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Record Keeping and Musings

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Post Op Update

Hi all. I had my surgery on October 11th at Shawnee Mission Medical Center in Kansas City under the care of Stan Hoehn.   Day of surgery: Surgery at 10:30 am. I woke up in a lot of pain in my abdomen. The original recovery room pain meds didn’t help. The next meds they tried caused an allergic reaction - rash, trouble breathing, inability to focus, nausea. It took hours to convince the nurse that the Dilaudid was a problem. In retrospect, as I am allergic to morphine, I can’t believe they gave me a morphine derivative and then denied I was having a reaction, but that is having a bad nurse vs. a good nurse, I suppose. For the record, all of my other nurses and CAs were the best and truly a great group of healthcare professionals. The Demerol that they finally put me on (about 7:30 pm) gave me a bit of itching around my eyes and nose, but was far more tolerable. I was able to suck on ice chips, take a walk around the unit, and sleep pretty comfortably.   Day 1 Post-op: Felt great, was doing great with all tests and measurements. Able to start clear liquids. Every bite felt like I was filling my stomach with air – uncomfortable but not painful. Started taking Lortab Elixir. It tastes terrible, but it was nice to get away from the powerful drugs. Went home moving well and optimistic. Took my everyday meds (Wellbutrin,Kariva, and Zantac) and went to bed around 10 pm. Woke around 12:30 am feeling crazy nauseous and vomited repeatedly – very painful. Woke again at 3:30 am for another round. I was in so much pain and so nauseous that I could not get the Loratab down.   Day 2 Post-op: Spent entire day in bed. It was almost too painful to get up to use the restroom. Too scared to take Loratab in case itmade me vomit again. Too nauseous to eat or drink, though I forced myself toget in 25 oz of water before bed. A frightening, dismal day. Realized that I was not supposed to begin taking the Kariva or Zantac right away, so that was probably the cause.   Day 3 Post-op: Called the doctor because I was so sick thatI was barely able to get anything down, including water. They prescribed an anti-nausea medication that dissolves on your tongue – took one and haven’t been sick to my stomach since! Still sore from vomiting, but feeling 100% better after getting the script filled and taken. Easily get my water and protein minimums met. Took a 15 minute walk around the neighborhood and then took a nap.   Day 4-6 Post-op: Energy is great and pain management is easy with liquid ibuprofen or Tylenol. Having soreness in my back, but probably due to too much sitting around. Was able to do household shopping and light cleaning around the house. Able to bend easily to scoop litter boxes, vacuum,and any other task that doesn’t require heavy lifting or pulling. Eating hasbeen an adventure. Protein shakes and liquids in general are no trouble. More solid things are hit and miss – pureed shrimp was okay, but salmon caused sliming. And sliming is no fun, but not painful, thank goodness. String cheese was fine once but not tonight. Hummus, eggs, avocado/yogurt soup, and refried beans have been no trouble. I find I am able to take one biteof just about anything and I am fine as long as I chew, chew, chew. And, ofcourse, I’m not trying anything outside of my nutritional guidelines. On the downside, I can’t tell when I am full, so I have been tying to keep all portions at about ¼ cup, as that seems to work without making me slime. Starting tomorrow, I need to really up my protein and water intake, so that might be a challenge as I feel like I have something in my mouth all the time already. LOL   Hunger is mostly gone, but head hunger is alive and well.   Dr. Hoehn prescribes a self-injected medicine called arixtra to help prevent blood clots. We must inject ourselves once a day for seven days following surgery. I was dreading this and was pleased to find that it is so easy and painless. Swab some tummy fat with an alcohol prep pad, pinch, and jab. The needle is so fine that I haven't felt it even a little. Believe me, super, duper easy.   I see my doctor tomorrow to have the staples removed. I’m hoping to be cleared for a bath as I dearly love soaking in the tub. I've been showering, of course. I just miss my bathtub. Otherwise, I feel very much on track.     I’m using myfitnesspal.com to keep track of every bite and that is so helpful. I am “hswelch” there if anyone would like to find me there.
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Pre-op Prep List

Non-Food Items:   Demitasse Spoon and Cocktail Fork ($1.99 each at Bed Bath & Beyond) Liquid Baby Tylenol Appetizer Plates ($2.99 each at World Market) Funnel (Set of 3 nesting, $1 at Dollar Tree) Gas-X Tervis Tumbler and Travel Lid (The cocktail shaker version, $18.99, has measurements on the cup. It comes with a removeable jigger, strainer, and pourer that is easily replaced with the travel lid, purchased separately for $3.99) Baby Spatula (Silicone Frosting Spreader $1 at Dollar Tree) Spill-proof Sippy Cup that looks like a travel mug Travel Baby Formula Dispenser ($6.99 at Overstock.com) Water Bottle with measurements and narrow mouth ($8.95 at llbean.com) Bariatric Fusion Multi-vitamin
  Pantry:   Cottage Cheese Cheese Sticks Broth Cream Soups Sugar-free Tang Refried Beans Fat-free Greek Yogurt Hummus Sugar-free Apple Cider Miso Soup Natural Applesauce V-8 Low Sodium Decaf Instant Coffee Packets (like Nescafe Hazelnut) 100% Juice (grape, apple, cranberry) Unflavored Protein Powder Isopure Bottles from GNC (buy 1 get 1 half off in stores right now) Individual packets of many, many protein powder brands and flavors       Only a month until surgery! Any suggestions that for items that you found useful?
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Day One of the Two Week Pre-Op Liquid Diet

Here I am in day 1 of my 2 week pre-op diet. I've been very excited to get here as it is a major milestone on the journey to getting "sleeved." I have to say, it hasn't been the easiest day for me. I feel a little like the universe is taunting me.   The day began with a very good peanut butter cookie shake and a cup of peppermint tea. When I arrived at work I was greeted by an email that a co-worker had brought in homemade apple crumble. No problem. I filled my water bottle and went on with work.   Lunch consisted of a terrible orange cream shake and I found myself both nauseous and wanting something more to eat. I filled my water bottle and went back to work. A few minutes later, the server from our executive dining room came by and offered me a piece of the leftover Robert Redford cake - one of my favorites! I gritted my teeth and declined. A few minutes later I ran into another co-worker who exclaimed how good he felt after indulging in a delicious, high-fat lunch (his words....can you believe it?). Are we such a food-centered world or am I being way oversensitive? Probably somewhere in the middle, I understand. But it is hard to not resent the easy, breezy offerings of empty calories without a thought for the consequences. I know, I know - I have made my decision and I can't expect the whole world to get on board just because I have. The payoff is going to be tremendous. I can't wait to start seeing the consequences of my decisions!    
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Day 2: Hello, Sugar Free Jello

Day two of my pre-op liquid diet was better. I drank a ton of water. I didn't have my 4th "optional" shake. And I felt great after buying a bunch of jello. It was a relief to take bites, if that makes any sense. I also bought a new tea to try and some different flavors of crystal light and propel. I get bored easily.
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Where I stand today...

2/14/11: Verified with Saint Luke's Center for Surgical Weight Loss that my insurance would cover their program   2/15/11: Attended St. Luke's Seminar   2/23/11: Attended first pre-op Dr. appointment. Sandy explained that I would need a 1) sleep study, 2) appointment with their nutrionist and exercise specialist to begin a three month supervised diet/exercise program, 3) psych eval, 4) letter of medical clearance from my GP, and 5) copies of notes from any doctor I saw in 2009 and 2010 showing my current weight. I would also need to attend at least one support group meeting. My appointments for the psych eval and diet/exercise specialists were set. I briefly met Dr. Price.   2/24/11: I received a call from the St. Luke's Sleep Lab to schedule my sleep study.   2/27/11: Completed sleep study.   2/28/11: Received call from Kara at UHC. They explained that my policy does not cover Saint Luke's Center for Surgical Weight Loss . In addition, my policy requires a 6 month medically supervised diet.   You might imagine my reaction to this news. I was devestated and furious at St. Luke's for assuring me that my insurance would cover everything when they clearly had NO IDEA.   2/28/11: Reserved a spot in the upcoming seminar (3/7/11) at the only local program my insurance does cover, The Bariatric Center of Kansas City at Shawnee Mission Medical Center. All I can do now is wait to see what my earlier mistakes will cost me and try to move forward despite them.   3/7/11: Went to DO's office for pre-supervised diet/exercise program blood work   3/7/11: Partipated in scheduled meeting via phone with my UHC case manager, Jill. She instructed me to 1) tell the folks at SM that she is my case manager, 2) called her with any questions at (866) 534-7209 x65559, and 3) check in with her in June to let her know my progress           Upcoming appointments:   Monday, 3/7/11, @ 6pm: Attend the seminar at the Bariatric Center of Kansas City at Shawnee Mission Medical Center Thursday, 3/10/11 @ 5pm: First appointment with DO to begin supervised diet/exercise program June: Call Jill, my case manager at UHC to update her on my progress        
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Some Rollercoasters are Not Amusing

3/7/11: Attended the seminar at the Bariatric Center of Kansas City at Shawnee Mission Medical Center. Delivered my paperwork and insurance and ID copies to the staff. Met Connie - what a sweetheart!   3/10/11: I called Jill, my case manager, in the morning to check that the dates I meant to schedule with the doctor who is supervising my diet will work within the parameters of the requirements. I had to leave a message and wait for a return call.   About 2:00 pm I received a phone call from Jan at The Bariatric Center. She called to tell me that my insurance only pays for a maximum benefit of $10,000 of weight loss surgery expenses, not nearly enough to cover even just the expense of surgery, let along the additional office visits and evaluations required. We decided not to set my appointment with Dr. Hoehn until I sort out if/how I should proceed with this new information. She explained that Dr. Hoehn's surgeon fees alone are $5000, and that to get the cost of the hospital stay, I should call Shawnee Mission Medical.   Of course I flipped - and it only got worse.   Next, I called and left another, frantic message with Jill. My first appointment was scheduled in just a few hours with my DO to begin my supervised diet. At this point, I couldn't be sure it was even possible to pay for the surgery and all of the appointments associated. After waiting a few minutes, I decided to call the member phone number on my insurance card to check if the $10,000 was accurate. The lady I spoke with assured me that the cap existed and was not subject to my yearly out of pocket max of $1000, so all excess costs are mine to bear. I started to ask which office visits would be billed against the maximum benefit, knowing that if the supervised diet, the psych eval, etc, etc were all debited from that bucket, there would be no money at all to pay the surgery. She wasn't sure of the answers, so she transferred me to the UHC bariatric specialists’ location where Jill is located so that I could ask more detailed questions. By this time, it was 15 minutes until I was leaving for my appointment. I tried to explain my problem to the operator. She wanted to know "what my question was" and I tried to explain that I had many questions, all relating to how my benefits work, and that I really needed answers before I left for my appointment. She insisted on knowing what my appointment was, and assured me that if I told her what appointment I was going to, maybe she could get my question answered. I told her the appointment had nothing to do with my questions. The operator (who had been extremely rude and could barely be heard over the constant, furious clicking of her plastic fingernails typing as she spoke) told me that elective procedures are not considered urgent by UHC and I would have to leave a message and await a phone call.   Waiting for my work phone to ring (oh, yeah - all of this is happening on my work phone, where nosy co-workers can easily overhear, my bosses keep coming by for one reason or another and find me still on the phone, red-faced and frantic...it wasn't pretty or good for my career), I took out my cell phone and called Shawnee Mission Medical. I was directed to Patty at (913) 676-7736. Patty explained that the actual cost for the hospital stay in considered outpatient, though I would be observed overnight, for a average total of $39,000. However, UHC's contract allows them to bill about $7500 ($5735 + observation hours). Then she dropped the bomb - this did not include the fee for anesthesiology. My heart sank. Even with a sizeable chunk in my flex account, there was no way I could afford this surgery. $10,000 isn't coverage, it's a tease. My stress level and psychological health would have been better served if my policy didn't claim to have any benefit for weight loss surgery. I said as much to Patty, who cheerily replied, "At least you don't have to pay $39,000!" Some consolation. Patty was kind and helpful, even if she did not understand my predicament. She gave me the billing code all of the docs will use for the surgery expenses (43843) and the name and number of the anesthesiologists’ office so I could call them to see how much they would charge. (Anesthesiologist Midwest Anesthesiology Group (913) 234-1600). In the meantime, it was time to leave and I didn't receive a call back from UHC or Jill.   I did begin my 6 month supervised diet, despite the turmoil. After all, a supervised diet that included accountability with my doctor was better than taking no action for my health at all, right? She prescribed daily caloric intake under 2400 calories and to resume my training with Bethanie at the gym where I currently belong.   3/11/11: Received a phone call from Jill fist this in the morning. I explained what happened. She assured me (numerous times, at my insistence) that there is no $10,000 cap on my weight loss surgery benefit. There is a $10,000 cap on travel and lodging expenses, if I were over 100 miles from the nearest approved Center of Excellence, but that is not the case. The promised she would call Jan at the Bariatric Center to clarify the insurance terms and she would ask Jan to call me to set up my appointments.   At this point, I'd like to ask for something in writing. But first, I am waiting to see what happens if/when Jan calls me. After so many dark moments in this process that has only barely begun, dare I hope it will all work out?         Upcoming appointments:   June: Call Jill, my case manager at UHC to update her on my progress          
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Thank Goodness I Can Still Drink Lemonade or What to Do with Lemons (Pre-surgery)

3/24/11: Appointment with my DO about a non-WLS matter. Noted that in the last two weeks, I lost 3 lbs.   3/28/11: Jan, from Dr. Heohn's office called to set up my initial appointment with Dr. Hoehn. She made no mention of our earlier conversation in which she said my insurance was limited to $10,000 and would not coverage a fraction of the total costs. She said that I should bring a list of current medications and the $500 program fee. I asked if this could be paid with my flex benefit card. She said it can. She asked if I understood how to get to the office. I replied that I had no idea where the office was, I had been only to the place where the seminar is held. Her directions are to take highway 35 to 75th Street, east on 75th, left at the light near McDonalds, then right into the parking lot. I asked if there was an address. She huffed somehting about it being suite 230, the address is 9301 W. 74th Street; Merriam, KS; but said she had yet to see 74th street anywhere, the address won't help. I wish I could convey her tone - it is hard to feel good about dealing with Dr. Hoehn and his staff when my contact is so thoroughly hateful-sounding.     Upcoming appointments:   4/11/11 @ 12:30 Initial Appointment with Dr. Hoehn June: Call Jill to update her on my progress
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Another List - Farewell Foods

There seems to be a lot of controversy about taking a food tour before going “all in” to this surgery. I kind of understand why people feel that mourning foods is the wrong approach. After all, if a few months I’ll be able to eat anything I like, more or less. But for me, that is the point of one last visit – the foods on this list mostly represent unhealthy things that I am preparing to cut out of my life altogether, whether I can eat them or not in the future. And in some cases, I am trying to get a taste of the holidays that I might miss since my surgery is about 5 weeks from Thanksgiving. I have made my peace with my decision. I can’t help it if others feel my choices are unwise. So judge not lest ye be judged.   Here are the foods that I have said or will say farewell to before I begin my pre-op diet:   Bo Lings – Gong Bao Chicken Crab Rangoon   Margaritas – Puffy Tacos   Lulu’s Noodles – Drunken Noodles Rainbow Noodles Basil Rice Crab Rangoon Corn Cakes   Steak N’ Shake - Frisco Patty Melt Fries   KC Sushi – I-29 Roll and various Maki   Homemade – Chili & Store Bought Steak Burgers Mashed potatoes and gravy Hot rolls Tortillas Stuffing Apple Pie White Cake with white frosting Doritos Trader Joe's Na'an and Creamy Roadsted Red Pepper Hummus Starbucks – Pumpkin Spice Latte Eggnog Latte Gingerbread Latte
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