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Going for Broke on the Laugh Track

My 25-year-old niece just called to see how I'm doing. She tells me she expects to see me in a bathing suit this summer. Laughed so hard I almost peed my pants. Really - when you weight 283 at your highest, regardless of how much weight I lose, the end product is a saggy Sharpei in a swimsuit. I may be healthy at the end of this, but I ain't going to be a looker.
RavenClaw779

RavenClaw779

3
 

What it Cost!?

Since January, $41,683 has been billed to my insurance company for services related to my procedure. The entire surgical charge was $26,829 - excluding the anesthesia. The procedure itself was billed at $17,735 - for a 45 minute pop. What's funny is my carrier's Reasonable & Customary for the surgery alone is $3,130 - so that's what Ellis gets paid. My portion of the entire surgical day - $389. My entire portion of the surgical process plus lead up - $1,482.00 I couldn't pay what they billed my carrier - who could? I'd be curious to see what my charges would've been if I'd pay out-of-pocket cash. Ellis will of course, write of the difference between billed/paid and my coinsurance on their taxes. Is it any wonder real reform is needed?
RavenClaw779

RavenClaw779

1
 

Cardio/Pulmonary/Sleep Worries

Having anxiety has led to a number of "cardiac" incidents over the years i.e., palpatations. Coupled with a family history of heart disease, I've had echocardiograms, stress tests, Holter monitering and other than some trivial valve issues and a slightly irregular heartbeat, every cardiologist I've seen has told me I have nothing to worry about. Last Friday's pre-surgical clearance with my doc had my BP at 110/74. Today - after the BiPap fitting, I drove an hour to meet with the pulmonlogist - for 15 minutes. When I got there my BP was 138/84 and he expressed concern. Nevertheless, my pulmonary function tests were fine - lung capacity and oxygenation well within a normal healthy range. The pulmonologist didn't even feel that my SA issues were that severe that if the BiPap didn't work for me, it wouldn't be a big deal...but the Resp Therapist told me my poor sleep quality and oxygen levels could lead to a heart attack or stroke. Apparently I shouldn't sleep on my back either. Okay - except that I have arthritis in my neck and any other position is uncomfortable, coupled the carpal tunnel which make my hands go numb when I lay on my side. I still have to wonder about the accuracy of the sleep study, when none of these issues are addressed. Beyond dealing with my weight, I have to say getting older sucks as it seems it's a juggling act of trying to balance life's responsibilities with managing health issues.
RavenClaw779

RavenClaw779

1
 

It's Working!

Yes! Between my dietary counsel from my NUT and the band, the scale has finally started moving and even with just 4cc in my 11cc band I can sense when I'm full. Was actually able to enjoy a modest meal of Chinese take-out last night. What's working for me is not neccessarily the standard "3 meals - no snacks" approach. My NUT has me on a meal plan structured for me which includes real foods(inc veggies and salad), carbs(limited - not zero) and an 8oz glass of moo juice(skim) half an hour after each meal. I use it to take my vitamins. My NUT gives me lots of reading material the latest being the Journal of the American Dietetic Association - April 2010 edition (Understanding the Impact of Bariatric Surgery). One over reaching theme of everything I've read is that there is no hard and fast rule on post procedure nutrition/meal planning and the ADA is trying to nail down specific recs to be made. That said - this works for me and it feels like it's a good mesh(for now) of proper nutrition, willpower and the band.
RavenClaw779

RavenClaw779

0
 

Surgical Clearance w/My Primary

Got the once over from my primary doctor; review of vitals, meds, allergies, urine screening. Together we reviewed the reports from the cardiologist(no concerns), the abdominal ultrasound, upper GI, chest x-ray - all normal. In fact after Friday's appt. with the surgeon and the diagnosis of "fatty liver" I was researching on WebMD and Mayo Clinic and getting worried, so I asked my doctor about it. He said that it's commen in obese patients, but that according to the ultrasound, and the radiologist's report, my liver was of normal size and condition - no mention of "fatty liver"?!   Was also talked about the need of a CPAP and reviewed the report from the pulmonologist. My doc was stumped as to why the report states, "no indication of sleep apnea" but the pulmonologist put the sleep lab/cpap in as a recommended follow up.   My doctor told me to have the surgeon call him and he would support me not having a cpap. Hope I don't end up having gone through all this for nothing.
RavenClaw779

RavenClaw779

1
 

Pre-Surgical Visit w/Surgeon + PAT's

Took my husband with me for the last meeting with my surgeon. She is pleased with my weight loss(21-25 lbs depending on time of day and level of dress:ohmy:), told me that all my tests came out clear but advised that I have a "fatty liver":sad:. My husband's concerns were addressed - still can't believe he thought the port was going to hang out of my body!?! What - like the tag on a stuffed animal!?   PAT's were a repeat of tests done several weeks ago plus a pregnancy test. Strange to have to have that done as I've been POST MENOPAUSAL(surgical) since 2007!?! Guess this is another sign the insurance industry needs reform - test after pointless test to hedge against any kind of lawsuit.   Told the surgeon about my CPAP failure and asked what happens now? She's going to have her patient case coordinator follow up with the pulmonologist but she made it pretty clear - No CPAP - No Surgery. So slap one one me in the recovery room.
RavenClaw779

RavenClaw779

1
 

Wow - What A Difference 50 Pounds Makes

At my highest I was 283 - now I'm 235...almost 50 pounds off. What really brought it home to me was went I took my five-year-old niece to the beach last weekend. Any one who has a small child knows that after a long day of play, with no nap, "cranky" makes PMS look like a walk in the park. So, when my niece whines, "Aunt Jill my legs hurt when I'm walking(chafing in a wet bathing suit)!" I had no choice but to pick her up and carry all 45+/- pound of little girl to the car. That is a lot to lug! That was what I was dragging around with me for the past seven years. No wonder my back no longer aches and my feet don't bother me and I can actually walk from my office to the downtown area for lunch. No - I'm not "thin" - yet - but I'm slowly but surely on my way.:smile2:
RavenClaw779

RavenClaw779

4
 

Good Read (kinda like "Good Eats")

Just like the band is a tool, I have found another helpful "tool" which helps me slow down my eating habits - Reading! Now, I know you're not supposed to do anything else while eating - like watching TV, but frankly, just how slowly can you consume a protein shake? Sometimes I'm having one while I'm blogging but I've also found that reading an educational book works as well.   I'm currently reading, Secrets of a Former Fat Girl, by Lisa Delaney and Diabesity by Francine R. Kaufman, M.D..   I especially liked this quote from Secrets of a Former Fat Girl as it rang true for me:   "INO(Its Not An Option) was invaluable in helping me overcome my need to please and my talent for rationalizing that putting other people first - just about at all cost - was somehow the noble thing to do....It helped give me the courage to break out of the Fat Girl mold that other people expected me to conform to, and start living my own way."
RavenClaw779

RavenClaw779

1
 

Reasons for Weight Loss Part II

(Continued) Through the remainder of my college years and through my twenties, I kept my weight under control; my weight averaged between 125 - 136, but I worked and worried about it endlessly, always feeling “fat”. As my career started to really take off and my responsibilities grew - travel, business dinners, I had to aggressively restrict my food intake to maintain my weight.   I spent the first seven years after I graduated living at home, helping to support my financially irresponsible father, nursing my mother through breast and then lung cancer and caring for my youngest brother.   I was finally able to break free in 1995. Money was tight and the debts incurred supporting my parents were high. I worked for an international insurance company, but the pay wasn’t great and my boss difficult to work for. Turnover in my department was over 50% that year, so I was working long hours, weekends and living in fear that I wouldn’t be able to keep a roof over my head. My weight escalated to 176 by January 1996.   As I became more acclimated to living on my own and managing my career, I was able to better manage my weight. Between January 1996 and August 1997 I lost 37 pounds.   I started dating my future husband, in July of that year. We both worked for the same company and although it was not against company policy to date a co-worker we opted to keep it a secret. That in addition to living 150 miles apart, was stressful and I began to battle my weight again. In the first year we dated, we both gained 20 pounds.   In 1998 I was offered a plumb position with a competing company, one that would provide a new direction to my career, a company car, double my salary, and eventually transfer me to the same city as my future husband.   I now telecommuted from a home office and inherited a service territory which hadn’t been handled in two years. Coupled with the fact that the promised “training” wasn’t provided, I was now working at times 14 hours a day, seven days a week.   Often on the road for hours at time, I turned to fast food. Late nights at my desk with pizza, long work hours, long distance relationship and loads of stress and I soon became a junk food, comfort food and binge eater. By the end of 1998 I was 166.   In 1999, I was a top performer with my company and was offered a relocation to the same city as my future husband. I was made aware that my assignment had problems and as I worked my way into my new territory, it became clear that the “problems” were quite serious and in some cases, potentially litigious. I was charged to, “treat this territory like it was my own business”. I did, and won the support of my direct manager and home office staff. I was still working 12 to 14 hours a day plus weekends. I ended 1999 at 183 pounds.   Year 2000 would prove to be the most stressful year of my life. My company decided to dramatically change my (and my co-workers) job duties. I was now juggling tasks that had been handled by three separate individuals. In April I got engaged and began planning a wedding for October in my future husband's home state, a 1,000 miles away. In August I found a lump in my breast and was diagnosed with breast cancer the same weekend the invitations arrived from the printer. Fortunately I became a patient at a world recognized research facility, but it was still a crazy, stressful time. Between August and October I was diagnosed, packed my apartment, moved to my fiance's house, arranged a wedding reception for 150 people, had surgery and worked full time. In November I began chemotherapy. By the end of 2000 my weight was up to 213 pounds.   I finished chemo in January 2001. A month later I started five weeks of radiation therapy. I continued to work full time, often 70+ plus hours a week. Despite winning multiple “key contributor” awards that year, I was given my first “unsatisfactory” performance review and told that as soon as my radiation therapy had finished, I should’ve been able to get back to my old service numbers. I was constantly stressed, sleeping sometimes just four hours a night - terrified that I’d lose my job and hence my insurance coverage. Couple with my new job duties as a “wife” I threw in the diet towel and ate whatever I wanted. By the end of 2001, I was 252 and 2002 added another 31 pounds - 283. In 2003 I was diagnosed with Type II diabetes and not surprisingly, due to the radiation to my chest, my thyroid had shut down. The job stress was incredible . My territory was supposed to be staffed by four people, but despite numerous promises from corporate that additional staff would be hired, I continued to hear that management didn’t feel we needed additional staff , since, I, "managed it all so well”. When once again my recommendations were ignored and resulted in a loss to the company in excess of 1M, I realized that I was just wearing myself out for nothing. My husband and I discussed it and as it looked like his company was going to transfer us to New York in 2004(actually took until 2005) we decided it would be best for me to quit before it killed me. Following my early “retirement” I enrolled in a local hospital's Simple Success Weight Loss Program and lost 20 pounds over 8 week period.   Over the last seven years, my weight has averaged between 253-267. I can manage weight loss for a limited time, but stress leads me to binge eating. I find myself haunted by memories of my childhood and sometimes wonder if I’m not stuffing myself to stuff down the painful memories. I am the primary “homemaker” and find that everything from paying bills, to housework, to family obligations are my resonsibility. I have minimal down time and often find my days are just as long now, serving my family, as it was when I worked full-time. I jokingly say that I “gave up” one of my jobs - now I can’t figure out how I managed to work the hours I used to and do all that I do now?!?   Nevertheless, not working has created a gap in my life socially and for my husband and I financially. I need to get back in the work force, but I’m afraid to get out there at this size. In the South, where I'm from, people are a little more gentile, a little less willing to pick on someone for their weight. I’ve found since I’ve moved to New York, that people, even strangers, will very directly comment on someone’s weight. I’ve had a neighbor snub me then very loudly comment on my weight and make disparaging remarks to other neighbors. I’ve had business professionals I contact on behalf of my charity work feel free to comment. I even had a medical professional at Memorial Sloan-Kettering harass me to the point I left the clinic in the middle of an MRI! I have had enough of dealing with and being defined by my weight, by being weighed in the balance and being found wanting because I’m too big.   I’ve spent 32 years with issues related to food and my weight coloring every aspect of my life. I was able to overcome the short comings related to growing up in a physically and emotionally abusive home; going on to have a productive professional career, a real family, and being an active member of my community. Despite numerous attempts to control my weight, this is one area in which I have failed repeatedly. I’ve been well-educated through nutritional counseling, and my own efforts to self-educate. I know the risks this extra weight puts on my overall health and I am already seeing the effects. Coupled with the social and emotional aspects of being “plus sized”, I feel like the “life” is gone from my life - that I’m avoiding doing more and more activities because I’m trapped in a body that doesn’t feel like mine. When I dream, I don’t look like this. I’m willing to make the changes needed to lose weight - I’ve done it before, but I need a partner(so to speak) to help me down the long road back to being me.
RavenClaw779

RavenClaw779

2
 

Checking In

LapBand + bad cold = weight loss! Just kidding - but it's too bad no one ever came up with a non-surgical solution to over eating.   Still hate shopping, but made myself go. Found a pair of great chocolate tweed lined slacks - size 18. Figured they wouldn't fit but they did. Needless to say I did a lot more shopping. Am now a L/XL(misses) on top and 18/20- maybe 1X on the bottom. Finally got rid of the sweatpants my husband said made me look like I was channelling MC Hammer. Another big step for me - actually wearing colors other than BLACK!   Visiting with my RD the other day. She attended a conference where I group of bariatric docs were talking about the "disappointing" success rate with WLS and how gastric banding can serve as "training wheels" for the new gastric sleeve procedure. Very expensive set of training wheels!
RavenClaw779

RavenClaw779

0
 

Winding down and some helpful day before hints

All the chores are done, suitcase packed and I'm winding down with a delicious mug of Sirloin Beef Stock - actually quite good or perhaps I really am losing my mind.   btreiger reminded me to bring a pillow to pad my stomach on the ride home - great idea and one not even mentioned by the hospital staff.   Here are some prep tips: * If you have to do a "cleansing" do a test run on the weekend. If I hadn't and had following the timing per the nurse, I'd still be on the toilet at the time of my surgery!   *The numerous trips to the bathroom create what I like to call "Burning Butt". 'Roid cream will only make this worse. Must have - kid's flushable wipes(very gentle) and diaper rash cream(w/zinc oxide and cod liver oil). Yes, it smells but if you 'butter you buns' when you take your MOM as time goes by it's a lot less irritating. Also keep some reading material in the bathroom - you'll be in there so much you can read the whole Harry Potter series!   *Don't forget to bring your insurance card and your health care proxy. Yes, it's a low risk surgery, but it is surgery so make sure your support person knows your wishes.   I'd write more, but I gotta run!
RavenClaw779

RavenClaw779

2
 

Poison Ivy!

So - having more energy can be dangerous! Got it into my head to clear some brush to increase the size of my landscape project. Out I go with my 1" lopers - chop,chop, chop(great stress reliever). I create a giant mound of limbs and brush before going off to help my husband with a building project. At the end of a long day I take a shower, feeling pretty good about my boundless energy. Two days later I'm covered in weeping poison ivy rashes - and I mean covered! That other weight loss positive - looser clothes - meant that as I worked, I was hitching up my pants, tucking my shirt in...so in addition to the sweaty ear I scratched(now big,itchy and red), I have a ring of rash around my waist, one boob with a similiar effect plus my arms and legs which look like I was in a battle for my life against some sort of clawed animal.
RavenClaw779

RavenClaw779

2
 

I See No Difference

I see no difference when I look in the mirror despite 35 pounds lost. What I do see already looks saggy and I'm wondering if I can afford the plastic surgery I'll need to look normal or if I'll spend the rest of my life never wearing shorts or a swimsuit. I guess I should just be thankful for 3/4 length sleeves and capris - my go to since reach 3X!
RavenClaw779

RavenClaw779

1
 

Getting in the Pre Op Diet Groove

I've been struggling since my Pre-Op MediFast start date of 2/1... The first three days I dropped three pounds but by that weekend I was covered in hives and running to the bathroom. Soy allergy. Between the cringe worthy beef broth and the awful tasting MediFast I lapse into - No, not non-nutrious eating - but eating real(GASP) foods. Back came the three pounds. Now I'm using Jillian Michaels' Whey Powder(same counts as Medifast, trace soy, taste is passable) and it seems to be clicking. Switched to "Kitchen Basics" Veg Broth - acceptable and am sticking to the plan. Oddly enough, I feel okay and actually feel like I have more energy. My poor husband is trying to eat what I do for dinner(except more) - tonight's fare (salmon,steamed broccoli and a cup of lettuce) didn't do it for him. Do we have any frozen pizza in basement freezer?!:confused:
RavenClaw779

RavenClaw779

1
 

Today's Laugh

S-i-l#1 called today on the pretext of asking me a legal question. "So how much have you lost?" Rather than give JabberJaws more fuel for her gossip machine I just said, "a bit". Hee Hee - it was fun to listen to her squirm: "...so how much did you weigh at the start?" * "Too much for my frame" "...how much do you plan to lose?" * "Enough to lower my BMI to a normal range." "Will you ever weigh what you did when I first met you?" * "Who knows - do you know what you weighed when I met you?"   God - One good BM and I turn into such a Bee-Atch!   Sidebar - Yes, I'd love to weigh what I did then (140) and it's definately a goal, but is it realistic that I could go from 283 to 140 - Not very likely!
RavenClaw779

RavenClaw779

1
 

Five Days to Go

All the pre-approvals, testing and clearances are done. I've been running around getting the pantry stocked, bills paid, post-surgical dietary needs stocked, laundry done - etc. Still trying to get my mind around the no lift/push/pull over 10lbs for 4 weeks. I have two large dogs - if one of them even bumps me, I'm a goner:ohmy:! Everyone keeps asking me if I'm scared or excited. Actually - neither. I'm so busy and it's moving so fast that I don't have time to really dwell - and when I have pondered I get myself into a low level anxiety. I'm doing this for my health and it's just a tool but all the testing ramps it up the anxiety a bit even though everything's fine. Having had cancer puts an edge on any medical testing even after all these years. Add on trying to get used to a BiPap in five days which isn't going to be easy - here I am at my desk at midnight dodging going to bed like a child:tongue_smilie:! Still trying to get my husband to grasp that this isn't like getting a Snap-On tool. He seems to think I'm invincible because I've bounced back from other surgeries and maybe I will, but I'm trying to prepare him for the unpleasant potentials and that if I tell him he needs to get me to an ER, it's not a debate. I think he's thinking I'm going to be whipping up a home cooked meal on Wednesday night:w00t:! As far as the pre-surgical diet goes - I think it would've gone better if it was just limited to the two weeks prior. I've been on this for over a month. I have cheated - not too terribly. Last Friday after the surgeon cleared me, we went out for a late lunch. I had half a fish sandwich, 6 fries and a 1/4c of cole slaw and was full. It's been a struggle since. I managed two shakes today and ate a 1/4 of a chicken breast and some crackers with cheese. Now I feel gassy & guilty! (but not sleepy)
RavenClaw779

RavenClaw779

1
 

Diet Fatigue

I'm within three pounds of my goal weight for surgery and not really hungry. But I am so tired I can hardly muster the energy to do the laundry. As a rather fanatical housekeeper, this ain't good. Big snow storm coming and my husband is going out of town on business. Since he's refused to buy a snowblower(he prefers to shovel our 90' driveway by hand?!!) he's suggested I just get an early start tomorrow shoveling. Had to so say no to that one - like I could shovel this monster on under 500 calories??:rolleyes2:
RavenClaw779

RavenClaw779

1
 

On the diet, sleep lab and other updates

Was hoping to avoid that second trip to the sleep lab tonight - using my unplowed 90' driveway of snow as an excuse...sadly, must go or the surgeon will cancel the surgery. Guess the hubs better get home early and get to work shoveling:laugh:   Was so hungry yesterday I ate a couple of whole grain waffles and a bagel. Was prepared for the worst when I stepped on the scale. DOWN - to within a pound and a half of my pre-surgery goal weight. My nutritionist said that when you're on an extremely low calorie fasting diet, your metabolism slows down to accommedate less fuel coming in. By eating a little more I "tricked" my body into feeling like everything's status quo.   Added one packet of nutrasweet to the Jillian Michaels shake - cuts that horrid stevia bittersweet aftertaste. Managed to choke it down...
RavenClaw779

RavenClaw779

3
 

Day II - Post Surgery

Got through most of yesterday with minimal pain, but by about 8pm I was feeling nausea and pain in my neck and shoulders from the gas. My mouth was dry all day - tongue stuck to the roof dry - possible side effect to the muscle relaxer and not being able to drink in more than little sips. I can hear/feeling the liquid move from my pouch to my stomach - strange, but not painful or distressing. Was up off and on all last night - finally ended up on the couch with my CPAP, heating pad and pillows - got about an hour and a half nap in. Been up since 7am - last Loratab was at 5:30am; trying to see how long I can going between doses as it makes me very sleepy. Not surprising, my sister-in-law has told everyone so the phone has been ringing off the hook. One "well-wisher" called and during the conversation told me that it, ..."was a shame you didn't have the will-power to do it on your own..." Charming - but I'm too tired to push back at this point nor do I feel the need to explain myself to idiots.
RavenClaw779

RavenClaw779

1
 

Thoughts on Insurance

There was a forum question re; doctors "scamming" patients which got me thinking. I have a commercial insurance background and stay on top of my medical insurance claims as I've had a number of denials over the years which were actually mistakes on the part of the carrier's claims adjustor.   Sadly, turnover in insurance companies is high. Burnout especially in the claims area is understandable due to the stress. Often the people hired have minimal experience in the field and no medical background. It really is in your best interest to know your policy and ask questions.   I don't think the United States needs universal health care, but we sure do need reform and oversight. Here are some great example from my own claims generating from the pre-surgical process:   *Basic Bloodwork $832(Billed to BCBS); $104 (BCBS - Allowed) - Required although I'd just had bi-annual labs with my primary two months prior.   *Medifast Nurse (15mins) $82.22(Billed to BCBS); $22.93 (BCBS - Allowed) - Didn't even include the Medifast product   *Pulmonologist (30 mins) $263 (Billed to BCBS); $134(BCBS - Allowed) - Wow; he asked the same questions already asked by another dept at the same facility and available online. Listened to my heart and lungs and told me that despite no flags for sleep apnea I had to go to sleep lab and have another "pre-surgical" appt with him.   This is why I love the Mayo Clinic. Their doctors are salaried and while their services are not cheap, they test because it's necessary not to gin up charges.
RavenClaw779

RavenClaw779

1
 

Surgery Day

Left the house at 5am to get to Ellis by 6am. Within 15 minutes I was in my gown and slippers give yet another blood sample. The anesthesiologist, the surgeon and all the nurses attending came in and introduced themselves. I was wheeled in to the operating room at 7:50am and awoke in recovery at 9:30am. The surgeon advised my husband that everything went fine and that she'd repaired a haital(sp) hernia. Left the hospital around noon and slept all the way home. Then I slept off and on for the rest of the day. Wasn't hungry and the pain was not too severe - actually it was the CO2 that was causing the most pain. The Kicker: The CPAP that I had to have and had to bring with me - WAS NOT USED.
RavenClaw779

RavenClaw779

1
 

Not Hungry

(Must be boring everyone to death - no one has any comments...)   Two weeks from surgery. I found I was allergic to the MediFast shakes with the soy so I changed to the MediFast "cold drinks" (per the nurse - "no soy"). I'm to have five shakes a day plus add'l protein as needed. I've now had "the runs" for two days and just the thought of eating anything makes me feel sick. Still 3 pounds from pre-surgery goal weight.
RavenClaw779

RavenClaw779

1
 

Some Real Nutritional Info - From a Reliable Source

Met with my NUT practice today(not the one affliated w/my surgeon). I explained that I was confused about what to eat and how much(don't know about everyone else, but I've gotten so many conflicting tidbits that I've got pages of notes). So the ladies get out the ADA Pocket Guide to Bariatric Surgery - Appendix C - LAGB Stages and Postadjustment Diet Instructions. Right there on the front it says, "Note: There is no evidence supporting a specific diet transition. Expert opinion suggests (a) a staged approach; ( diet advanced as tolerated. Some other notes of interest: Stage III (whole grain crackers may be added to eat with protein) StageIV (your calorie needs are based on height, weight , age and activity - so much for the "1,000 calorie" pat answer)   Another great help was the ADA's EatRight - Bariatric Surgery Blended and Pureed Nutrition Therapy which provided a Sample Menu by Hour with amounts to consume - you are literally eating or drinking every hour from 8am to 10pm! I had no clue - so this will help as I go through the stages again following my fills.
RavenClaw779

RavenClaw779

1
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