Here is what I did on my last surgeons visit day 6 days before surgery.

--I met with the before surgery nurse,

She checked my meds, went over the steps I would have to take to get to the surgery. Talked about the self injected blood thinner I would have to take for a while and gave me some booklets on how to inject myself and the lists and maps of where I would have to go during the day and the day of surgery.

--a "fellow" (Dr intern),

went over the consent form contract for the surgery and had me sign it. Got my copy. Asked him if the center ever did sleeves... he said yes, that he had assisted on 5 himself and there were many other interns that were assisting at other times. He said that the bypass takes a ton of skill, and not just anyone can do it, they do a bunch of bypasses and have for years, he said the sleeve just needs someone who knows how to do it. I asked if I could have a copy of my surgery recording... and he said no, it was a liability for them. I asked him what Bougie size the Dr used and he said of all the questions anyone has ever asked, no one has ever asked that one. He said they use a 36 and staple it loose. He said they hand stitch the staple line or sometimes us a robot to stitch. There is no advantage they have found to one or the other. The surgery is 3 1/2 -4 hours long. I said that seemed long, and he said Teaching Universities are in no hurry. There is plenty of time taken for surgery, no need to rush. The hand stitching takes a long time. I asked him why I heard so little about the sleeve before my first meeting with a Dr. He said that California is way behind the east coast as far as sleeves go, not because the Drs skill or desire, but the insurance here is so screwed up that it has been excluded until recently by most insurance companies. He said he worked doing sleeves for three years on the east coast before coming here to California.

--a research representative,

asked me to agree to be part of an ongoing study of WLS as part of them keeping their "Center of Excellence" status. The want to do followups for 5+ years if possible. I signed that.

--the during and after surgery head nurse, Anne.

She went over much of the same stuff as the before surgery nurse, and we chatted about travel, and how 50 is the new 40. She wrote me a note to give to my work saying I need 6 WEEKS! off to recover. Ouch, I have sick pay/time saved up for 3 weeks, and one staff at work is going to try and give me some of hers... well see....She said the Dr (Ali) was at a meeting and couldn't see me that day, but he would see me on the day of the surgery. She decided what my med schedule would be before and after the surgery. She put a list into the pharmacy for the dissolvable meds I would need. She did a short physical to access my state for surgery, checked my heart, reflexes, flexibility and asked questions about arthritis and such.

-- the Lab for blood work and a pregnancy test, and then

I went next door and got my blood and urine done. They need a pregnancy test. I told the lab tech that if I was pregnant then she was witness to a miracle. (being menopausal) They took about 6 tubes for testing.

--the surgeon

I went back to the office to pick up my letter for work, and the after surgery nurse grabbed me and said the Dr was back and wanted to talk to me. I went in and had a nice 20 minute visit with him. He was really nice, and personable. I asked him about the bougie size and he asked me why I wanted to know, and i told him about wanting good restriction and not to leave much of the stomach that stretches out more. He said all the parts are stretchy. He said they use a 36. I asked them about the loose cut, and he said it has to be loose because they stitch the whole thing and the extra room is to do that. He also leaves a little bit extra by the pylorus end to avoid complications that sometime happen there. He said that even people that have a 60 bougie lose weight, that the main reason for people gaining weight is their own actions, not the size of the bougie. You have to make changes in how and what you eat for the surgery to be a success. He also warned that it is his opinion that more people will gain weight back from the sleeve than RNY. Even though the long term results are not in yet. I asked him if he thought the people who gain back weight do it more because they eat around the sleeve, or because the sleeve stretches out, and he said they are related, and the people who gain weight back are more likely to look for some outside reason for it than how they eat and exercise. Those who follow the plan and exercise into the future lose the weight and keep most of it off. He talked about leaks, and nausea. He said that nausea is the most common complication. It can last one day to months. In the case of months, some people need to be fed by IV. 20% of his patients have some amount of nausea. There are meds for nausea. He said he thought I would be a good candidate and believed I could find success with the sleeve. I asked him why I didn't see or hear anything about the sleeve in his lecture or literature, and he said that until recently the sleeve was not covered by insurance in California and so he didn't bring it up as a choice.

--the anesthesiology offices.

They checked my meds, asked again about allergies and such.

About a 5 hour day.

They will call me friday to let me know when I need to go in for surgery on tuesday. The day of surgery will be about 8 hours of check in, wait, surgery, recovery and to the room. They expect I will be in over night, there will be a leak test the next day. If all looks well, I can go home the next day. They want to see that I don't have a lot of nausea before I go home and will keep me an extra day if need be.

There ya go. The rundown as well as I remember it.

More later!