3 week update

I don’t want to update too much here as I want to save it all for my 1 month surgiversary...

But the main difference in this surgery is that I had one incision left open to drain. Last week the doc finally stitched it closed and this morning I went in to see about getting them out. He only took out some, not all. However the good news is that there is NO infection and it’s past the point where infection is likely to set in.

So I need to go back in on Friday to see if the rest can come out!! Fingers crossed because damn I want to have a normal shower at some point!!! LOL

The weight is coming off and I’m happy to report that the conversion to DS had diminished my hunger. I was worried about how high my level of hunger paunges that I had pre revision. He assured me that his other revision patients noted that it was reduced in that area.

Okay, that’s all for now... next week... revision surgiversary... revisaversary??

Backed Up

Day 6 post surgery, I was really suffering yesterday with belly pain. However I was also on day 7 of not pooping!!

The pre-op liquid diet was hard on my bowels since I eat a lot of fiber. The lack of anything my mouth and a few days of 400cal of liquids only left me very uncomfortable.

Yesterday I had 30ml of Milk of magnesia, and 15ml of the same this morning and I finally passed it. What a relief!!!

It was very strange to me to be constipated because all the DS people talk about loose bowels. That might come now too, but I was getting concerned.

I’m happily resting and my incisions are feeling less strained.

I have an egg timer to remind me to keep sipping all day so I’ve been getting 50ish grams of protein and 48-60ml of calorie free liquids as well.

Feeling pretty good!

DS Done

I went into the hospital on November 7 for my Heidel hernia repair and the DS switch.
It’s now Thursday, November 9 and I’m hoping to get discharged today.

It’s been going pretty good so far I’m sore but the pain isn’t horrible and less I can’t. My shoulders are a bit sore from the gas and of course postop you’re not allowed to drink any water for 24 hours which is always the worst part of this, the dry mouth!

Since yesterday at noon I have been allowed to have 1 ounce of G2 every hour, so that certainly made an improvement.  I had my catheter out and I’ve Peed in the toilet which is also nice, and been doing several laps every couple of hours in the hospital ward.

My painkillers here are just down to liquid Tylenol last night I didn’t get any narcotics for sleeping so that’s really good.

I’m still getting IV fluids which is good because I need that liquids and I’ve been using my speaker on meter to get up to a long volume where I’m breathing properly.   I think that the hiatal hernia is actually the worst of the two procedures. My doctor said the hernia fixed was just over two hours almost 2 1/2 hours so it was really big and really bad. I think that is affected my breathing the most and moving is that repair to the diaphragm.

This hospital bed is making my ass sore so I’m looking forward to getting out of it.

The doctor left one of the incisions open it’s larger than the others so that it will drain and so that one will need to be changed for the next week it’s been done here at the hospital and then at home as well. He’ll switch it up next week at my one week visit.

That’s all I can think of for now. I’m using talk to text on my phone, So there may be some errors in the text above but I’m too lazy to go back and look. Sorry!

Pre-Op Liquid Diet, Prep and 5 days and counting!!!

I've been doing okay on my liquid diet.... but have included scrabbled eggs and cottage cheese. 


I just ate a giant handful of M&M's at my desk and am feeling disappointed, reckless, and irritated at no caffeine and no sugar and the crazies are setting in. This makes me long for the first few months out of surgery where I had no desire to eat and the next year where interest in food drops again.


Thankfully my husband is in NYC for work this week so he is not at home for me to yell at in my spiraling crash.  I thankfully found some caffeine free tea in the house last night so that I had something to keep my mouth and hands occupied doing.  I'm going to have to stock up on some more of that today.


Yesterday I had my pre-op EKG and blood tests.  Got the whole NIL by mouth after midnight on the night of surgery and my surgical shower scrub and instructions to reduce infections.


Weigh in this morning was 245.6 again.  This is the lowest that I've been in 2 years.  (YAY)!


I'm also off my pooping schedule right now so it would be nice to have a big BM, but mostly I'm feeling bloated from the liquid diet messing with my system.  I typically eat a LOT of fiber, so this is a drastic change.  However, as I type that... I am going to be doing a drastic change, so best get used to it now.


Trying to get prepped for the last 2 days in the office this week before my three weeks off, get caught up on my homework, clean up the spare room for my girlfriend that is coming in for the weekend, prep the food I'll need and make sure that these M&M's are the only off track thing that I do.


I will say that I am so glad that I have continued to track my weight even though I wasn't happy with how it was going.  looking at the following graphs that I have from my data in excel is great!


5 Years from first surgery in 2012 to weight on Oct 31, 2017
Oct 2012 - Starting weight 301
April 2014 -Lowest weight 232.2
1 year out from surgery I was 236.4

Current View of the April 2014 (lowest weight to now)
Sept/Oct 2015 was the last time I was in this weight range.

Vitamins and Minerals

I have been REALLY bad at taking my vitamins.  That will have to stop now that I'm going to a malabsorption method of WLS, the Duodenal Switch.  I will lose 8feet of my 10ft of small intestine and so I will be at risk of vitamin and mineral deficiency.


Today I buckled down and bought all the recommended bariatric Vit&Min:
Multi with extra ADEK - 1 dose
Iron + C   - 18mg
B-50 complex
Calcium Citrate - 1800-2400mg (although I REALLY love milk products, so I might be okay on the lower end of this one).


The calcium and Iron need to be taken at different times from one another, so I'll have to put that in the rotation.


I also bought some protein chicken soup from Celebrate.  I struggled with my VSG in 2012 in getting enough protein daily in my liquids and soft phase. I want to try and eat more protein laden foods and lay off the puddings and jello pops.


Other than that, I'm on an eating approx. every 2 hours.
7am - coffee & premier protein shake
9am - decaf coffee and premier protein
11am - 1c cottage cheese
1pm - 1c fat free milk & package of oatmeal or cream of wheat
3pm - 1c cottage cheese
5:30/6pm - minced beef stew or broth with mushy peas
8pm - skyr and fatfree/no sugar jello


This is my "pre-full-liquids" liquids week.  I'm trying to wean myself off of caffeine right now, so down to a single shot in the morning from my 3-4 shots a day.


Next week (Oct 31) I will be full liquids and there will be no more cottage cheese and beef mince at night. 


I've weighed in at 248 for the last three days... I'm hoping to see some good news on the scale tomorrow morning to get some motivation back into this.  I watched a portion of the surgery again last night and I know that I need to buckle down and get this done.  I thought that I could lose 20lbs by the 7th, but I think I will be lucky to see 10lbs.


12 days to go to surgery!

Time away from the office

is it normal that I'm almost as excited to have time off from work as I am to have this surgery!

Duodenal Switch - Pre-surgery doctors appointment

Today was the pre-surgery appointment.  I'm SO excited.


Weighed in at 249.6lbs
Got my front on and side pictures done.


He went over what they were going to do, ensured that I didn't have any questions. Made sure I understood how important my vitamins are from here forward and that I would very likely have "loose stool" especially if I eat fatty foods. 


Check, check and check.  I need to have at least one night in after surgery, because of the bowel changes, you have to stay in to make sure there is no leakage.


There will be no revision to my sleeve at all - it is "too risky", however he did say that most of the VSG to DS patients say that they notice a decrease in the amount of food that they eat.


I was originally told I would start my pre-op diet 2 weeks out, and so I was prepped to start tomorrow.  They said I could do one week if I wanted, but I'm already primed to start now, so might as well.  Any weight I lose on this side of the surgery will help me get to my goal on the other side faster and better.  I might have a cheat meal this coming weekend, but if I'm doing really good... I might not!


Paid my $10.5K, all set for surgery on the 7th.


2 weeks!!!!

26 Days and Counting!

3 and a half weeks to go!


Trying to not get TOO excited.


:)

Prepping!

Such a great feeling knowing that this is all scheduled!  


I have my pre-op set for the 23rd, and my diet starts on the 24th. 2 weeks away! 


I'm a secret WLS person, so I have been (again) prepping my coworkers with the details about hiatal hernia surgery and that I will be on a controlled diet afterwards and the dr. wants me to lose 50lbs. 


I want to shoot for 70-80lbs.  To the layperson that will look like 50. Ha!  


As I was typing this the notification for my surgery cost and instructions came through. YAY!


Surgery will cost me $10,500 for my portion of the DS, the hospital will contact me for the portion of fees/anesthesia that my insurance is not covering.  Plus all the other BS about if there are other things I will have to pay for them if they are out of network, first born, left arm etc. etc.


Pre-Op Liquid Diet:
1,200 Calories a day
High Protein, low carb, low fat, low salt
+1 multivitamin/day


4-5 Meal replacement drinks (160*5=800 calories)


Plus:
Sugary free gelatin, popsicles
Skim milk
Water (w/ crystal light or similar 0 calories waters)
Broth and tomato soups (low salt), Reduced fat cream soups
Fat free pudding
Greek yogurt (no fruit), cottage cheese (no fruit)
Cream of wheat (with skim milk)


Avoid caffeinated, carbonates, and sugary beverages.
No alcohol, No smoking (easy... I don't do either of these).


The only part that will be hard for me will be the coffee wean.  I love me some caffeine.

I found some really interesting bone broth at the Whole Foods that I'm excited to try. Turkey, Sage & Rosemary, and Chicken and Ginger. YUM!

Surgery Date!

It pays to be persistent and organized! The doctors office submitted the surgery under different Hiatal Hernia codes that my insurance WILL pay for. 


The only problem is that there will be an overnight stay needed, which will not be covered by insurance, but that's fine.  I will end up paying about 10 - 14K out of pocket.  Better than 40K. 


November 7th is the date. 


I had the option of Oct 31st, but my husband is traveling that week, so that won't work, but I REALLY would have loved to have had surgery on Halloween!! haha!


Regardless.  I am so excited for the surgery.  Hernia repair is needed - I had a piece of hard boiled egg get stuck in my esophagus a couple weeks ago and I can feel it moving more and more. 


Very Pleased to finally be on track. 


Pre-Op diet will start on Oct 23.  PERFECT.  No candy for me at all! 

Insurance Shenanigans

First of all, my insurance should pay for the hiatal hernia portion of my surgery. That is covered, however, as of yesterday - it was denied because they didn't think that the code provided by my surgeon was "specific" enough. 


FFS.


So I had to get the insurance co, the billing dept from my dr, and me on a three way conference call.  The billing dept confirmed that the coding is correct and all submitted documents were received.  Then insurance co. decided they would resubmit that code and see why it was rejected, as the code is correct and the denial gave no specific reasoning for the rejection. So the wait continues, as the insurance co attempts to weasel out a real reason from the "denial dept". 


I'm going to go ahead and assume that they just flat out deny all claims the first time, for no reason other than to see who really needs the surgery. Which (as a Canadian living in the US makes me SICK).


In 2012, after my first surgery with the hiatal hernia (insurance approved) repair and VSG (self pay) , I had a year long fight with the insurance to pay the portion for their portion of the bill for the hernia repair.  They denied the claim after first approving it because.... they claimed that the reason for the hernia repair was obesity, and they don't cover weight loss surgery. *BOGGLE*


I had to basically had to start a month long calling campaign and then threaten to sue them over the cost of the hernia repair. They finally acquiesced.


The hoop jumping required by insurance is brutal.


I am a smart, organized individual and they make it very difficult.   I am fully aware that they will very likely pull the same shenanigans this time - starting with denying my right to have my hiatal hernia repaired. 


So, I will document it all carefully, and then spend the next year post surgery fighting with them, but I won't play nice from the start. I'll just go straight to the jugular.


The worst part of me, is that this is just taking a lot longer to get done than I was hoping. I was really hoping that I would have a surgery date now, and I would be able to start planning my life around that. 


But... I guess I can count on this...

I am a terrible failure at weight loss

I am a terrible failure at weight loss.

I have been my whole life and so why would that change in my 40’s?  In letting go of trying to be “good at this” and accepting that I need more help (revision), I am doing myself a favor.   

 

I have already talked about how I don’t like to “blame” me for failing the sleeve, but the truth is that I did a lot of things wrong.  Stuff that I knew I shouldn’t be doing, but it was easy, familiar and comfortable.  I did a lot of good things, and I changed significantly, however, I want to take time to look at what I want to do now that I have more information and experience.

 

I have been seeing a lot of newly sleeved people doing things (that I also did) that lead to decreased weight loss. Specifically - Eating small quantities of shit food, and saying things to justify them. IAMGUILTY TOO....I used to say all of these things to make myself feel better about eating bagels, ice cream, chips, cookies, candy, etc. etc. 

• It’s just a little
• I still have to enjoy myself or what's the point
• I can’t eat anything else
• I can’t tolerate anything but carbs today
• Sugar is fine
• I’ll never have a life without being able to eat X (insert whatever food is your poison of choice)

 

These shitty foods feel good to MY brain, and in so…. I was willing to overeat more of those foods and damage my results because the BRAIN GOOD overrode the STOMACH BAD feelings. Overeating, overeating, overeating.  

 

The reward was worth the agony, and that agony lead me here.

- I can eat 3+ cups of food in a sitting.

- I can easily eat 3,000cal a day

I have learned a lot of things about the sleeve and bariatric surgery through trial and error, as many of us do.  I am one of many that has become obsessed with food in a completely different way from when I was super obese.

 

In the last few months while thinking about getting a revision, getting my consultation, check-ups, and now waiting on an approval and date for surgery - I have been introspectively looking at my behaviors and thinking about the corrections that I want to make this time with my revision:

 

1. Eat more “whole foods” in the puréed, mushy and beyond stages. 
- Eat less pre-packaged bars, cups of pudding or jello, easy soft carbs like oats and grits mixed with protein powder.
- I bought a blender to purée my own meats, I make my own soups now, and I’ll have a LOT more eggs in all its variety of forms. 


2. Stay off the Gawd Damn carbs.
- I went straight to bread as soon as humanly possible, but I had been eating oats, grits, and soft carbs like that for my soft and purred stages.


3. Better hydration. End of statement. 


4. Stop thinking of my new stomach size as a challenge.
- I used the sleeve as a challenge instead of a tool. How much can I get in there, instead of how much should/can I put in there. Be more mindful.


5. Eat slower. I'm still a wolfer instead of a chewer.



6. Take full advantage of the honeymoon period.
- Last time I thought the easy & fast weight loss would continue for(ever) or at least a year or more. It came to a quick halt after about 4 months.  Then I had another 8 months of slow losses, and then… stopped.


7. Exercise.
- I didn't do anything at all the first time. I bought a treadmill for this time around, walking more will happen and does happen now.


8. Forget what others think.
- First time around I worried about what people would think about my food portions so I was always trying to eat more to appear "normal".  
- Avoid eating out with co-workers, that is a big one.  Everyone wanted to eat with me and talk about my weight loss… ironic!  I spent entire meals trying to look “normal”, this is no longer a concern for me.  I’m busy and I bring my lunch.


9. Better meal planning.
- I was always good about getting in my protein, keep at it.
- Keep packing my lunches. Make more meals at home.


10. Set better goals!
- I was so excited to have lost even 30lbs that I didn't care if I ever lost another pound again. That changed!!


11. Stay away from dessert longer.
- I always followed up meals with a spoonful of whatever was for dessert, and stating that “one spoonful can’t hurt, look at how good I’m doing etc”.
- Food will always be there – so no need to eat dessert every night. 

VSG Failure? depends on your perspective.

So I've had a lot of time to think about what a revision to my original WLS, vertical sleeve gastrectomy (VSG), means to me.  The word failure comes into mind a lot, and I try and fight that off, since I don't actually see the original VSG as a failure.

If you start looking around at information on VSG failure/regain you will see very quickly that the community really beats up on the person that is not successfully keeping weight off.  Its a pretty depressing situation, and actually, it kept me from seeking help a lot sooner as I did. I bought into the fact that it was me, my fault, my failure, my issues. 

However, when I evaluate the situation, it wasn't really a failure, in my perspective.

I did fail to make it to a normal BMI. 
I did fail to keep off all the weight I initially lost.

Based on those 2 things I am considered a medical failure, and I qualify for revision.

However, I don't see my journey as a failure and I don't see me as a failure.  The VSG has already done amazing things for me and my life.  I made massive changes to my eating habits, my portions, my choices.  100% good, no.  Better than they were before, yes.  

In 2012 I was on a slippery slope, 315lbs and gaining.  With the VSG I managed to get down to 230, and then springboard back into the 240-250lbs.  The surgery halted my upwards trajectory into the super-super morbid obesity and has made me a mostly normal looking, albeit hefty sized person. 

The "failure" comes into play for me in that I am still not a normal BMI, and I'm at least 50lbs heavier than I would like to be (my preference would be to be in the 190-200 range), and 86lbs heavier than a normal BMI for someone my size. 

Current BMI - 38, 250lbs
Normal BMI - 24.9, 164lbs

Hilariously, here I said that if I never lost another pound under 260lbs I would still be happy.  LOL perspective. That was 2 months post surgery in 2012.

I never made it to my goal weight of 190. Perhaps that is because I was comfortable? 

There are a lot of things that I am going to do differently this time as well.  I've been making a list of them and will make another post.  The main ones are that I ate too many carbs too soon, not enough water, and I didn't/don't exercise enough.

Regardless, there are also other things at play. My surgeon said that there are lots of people that VSG doesn't work for, those with metabolic concerns.  My fundus (stomach) is dilated. My normal anatomy might let food pass more quickly through then normal.

I can also say that my mom put me on my first diet when I was 5 years old, and basically I've been chubby ever since. I have lots of food anxiety, stress, and secret eating.  These are things that I have been working on.  I did a great emotional eating class earlier this year that help solidify my position that I should seek to see if there is another surgery/re-sleeve option for me.

So, I'm positive feeling about the upcoming duodenal switch. I am so excited to think about being a normal sized person for the first time ever in my adult life. 

For those that find their way here and are thinking about a revision for lack of weight loss, or regain, I'm with you.

Here is another great article on revisions to the VSG, a very easy to follow along power point from Duke University.

This is a long one, but if you are interested in this material, then you might find it worth reading.  The conclusion is one that is not very comforting, but pretty realistic. 

In summary, SG as a stand-alone operation is gaining popularity among both bariatric surgeons and patients. This enthusiasm, however, has to be balanced against a paucity of data in regards to potential long-term failure rates. Similar to other bariatric surgery procedures, SG failure is likely to be multifactorial and related to a combination of technical, physiological, and psychological parameters. When discussing SG, bariatric surgeons must review these unknowns with their patients to ensure they will make informed, long-term, surgical decisions based on all available information.

Duodenal Switch confirmed!

I originally had my follow up appointment with the surgeon for this coming Monday, however the hurricane in the gulf right now is going to circle around all weekend and make Monday appointments impossible.  I gave the office a quick call and they actually squeezed me in today, Friday, for an appointment before the weather turns for the worst.

My surgeon reviewed the results of the endoscopy and the result of the upper G.I. His recommendation is that I convert to the Duodenal Switch as well as fix the sliding hiatal hernia and perhaps some trimming of my current sleeve.

The upper GI showed that I have a giant sliding hiatal hernia  that is obstructing the esophagus from working properly. I'm mildly embarrassed by my own lack of body awareness, I guess I feel like weird feelings in my stomach and throat are just "normal for me ".  He  reassured me that this is in fact not normal.

The only good thing about the hiatal hernia is that my insurance will definitely cover the repair to that and I know that my insurance does definitely not include  any weight-loss surgery.

This means that a good portion of my surgery will be covered and I will only have to pay for the time it takes to complete the duodenal switch. A significant savings, and my work will allow me to go on short term disability to recover. Which is even better, so I don't have to use all my vacation time for recovery and possibly have to return to work sooner than I should.

I actually didn't really know anything about the duodenal switch until my first consult where he told me about it.  I've been reading a lot.  The conversion from a vertical sleeve gastrectomy to the duodenal switch means that I'm halfway done the surgery, all I require is the detouring of the small intestines.  Although he did say there might be some revision to the fundus, stomach, as mine is quite distended.  However he didn't recommend a re-sleeve by itself because they are not quite as successful and just revising the stomach tissue has a higher risk of leakage.

Because I have so much arthritis in my neck, I require ibuprofen on a pretty regular basis.  The other option of a gastric bypass is definitely off the table,  as that surgery is very intolerant too ibuprofen. The good news is that I regularly take ibuprofen and I don't have any stomach ulcers currently, so that is a positive indicator that this will continue to work well for me.

What I'm really happy about  is that all the waiting and wondering about what might happen, what's the recommendation,  which revision is going to be best for me  .... etc etc is over.  Knowing is just so much better, now I can rest easy and do research on my upcoming surgery.

Phew! So happy that I know the next steps.

His office is submitting to my insurance for the hernia fix and is going to get in touch with me with a quote for the remaining surgery that will happen at the same time. Then we can plan a date for the revision - which will have to be in October, I have too much going on work wise in Sept.  I'm hoping for  October 2,  first Monday of the month and almost exactly 5 years to the day (oct15,2012) from my initial VSG.  That will be a good date as well, so I can take almost that whole month off  to recover.

Happy Dance!!

The Waiting Game

It's so hard to wait now that I have all the tests done. I'm impatient and there are so many scenarios that this could play out to, so I keep over thinking what might happen.

The one thing that I need to get done is a check in with a regular GP to have my vitamin levels tested. Putting that on my to do list. I also need to scroll back in my calendar and review all the pre surgery steps that happened and in what order.

I'm struggling with the up down on the scale, as I always do. Weight down = flying high and feeling good. Weight up = angry frustratinion

I wish that I had a better relationship with my weight.  Guess I can file that under things to work on.

I've been doing better at lunch with bringing my pre-made good for me food. We are doing better at night with making dinners and not eating out, which is a huge downfall.

At this point it's just one day at a time and one snack at a time!

Endoscopy done

You know what doctors of anesthesia don't appreciate, jokes about Michael Jackson when they're going to use propofol on you for your procedure!! Oops!!

All went well for my procedure. I read the report they give after but am trying to not read too much into it, since I don't want to think one thing and be told another when I have the consultation.

I've started prepping people at work that I am going to need some substantial time off for recover from hernia surgery. I did this the first time as well- I am a "secret sleever". I don't want to tell many people about my WLS so I just don't. Especially at the office.

I'm actually feeling very restless and impatient. I have 10 days until my consultation about the tests and then September is a terrible month for work for me, so I'm going to have to schedule the revision surgery for October. Which feels like forever from here.

But I'm sure that it will go by quick!

Another Hiatal Hernia... Good News, Bad New

Bad news, I have another hiatal hernia... Good new, that means that my insurance will cover the part of the surgery to fix that. 


Side note... barium is about as yucky as I expected.  When you have not had anything to drink in 10+ hours you would think that drinking anything would be awesome... yeah, no.

The curious part of me is wondering why I have one again.  I imagine that its a combination of genetically having a big hiatal hole (hahaha!), and being overweight with the majority of my weight being carried in the front of my abdomen. This creates more pressure on the organs and could be forcing the stomach up. 


Anyway... all problems that can be sorted out.


Onwards to tomorrows 5am wake up call.  At 6am I have my endoscopy to have a look see the inside and I'm guessing I have ulcers again. 


Regardless, it will be a day off after conscious sedation, so I'm going to turn my work phone off and rewatch Game of Thrones last season and this season (if I can stay awake), and snooze with the dog.


I'm super curious to see what the doctor has to say about my sleeve and how it looks and his opinions on how to move forward from here.  

Upper GI X-rays Tomorrow

Tonight at 10pm, nothing more by mouth for my upper GI tomorrow morning.

I've only had barium once before, post first VSG, to make sure there were no leaks. Or, at least I think it was barium... pain meds make things fuzzy.

Very excited to kick this off again. I've also started an instagram account: TammyTake_2 if you want to link up where the "kids hang out"!!

This morning I was down on the scales again, which is great! But then I get wracked with guilt... am I just not trying hard enough? Can I do this without another surgery!? Ug, such ugly feelings. I have worked hard and I never came close to my goal weight, so I know that this is the right decision. I have to keep reminding myself that.

I've struggled for three years and done nothing but creep ever upwards. This is the right decision.

I found my 1 year pictures from 2013 and I'm excited to see the next phase of progress!

Duodenal Switch

I had a good 24 hours to think on everything the doctor said about the re-sleeve and duodenal switch, which he thinks is the solution(unless the testing reveals another story), and I had gone into the appointment thinking that re-sleeve was the only option for me because I didn't want to have my intestines altered.

I have done a good bit of reading and soul searching... the husband and I talked about it and we both agree- whatever he recommends I will do.

We went and bought a bullet mixer so I can get through my pre op and post op liquids and puréed phases making my own baby food. I want to be sure to eat more protein this time and less pudding and cream of wheat. I also got some more small containers for food prep and some mini popcile maker for frozen yogurt pops of my own design.

My new passion is riced and mashed cauliflower!! Which will fit into the puréed phase and beyond. Tonight we had it with sautéed shrimp as the grits replacement- Devine.

All in all, I am feeling happy and now comes the long wait to testing, results, and scheduling. It would be great if they kind of find something else to fix in there that my insurance will pay for to divide out the costs, but I don't suspect so and that's fine. Husband is on board and I have a month of vacation time saved up so I will schedule my time off via that.

Feeling positive

Weight today: 248.2

Re-Sleeve Consultation

I had my re-sleeve consultation with my surgeon this morning. On the drive out there,  I started to get more and more worried about my middling success with my first sleeve and what he might say about it.

When you've been fat for your whole life and you're used to being blamed for it - I suppose it's a natural reaction that I would feel that this doctor, like all my other doctors, would be judgemental about my "success"  and question my every single behavior.

Of course, he wasn't.  Not that I still didn't get emotional talking about it, which I did, but I managed not to cry. He reassured me by saying that VSG doesn't always work for everybody especially if there are metabolic concerns. He also said that RSG (re-sleeve) is not very common and he would usually recommend either gastric bypass or a duodenal switch- DS. However,  reality is is they need to take a look inside to see what's going on before he can make a decision.

 I have an upper G.I. scheduled for next week Tuesday and an endoscopy scheduled for next week Wednesday.

I had a good cry in the car on the way home, I'm pretty sure after my first consultation I did the same thing (except I had a dozen donuts after),  and thought about how I judge myself just as harshly as I think other people do for being overweight.  I thought about all the things I could do better, I thought about all the times that I could work harder on my diet, all the moments of weakness and over eating and not following the rules.  It was exactly the same kind of conversation I had with myself before my first surgery, how I could exercise more eat less, blah blah blah all the same shit .  The problem I guess is with me and it's hard to fully except that I'm flawed in this department and I'm so flawed that I can't even manage to have surgery work for me.  At the same time I have to remind myself that I'm not the only one and that I should be allowed to solve this problem,  with freedom from judgment even my own judgment.

 I'm not keen on a DS ,  but in thinking about the doctors comments about being metabolically challenged I think that probably applies.  When I stick to anything over 1200 cal I struggle to lose weight.  Even after this surgery now sticking to 1200 cal is difficult for me.  Over the last week I've had between 1800 and 2200 calories a day and I've gone to bed hungry each night.

I had a good long argument with myself about surgery and in the end I realized that I'm going to eat a cookie the day before I die and I'm going to feel guilty about it.  So if I want surgery now who cares it's for me to decide it's for me to choose I'm still accountable but there's no shame in admitting that I need help.

I'm going to do some research on the duodenal switch and go for my appointments next week I have a follow up appointment on the 28th to review my results and I guess I'll know after then what can or can't happen.

Looking Back

I spent some time last night and read through all my first 2 years worth of posts.  It was a delightful and terrible walk down memory lane.


I can see all the errors that I made back then, things that I wouldn't do again. 
  - too many carbs
  - too much sugar
  - no exercise
  - always attempting to eat too more


I also see just how far I have come from and I'm still proud of that. 
Changes that I have made:
  - no soda
  - no booze (not that I was a big drinker anyway)
  - generally make better food choices, more protein
  - 50lbs gone and to be fair, I was headed to 350+, which is not my reality anymore


I feel like this surgery was a pendulum swing for me. I was so far to one side (binging and eating amounts) and the surgery swung it way to the other.  The final result was that I settled in the middle, which is still too many calories to get to where I want to be. I can and do eat 1700 - 2200 a day and I am hungry several times in the day. 

If I get approved and have surgery to re-sleeve myself, then the arc of the pendulum will be so much smaller this time, that I think the final resting place will be more reasonable than 250lbs and more like 1195/200.


Directly after my first surgery consultation in 2012 I went to Shipley's donuts and bought a dozen donuts and ate 11 of them in my car.  The week before my pre-surgery diet started I ate three full sized bagels and a tub of cream cheese.  I also used regularly eat a whole large pizza, followed by a pint of ice cream and a liter of soda. I never left anything on my plate.  

I feel that the mental leap from eating 4,000 calories in a sitting to ~1,000 calories a day was so huge that I couldn't even grasp it.  It was actually mentally impossible for me to see that I need so little food that I could get by on a 1/4 of what I had in a single sitting.  I couldn't conceive of a meal that didn't have a starch of some sort - WAS it even possible to HAVE A MEAL without carbs?


I do a lot better now, I eat better, more protein and actually follow the diet guidelines, +100g protein a day - but the issue is how much I can eat. 
 
I've read this a few times and I don't like how it sounds, but there it is.  Looking back through all my other posts it was nice to have a few that were stream of consciousness - much like this.  So, posting these thoughts for my own good.

Re-Sleeve Thoughts

I was correct in thinking that people don't really blog that much anymore about this, or .. not that I can find on google anyway.


I have found a few re-sleeved people on Instagram.  Most of the accounts were private, understandably, as its a platform for sharing photos, so I totally get that (I would likely do the same).  There were a couple of accounts that were open and had some good positive data on being re-sleeved and did a little poking around on their posts to see what they thought and how it went. That was a positive!


Sadly, all the WLS/Obesity forums I've found on re-sleeving revision have been almost unanimously negative towards the person that is asking about getting it done. 


Its one of those strange things about WLS surgery, there is a sort of hyper-competitiveness over how it has worked for some people, who is "doing it the best", etc.  Mostly I've noted that if it is not working for someone - there seems to be a significant amount of finger pointing to the person that is not successful. 


I was laying awake last night thinking about what the surgeon might say to me on Friday about not being as successful as I could have been  and what level of "disappointment" he is going to have. I was already lining up a bunch of excuses, but the truth is....


This is hard.  No matter if you have surgery or not.  If I was able to control this myself, I wouldn't have been in for surgery in the first place.  


I thought back to my first meeting with him and remembered how NON-judgmental he was.  So I hope that I get met with the same amount of care for my feelings again, and then I can move forward with finding out if I meet all the right criteria.


I did find another great medical article on the Re-Sleeve: Better Results in Weight Loss after the Second Gastrectomy in Re-Sleeve Gastrectomy




Very promising material. Here is a nice graph that shows the results.

Weight today: 250

BMI Progress (2012 to 2017) and ReSleeve article

The best article I've found so far is here: Re-sleeve Gastrectomy for Failure of Weight Loss After Primary Sleeve Gastrectomy; 3 Cases


Its a very interesting read and of course, they use BMI as that is a better indicator for research than weight, due to variation in body size etc.  I do feel that some BMI is bullshit, since I really don't even want to be 175lbs, I want to be 195lbs and all the rest of the usual argument, muscle mass etc. 


As a result of reading this article I had a look at my BMI changes to give me an indication of my progress.

Date	Weight	Lost	BMI
Start	301		45.8
6 month	240.8		36.6
12 months	236.4		35.9
18 months	234	-67	35.6
19 months (low)	232.2	-68.8	35.3
24months	240.6	-60.4	36.6
36month	247	-54	37.6
48months	247.4	-53.6	37.6
57 months	251.4	-49.6	38.2

So I lost 10 points off my BMI score, then gained back 3.  I would love to lose another 10 points off this BMI of 38 down to a BMI of 29 (190lbs) or 31 (205lbs).  This is the range that I am shooting for anyway.


I have started to track my food again, and make better choices for the interim and "work my sleeve".  As I said - I am not good at this, and now I am often hungry and don't feel full.  Which is my kryptonite.  Last night I was hungry after dinner (6oz of beef and 1.2C of veggies).  So that is a problem for me.   This morning since breakfast I've been thinking about food nonstop except for the 45min meeting that I was in.  


I have 10min before I can eat my lunch, countdown is on.

2017 update - revision/resleeve - 5 years later

Does anyone even use blogs anymore?  haha!  I think all this sh*t is done on Instagram now, but whatever.

I have updated my weights page and am back here because on Friday (august 11) I have a consultation to see about being "re-sleeved". 

I have been searching blogs to see ... has this been done? are there people out there that are talking about this?  What are the results?

Mostly I've only found medical articles, most of which are promising.  I'm not sure if that is because this is too narrow a search, or I'm bad at "googling", or if people are just not talking about this.   Regardless, I'll consult with my physician on Friday to see if I am a candidate. he has done and does do this procedure, so I'm cautiously optimistic.

I'm currently stuck in the 240-250 range.  Back to battling the same 5-10lbs over and over and over again.  I spent 20 years doing this pre sleeve, and now... I just don't want to waste time again.

I want to knock another 50+ pounds off and get a tummy tuck. I also want to do that before I'm in my late 40's instead of my early 40's. Since I was 43 last month, time is a wasting.  

I have also spent a good deal of time re-reading my early entries and wish wish WISH that I had paid attention to the bloggers that talked about the honeymoon phase and to use it to lose as much as possible. Anyway, certainly there are things that I could do better, and things that I would do differently this time around. 

I certainly do not regret getting the surgery, I would do it again in a heart beat and I hope to get a second swing at the plate as well (pun intended).   If I was good at losing weight and managing my eating, then I wouldn't be here.  So, we will see what the doc says.

Small recap:

	wgt	Lost
Start	301
6 month	240.8
12 months	236.4
18 months	234	-67
19 months (low)	232.2	-68.8
24months	240.6	-60.4
36month	247	-54
48months	247.4	-53.6
57 months	251.4	-49.6
	Average lost	-58.9