Four Ounces

So, my friend ben asked me to start a whole new blog to document something huge that is going on in my life. I began to do so, and then I decided that I might as well put it here in this blog, since it's what's really-really happening in my life.

I'm going to be having weight loss surgery in July. It's a procedure called the Duodenal Switch. It's one of the five types of weight loss surgery now commonly performed. Basically, a large section of my stomach and intestines will be partitioned off and bypassed, leaving me with a four ounce stomach capacity and a much shorter intestinal tract. This serves two purposes: it will reduce the amount of food I am able to consume, and it will reduce the absorption of that food. More information about the procedure can be found at http://www.obesityhelp.com/morbidobesity/m-surgerytypes.phtml

I've been preparing for this procedure for several months. This is what the surgeon required before he'd even schedule an appointment:

• I had to attend an orientation seminar that the Bariatric Surgery staff hold every other week. This served to introduce the staff, explain the procedures, risks, benefits, and acquaint us with the pre- and post-op issues. I wish I'd had my husband attend as well, because it was a lot of information. At this point, he's probably gotten all of the information that was covered, but they did a much better job of presenting it than I could have.
• I had to be examined and cleared by the surgeon, himself.
• I had to get my primary physician to report that I had tried other methods of weight loss, and failed.
  
• I had to be cleared by an oncologist, because I had cancer when I was 15. At this time I also had my baseline mammogram, which thankfully was normal. It was also much less painful than I was led to believe it would be. It wasn't even very uncomfortable. I had the impression that it would feel like feeding my breast through a paper-port scanner or something.
  
• I had to have several kinds of bloodwork drawn.
• I had to have Arterial Blood Gases drawn. The last time I had this done, I found it to be the most painful experience I could remember. They draw it from an artery in the wrist, which is loaded with nerve endings (probably to protect precious arteries). However, the technician who drew the ABGs this time was amazing. It ended up being less painful than the normal bloodwork.
  
• I had to have a sleep study and chest x-ray, and be cleared by a pulmonologist. The sleep study showed that I have pretty severe sleep apnea. I had over 70 instances of apnea in the 5 or so hours that I slept at the study, the longest lasting for about 35 seconds. I stopped breathing for 35 seconds while I was sleeping! Crikey! I was put on oxygen at night for a couple of weeks following that. I was given this machine called a concentrator, which takes the air from the room and converts it to oxygen and runs it through water and into a cannula in my nose. I was then scheduled for a second sleep study, during which they tried different amounts of air pressure on a machine called a CPAP (Continuous Positive Airway Pressure). I was issued my own CPAP to use at home, and I use it more or less every night. (I'm supposed to use it every night without fail, but sometimes I just don't, alright?) The CPAP during the sleep study was this big triangular mask that made me all sweaty and uncomfortable, but luckily I was able to get a more comfortable "nasal pillow" style cannula-type thing. The CPAP is much more quiet than the concentrator was, but I still sound a bit Darth Vaderish.
  
• I had to have a mental health evaluation, to determine if my psyche is healthy enough to deal with this type of change in my life.
  
• I had to meet with the surgeon's staff nutritionist, who covered all of the changes I would have to begin making now in order to prepare for the habits I would have to acquire post-operatively. I won't be able to drink any fluids during meals, or for 30 minutes before or after. I can't have any caffeine, because of how it irritates the gastric system and dehydrates. I'm not supposed to drink carbonated or alcoholic beverages. For a considerable time following surgery, I'll be on a liquid diet, and then mush, and then only soft meats like fish and chicken. Even after I can eat any kind of food, I'll be following a diabetic diet, in order to make sure that I am using the limited space in my stomach for the nutrients I need. I have to make sure to eat at least 60 grams of lean protein every day, and then try to fit the rest of the fiber, vitamins, and stuff into my diet. I also have to drink 8 glasses of water a day. I have enough trouble doing that now. I have no idea how I'm going to manage it with only 4 ounces of stomach capacity. I'm also going to have to give up rice, pasta, and bread, because they expand in the stomach.
  
• I had to lose about 10 pounds before they'd even schedule the surgery date. This is ostensibly because the surgeon needs room to poke around, but I think a large part of it is to prove that I can commit to making such a huge change.
• I had to be cleared by my insurance company. The practice of insurance companies dealing with weight loss surgery in the past has been to automatically decline the initial application, thereby weeding out those who are not fully committed to the process. I completely expected to have to file an appeal. However, I think that UHC is sick of dealing with all my back injuries and stuff, so they cleared me right off the bat.
  

I'll be in the hospital for as much as a week following the procedure, and then I will be recovering at home for 2-6 weeks, depending on whether the surgeon is able to do the procedure laparoscopically or if he needs to do it as an open procedure. He is going to begin the procedure laparoscopically, and if he runs into problems with scarring and adhesions from the surgery I had when I had cancer, he will continue the surgery as an open procedure.

The benefits of the laparoscopic surgery are that the camera can see into places he would not be able to see if he did the open procedure, and the recovery time is much shorter. The benefits of the open procedure is a shorter time on the table (and under anaesthesia, which reduces the risk of mortality), and a better ability to deal with the adhesions that are likely there from my splenectomy.

So, I have my surgery date. It's July 25th. I'm currently mostly fretting about preparing financially for the probability that I will be unable to work for two months. I think it's my psyche's way of distracting me from worrying about the pain and risk and upheaval to my life. I'm sure it will all hit me as I'm being prepped for surgery, and I'll have a stop-the-ride-I-want-to-get-off moment. Still, I am really committed to this process, and I'm very excited about the benefits. I'm looking forward to an end to back, knee, and ankle pain. I'm looking forward to being able to breathe normally after climbing a flight of stairs. I'm looking forward to more energy. And of course, I'm looking forward to looking better.

I'll continue to post as new developments crop up. Thanks for being interested.