Go-Time

When given the option of three different surgery dates in February, February 1st seemed relatively innocuous. February 9 posed a problem because it meant being hospitalized during Josie's birthday; February 16 posed a similar conflict with Norah's birthday. Would that the surgery scheduler and I have known three weeks ago what February 1 will hold!

We're under a blizzard warning. Understand, I'm a life-long Missourian. Blizzard warnings are what happens in the northeast or in the mountains out west or 800 miles north of us. But not Missouri. In fact, the local news reported it's never happened for Missouri in history. Save for the Mississippi or Missouri Rivers getting out of their banks as they've been prone to do, I'm guessing Jim Cantore hasn't spent much time doing live updates on The Weather Channel from Missouri. All this mess of a snow prediction of apocalyptic proportions has played havoc on surgery plans, but I think all systems are go. The girls are safely at home with my mother, who when the final chapter of this saga is written will have earned her merit badge. Work responsibilities have been handed over, and the automatic work email reply has been set up. Fearing the forecast, Molly and I made the drive through some freezing drizzle tonight and are holed up in a hotel a couple miles south of the hospital. When I saw the surgeon this afternoon ever so briefly, he shook my hand and promised to be there at 6am tomorrow if I would be -- and despite the fact that University Hospital Clinics and the University as a whole is closed, I've been told nothing to contradict the our handshake deal. Molly has packed a sleeping bag and pillow and, thanks to the soon-to-be impassable roads, is with me for the long haul.

So, if all goes as planned, tomorrow is go-time. I've survived two weeks of clear-liquid diet and a near-overdose of strawberry sugar free jello. The last substance I ate was some ice cream on Martin Luther King day. The first twenty pounds has fallen off of me, including seven pounds the first day. I should be hospitalized for two or three days at most, and after another couple weeks of liquids will slowly reintroduce foods according to the strict protocol.

Incidentally, Molly has survived quite a lot more than I have, and I don't just mean my flakiness in leaving the stove burner on, forgetting to put the kids' lunch in the oven, or that inadvertant attempt to asphyxiate her by starting her car and promptly lowering the garage. I can't imagine the journey for her thus far has been a picnic, and the days ahead surely no easier. I gave her full veto rights to nix this whole notion of the surgery before it ever got off the ground, but she has never wavered. Of my love for Molly and our girls, words fail me.

Humbling also has been so many expressions of love and care from so many of you. Facebook posts, emails, phone calls, and text messages have touched me more than I can say. I'll post an update in a few days as soon as I feel able. The journey begins now!

Day 5 and Still Alive

Somebody at some point will inevitably say to me that having this surgery was the "easy way out".  My sincere hope is that I don't punch them in the face.  I've been at the clear liquid diet since first-thing Tuesday morning.  It's been humbling -- humbling because of how hard this has been, humbling because I know the process will inevitably get harder.  I chose this path with my eyes wide open, fully aware that this wasn't a two-week or six-week commitment, but one that will forever change my life.  And quite honestly, I pray it does.  In my vocational role I have been privileged to counsel countless folks prior to their elective surgeries, and despite myriad differences, one thing remains common to most all of us:  we opt for surgery when the negative aspects of the operation pale with the status quo.  I am no different.

Truth be told, I've wondered why the two weeks of liquid diet beforehand.  Sure, the paperwork and the nurses and the doctor all say the same thing, that the pre-surgical diet is to minimize surgical risk.  I suppose that makes sense:  the heavier one is the greater the surgical risk, generally.  Also, the no-fat diet causes the body to rely upon the fat stored in the liver thereby making the liver smaller at time of surgery.  But there's also a part of me that wonders if at least some of the reason for the liquid diet isn't somehow psychological -- make it these two weeks, big guy, and you can surely make it the rest of the way.

So, this is day five of fourteen days of living only on a clear liquid diet and liquid protein supplements.  They say to maintain energy and health I must have at least 80mg of protein a day.  So far I've been able to keep at that threshold.  I get most of my protein from a pre-made drink that GNC sells called Isopure, along with usually one shake I blend a day from powdered whey protein isolate and skim milk.  I've also found low-carb SlimFast and sugar-free Carnation Instant Breakfast to be decent (although much more expensive than their standard, forbidden versions).  Additionally, I eat a fair bit of sugar-free jello and chicken broth.  My greatest luxury includes no-sugar-added fudge bars.  Our kids are helping me eat the fudge bars but flatly refuse to get within five feet of the chicken broth for fear that I'll try and feed it to them.

I think I learned what they mean by "water weight".  The first day I lost seven pounds, and have lost about a pound each day since.  I suppose I could forgo the surgery at that rate and just opt for the liquid diet for the rest of my life, but then I'm sure I really would end up punching someone in the face.

The Last Supper

The real fun begins tomorrow.  The liquid diet begins.  As the funny pharmacy tech engaged me about all this craziness, I had to tell her unfortunately that doesn't mean milkshakes.  She told me she was horrified for me, but she was good to suggest that tequila is a clear liquid!

In truth, it's a high protein liquid diet that I'm to follow for these two weeks prior to surgery.  No carbonated beverages and nothing with more than 20g total carbohydrates.  And no food whatsoever.  I spent an hour or so recently at GNC buying Isopure protein drinks and whey protein powder for mixing in milk.  I went to the store and bought a variety of boxes of jello and a bunch of sugar-free popsicles and fudge pops.  I also found some Muscle Milk light and low-carb SlimFast (I'm guessing regular SlimFast is creme broulee compared to the low-carb stuff!). And I have sugar-free Carnation Instant Breakfast that I'm to mix with skim milk fortified with powdered milk.  I'm to do all this because apparently the weight loss caused by the liquid diet lowers surgical risk.  I've taken inventory and I'm as ready as I'll ever be.

And so, tonight was the proverbial "last supper".  Fittingly, it was a normal night around here.  We cooked a flank steak over the weekend and tonight enjoyed the leftovers alongside baked potatoes and a nice salad.  I cannot confirm that there might have been a carbonated "grown-up drink" alongside.  Much later this evening, a bit of our favorite holiday peppermint ice cream was the last thing I ate, alongside the last diet root beer in the fridge.

Of course, what I ate tonight I'll eventually get to eat again, though I'm sure only a fraction next time.  Slowly I'll get to reintroduce food in the weeks post-surgery.  But drinking will forever be different.  Nothing carbonated, ever.  I'll be able to drink tea and coffee again in weeks ahead, but no longer with a straw, and not within 30 minutes either side of eating food.  Inasmuch as there was nothing out of the norm about the night, the present and the future couldn't feel any further apart to me -- and tomorrow is the next big step into this wild, new beginning.  I don't expect these next two weeks to be a piece of cake (no pun intended).  But not to put too fine a point on it, darkness comes after the last supper.  And while I don't yet know the whole story, I know the One who does.

Well, that didn't take long

If I've learned nothing in the past three months, it's to answer the cell phone even when the screen says "UNKNOWN."  It wasn't that I wasn't hoping for the call, it was that I didn't expect it today.  It wasn't that I wasn't hoping to be told what I was told, it was that I never imagined what has become.

I have a surgery date.  February 1.  It was, for me, a "say that out loud" kind of moment.  (I personally believe we could advance public discourse light-years if more people spoke out loud to themselves first before they spoke out loud publicly, but if that were true then neither candidate would have spoken at the last Vice-Presidential debate.)  I said it out loud again and again, although the surreality never lessened.  The issue for me is timeline in which two competing ethics are at play:  if we're gonna do this, let's do this sooner rather than later, and yet both of our daughters' birthdays are in February and I find quite unsavory the prospect of being in the hospital on either of their special days, so neither other proposed February surgery date was an option.  And yet, from my first phone call as an inquiring patient last fall to this very moment, my interaction with the surgery center has been limited to a doctor's appointment, two blood draws, and numerous phone calls and emails.  And as I also learned today, all of my learning about the surgery, the prep, and the aftermath will take place in an eight hour marathon session on January 31 -- the day before surgery. 

Understand, this is entirely of my own doing.  I signed up for it, and beyond a few wistful "what the hell am I thinking?" thoughts, I have no reservations.  But I never imagined the timeline would be this crammed.  So, the whole liquid diet thing -- that starts Tuesday.  I'm sure I'll have something more to say about that soon, but for now my day off tomorrow includes a trip to GNC to investigate liquid protein supplements.  *shudder*  And my tomorrow night may include weeping and gnashing of teeth.

And so, in the midst of a busy workday, I burned up the phone lines talking things through with Molly (she and I don't even work in the same area code -- how did we live before unlimited cell-to-cell minutes?), made a half dozen calls to nurses in the bariatric center as well as general practitioner, informed my mother of the sudden clarity of timeline, touched base with a couple of trusted friends who've been down the bariatric surgery path simply seeking assurance that I wasn't crazy to agree to surgery so soon, checked in with my boss (for those who speak my language:  the District Superintendent), and secured needed folks to be on-call for me and preach for me while I am away from church duties for surgery recovery.  That last part all worked out very, very easily -- astonishingly so -- so I'd like to think God is blessing this whole situation from the start. 

The last piece of the puzzle that needed to be placed today was to have a conversation with our oldest, our almost-nine-year-old.  Josie is the type of kid who can seemingly adapt to anything so long as she knows about it in advance.  We knew she'd need to fret and stew and ask questions, both tonight and in the future.  It's fascinating the capacity kids have; she was appropriately curious and concerned and wanted to know what the surgeon was going to do and if any of this was going to affect bedtime "snuggle-time" down the line.  And then she wanted to know if I was going to be in the hospital on her birthday.

A New Beginning

Well, I did it. I’ve made the calls and shared the news with all my folks. I’ve started sharing with colleagues and began planning how to make work work while I am away. More calls, more plans, more arrangements are in store before it can happen. It feels a little surreal. I’m finally at the crossroads and ready to take the plunge into bariatric surgery.

I’ve never thought much about bariatric surgery before. But about 18 months ago I became quite ill — easily the sickest I’ve ever been — headaches, fatigue, and excruciating pain in my lower back and groin. It took months to form a diagnosis of chronic prostatitis, only after an MRI, sleep study, EKG, cardiac stress test, trips to the neurologist and endocrinologist, and blood work — lots and lots and LOTS of blood work. After all those tests the answer seemed quite simple: the prostate was infected (not enlarged), which inhibited testosterone production, which caused then the pituitary gland to underfunction, and thus cause the headaches. Further, the infection spread to my pelvis and created significant pain in my lower back and hips. I’ve discovered first-hand the wisdom of my urologist: prostatitis is an insidious infection, extremely difficult to effectively treat, and has a high likelihood of recurrence. I’ve been on antibiotics more days than not in these past 18 months (Levaquin, Doxycycline, and Bactrim), to only moderate relief. The tipping point came this past fall when my really, really good general practice doctor and I began talking about my health, generally. My weight and type II diabetes weren’t the cause of my infection, but they were certainly factors inhibiting overcoming the infection.

With Molly’s blessing, I made the phone call to Missouri Bariatric Services. I watched their online video and took the virtual quiz and made the appointment with Dr. Richardson. Missouri Bariatric Services require a sleep study and a cardiac stress test — fortunately I’d recently had both. They also require consultation with a psychiatrist, so I made that appointment, too. In November, I began nutritional supplementation, per doctor’s orders. In addition to a quality multivitamin (I currently use GNC’s ”mega-man” formula which includes additional thiamine/B-1), I take 1000mg of calcium, 1000mg of sublingual B-12, and 4000mg of vitamin D. I was off and rolling.

That was the fall of 2010. In the past couple days, the final piece came into play — I’ve been approved by my health insurance carrier for surgery. Say what you want about United HealthCare — and I can say plenty about their runaround and idiotic delay tactics (they wanted five years of clinic notes and weight history — and when they initially only received 4 3/4 years’ worth, they rejected approval and the process had to start from scratch) — when push came to shove they approved the surgery several other carriers won’t cover.

I’ve been approved for gastric sleeve surgery (also called sleeve gastrectomy). Until I met my surgeon, I hadn’t even heard of the surgery. Basically, the stomach is surgically modified — made radically smaller — but doesn’t require re-routing/bypassing or installing a band. In the end, to me gastric sleeve has more appeal over the far more common lap band and gastric bypass. To each his or her own — and for certain I didn’t want to be beholden to occasional adjustments (“fills,” I guess they’re called) as in lap band that I knew my insurance wasn’t going to cover. I could totally have lived with gastric bypass, but the upside of gastric sleeve surgery appealed to me most, especially the nutritional malabsorption issues common to other bariatric surgeries. (I hope to write more in the future about what I learn about gastric sleeve — in the meantime, I found this link especially helpful for its simplicity: http://www.yourbariatricsurgeryguide.com/gastric-sleeve/ .)

At the moment, my file is undergoing final evaluation at Missouri Bariatric Services, and I hope by the end of the week to be told a surgery date. A day of classes at the center awaits sometime soon, as will an appointment with the anesthesiologist. I’m told we’re talking surgery within weeks, not months — so we’ll see.