting for me. They kept me for an hour for observation and then I was released. As the painkillers died off the mother of all headaches arrived and stayed through the rest of the day and well into the next day. I took my sleeping meds and tried to ride it out.  


On Friday I still felt horrible and my spleen hurt a lot, but this morning I feel much better. I still have some mild pain in my spleen, but I'm not too worried about it. I'll probably find out the results by Wednesday.


If it is just a fatty liver, I will need to lose weight. Duh. And if it is further along I will need to lose weight. Duh. If it is to the point of cirrhosis, then I may be in trouble.  

Wednesday May 4th, 2011 - Ten Commandments of Weight Loss Surgery

Quick update. (I swear I did this yesterday) Anyway, yesterday I had my psych evaluation with my psychiatrist and today I had my pulmonary testing. It's basically blow in the tube kind of thing. Piece of cake. Tomorrow I have the liver biopsy and I am nervous about them cutting my jugular vein.


Here are the commandments:

Ten Commandments of Weight Loss Surgery

1. THOU SHALL NOT DRINK with thy meals. This means never!  This is cheating...cheating yourself.  It washes the food out of your pouch and allows you to eat more.  This will slow and eventually stop your weight loss. PLUS you will not be getting all the benefits of the wise choices you have filled your little pouchy with.
2. THOU SHALL EAT SLOWLY, very slowly. This is not a rule for the first few months post op.  This rule is for the rest of your life. If you eat too quickly, you will surely stretch your pouch. Eat too quickly and you will learn the hard way...the nausea is stifling.  And CHEW CHEW CHEW!! And when you think you are done, CHEW SOME MORE.  Or your food will keep coming back to visit you.
3. THOU SHALL TAKE THY VITAMINS. This surgery is a great tool for weight loss. But, as with all benefits, there are costs...and malnutrition is one of the potential prices of this surgery. Take a multivitamin supplement every day for the rest of your life and it is one you may never have to pay.   You will also need to have your blood checked periodically for B-12 levels.
4. THOU SHALL EAT ADEQUATE PROTEIN. 
5. THOU SHALL EXERCISE. Just do SOMETHING.  Even if it means starting off simply...take the stairs instead of the escalator or elevator.  Park at the furthest spot in the parking lot.  Carry your shopping basket instead of pushing the cart (on small shopping days of course...LOL). 
6. THOU SHALL DRINK at least 64 ounces of water, everyday. It seems that some people have problems doing this. Use a water bottle and carry it with you everywhere.  Sip all day long.  Or refill a gallon jug and drain it every day.  Do it in 2 pitchers.  Do it with 2-32oz sport water bottles. Please note however, that if you are drinking coffee or tea with caffeine, you will have to compensate for the diuretic effects of the caffeine.  Caffeine robs your body of water, therefore, you will not only be unable to count the coffee or tea, but you will have to drink an extra cups of fluid for every cup of regular coffee or caffeinated tea that you drink to compensate for the diuretic effects of the caffeine.
7. THOU SHALL EAT WELL BALANCED MEALS. A  doctor said it best: Protein first and foremost, then green/yellow vegetables,  then fruit, then starches. 
8. THOU SHALL NOT EAT SUGAR, in ANY form....no candy!!! Treat yourself with some fresh fruit!!  
9. THOU SHALL NOT modify these commandments to suit thy needs.  It will not work.  You will only defeat yourself physically. 
10. THOU SHALL LOVE THYSELF and be happy with the body God gave you. God did not intend for all of us to be supermodels, and this surgery will NOT make you one. Happiness comes from within. Be happy with who and what you are. Or you will defeat yourself mentally.   Then the battle will be lost before it is ever even begun.                                                                              

Monday May 2, 2011 - Details from my first consultation

First, I started my vegetarian with seafood diet yesterday and found myself in a huge rush for lunch and accidentally ate a ham and cheese bagel. Seriously, I was half way through it when it dawned on me. I am possibly the stupidest smart guy on the planet. Nonetheless, yesterday's cuisine was very healthy, however, I did eat too much tabbouleh and falafel. The blackened grilled yellow fin tuna was awesome. Tonight I am grilling portabella mushrooms and organic hamburger for the boys. I need to define my one through five scale again. I suppose five being the best should represent a healthy day with smaller portions following the pre-surgery guidelines for the bariatric surgery plus the gym. Four being a good day less exercise. Three being healthy, but with servings that were too larger. Two should be deviating from healthy. Perhaps not so healthy and too much sugar. One, being the worst, would be any day that I have fast food or over-eat at a full service restaurant. I would give yesterday a three, but I didn't make it to the gym. Instead I took a Sunday afternoon nap.

My primary mission right no is to get all of the preliminary appointments and endorsement letters collected. I have a check list from the consultation meeting last week. All of the following must send in an endorsement letter.

1. Psychological endorsement- Purpose: to evaluate your emotional state and your capacity to understand the dangers and life changes resulting from bariatric surgery. Must be done by a psychologist or psychologist. In my case it is my bipolar doc, Cathy Collins, since she also conducts a therapy session each time we meet. She knows me best. I see her tomorrow, the 3rd of May. (Sample letter below).
2. Pulmonary test - Purpose: to evaluate your ability to breath and exert energy. My appointment was setup through the bariatric surgeons office. I have to go down to take one hour of tests Wednesday the 4th. 
3. Primary Care Physician - Purpose: to evaluate your health in regards to being able to handle the surgery and the post surgery change in life style. I am using my annual physical as an opportunity to get Dr. Goldstein's endorsement. My blood draw is on the 10th and my exam is on the 19th. (Sample letter below)
4. Cardiologist - Purpose: to evaluate the health of your heart. Must make an appointment with Dr. Levene.
5. Gastrointestinal doctor - Purpose: evaluate the health of my liver and NASH. While not named on list, but, just to be on the safe side, I will include an endorsement from Dr. Springer). I am waiting for my liver biopsy.
6. I must also attend a mandatory nutrition class given by Swedish hospital. It's focus is on lap-band patients. I should call as soon as I finish this post.

That's it for the required endorsements. Hopefully I'll get this done this month. Next big hurtle: $$$$ but I'm working on it.