Four Weeks

The fast started four weeks ago.  On Martin Luther King Day, I ate my last meal, and soon thereafter began the liquid diet.  This morning I broke the fast with a scrambled egg, cooked for me by my Valentine.  A half-dozen or so bites of egg never tasted so good, and a single grind of pepper never had such a kick.  This week I can start eating a few soft-solids:  eggs, potato (mashed or baked), oatmeal, yogurt, pudding, and chicken noodle soup.  The instruction is to blend before eating -- I'm really hopeful my system will tolerate small, well-chewed bites and that I won't have to break out the food processor, but it's on stand-by if need be.  I can also have cottage cheese, but I cannot conceive of starting that trend after nearly 38 years of avoiding the stuff.

Surgery was two weeks ago tomorrow.  The so-called post-operative "anesthesia-brain," for me, has been a very real thing.  In some ways, it's been the hardest adjustment to make.  Holding two congruent thoughts simultaneously has been impossible; at times, formulating a coherent sentence has been like dancing through a minefield.  It's also been a real challenge to gain strength given the incredibly limited calorie intake that characterizes the liquid diet -- especially given that I was restricted from milk-based protein the week after surgery and subsisted on sugar-free jello, chicken broth, and Gatorade.

Molly insisted, while totally understandable that I hadn't felt up to writing until now, that I at least needed to jot down some notes in the moment.  I'm grateful she had that foresight (and for her excellent blog contributions while I was unable to write), as one of my goals for the blog is to archive the journey in hopes it will help someone else. 

• Monday, January 31 was the mandatory education day at Missouri Bariatric Services.  Class lasted five hours and included a primer on post-operative nutrition, immediate post-surgical after-care, exercise necessities, risks, etc.  The day ended with a face-to-face with the surgeon to sign consent forms and ensure that he and I were on the same page with regard to surgery the next morning.
• Tuesday, February 1 was surgery day.  If this day sounds familiar to you, it's the day the Midwest Blizzard of the Millennium swept across the country leaving two feet of snow in places that often don't receive that much snow in an entire winter.  Our early morning began after a mad-dash trip to a nearby hotel the night before.  I was never so glad to see my surgeon walk into the holding room and tell me we were a go.  He also told me that I was the only elective surgery who hadn't cancelled that day -- my steadfastness impressed him, although his wife was "pissed off" the hospital hadn't cancelled it as a matter of course, even going so far as to call the Operating Room to verify herself!  My first memory in the recovery room post-surgery was intense hiccups, long before I experienced pain or even knew my name.  I later learned that my diaphragm had been irritated during surgery and I hiccuped throughout.  I hiccuped off and on throughout the day and night.
• Wednesday, February 2 was a little like the old.bad movie "Groundhog Day" -- I kept reliving hiccups over and over again.  Blessedly I was sprung from a truly awful roommate situation, which improved my disposition greatly, but did nothing for the hiccups.  A round of hiccups Wednesday night lasted well over and hour and I became afraid I would pass out from the accompanying belly pain, and I was given a tablet of Thorazine and an instruction to "just get it down somehow".  Somehow I did, and quite literally within seconds the hiccups ended.  Knock on wood, but I haven't had them since.
• Thursday, February 3 was moving day.  One of the trauma team docs (my surgeon barely made it home after my operation and was snowed in the remainder of my stay) came in early that morning and threatened to keep me if I didn't walk, drink, and pee more.  Typically, give me a goal and a roadmap and I'll perform.  Molly charted my water intake and I walked the length of University Hospital from one of of 5-West to 5-East and back each hour, and by noon I had the doc paged.  We were home by 2:00pm, where fourteen inches of snow had been shoveled off our driveway by still-unknown angels and a path hollowed out to the back door.  I never received a sweeter gift in my life and no better medicine than our girls' hugs once inside. 

Thanks to the snow, Molly was stranded at the hospital with me.  The hospital is a poor place to be stuck under any circumstance, but she suffered the hospital during a blizzard -- with limited food options and unsavory sleeping accommodations.  The depth of her sacrifice during those days and since surgery has been, for me, an indescribably blessed gift of grace.  Maybe someday I'll be able to convey the depth of my appreciation to her or to adequately describe what she continues to mean to me.  I remain humbled and awed.

And finally, I'll update where things stand at the moment.  While I'm down 30 pounds in these past four weeks (and 40 pounds overall since the initial surgery consultation last fall), that's not what delights me most:  I haven't had a dose of diabetes medication since the day before surgery, and my glucose scores have remained normal.  My prayer is with each passing week and as new, healthy foods are reintroduced, diabetes becomes less an impact on my life.  I'm told I already look different.  I see the difference in weird ways.  I have ankles again.  When she hugs me, Molly says my shoulders are smaller and I've had to adjust ballcap sizes down.  And my fingers don't look like my own.  I found my wedding ring in the big bucket of almonds we keep in the pantry -- I can't eat them yet, but I had gotten a handful out for Josie's snack the other day, and discovered that the ring had slipped off.  Nothing fits, and that feels great.

Gotta run.  I'm hoping to take my Valentine out for a baked potato.

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!

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.