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!!