Nepenthe44

Anyone else with an April surgery date? Apparently my surgeon is going on vacation and lots of the patients approved October and November deferred until after the New Year, so instead of getting a March date, I've been pushed all the way to April 25. I'll be on full liquids on my 35th birthday. Not doing well with the waiting!

I finally started my pre-op diet after having my final clearances/ultrasound/endoscopy done last Friday. This process has taken so, so long. I'm so relieved it's finally happening

@Libra758347 and @JS1982, when did you guys get your final clearances?

Noom works for a lot of people I guess, but I don't really get the draw. Basically, you pay money to have an app tell you to eat more vegetables and fewer donuts. A slight oversimplification, but basically foods are categorized as "green" - go ahead "yellow" - be cautious "red" - reconsider whether you want to eat the food Examples of green foods: asparagus, broccoli, egg whites Yellow foods: lean meats, beans, whole eggs Red foods: nut butters, pork, donuts Basically a simplified, low-fat volumetric diet. Don't eat calorie dense foods, substitute for less dense foods. Like, I already know to avoid peanut butter at all costs. I don't see why I would want to pay for an app to remind me not to eat ranch dressing, string cheese, and raisins. It's probably not bariatric appropriate either because it's carb agnostic. Whole grains are green, whereas chicken and tuna are caution foods. I suppose you could build your diet around non-starchy vegetables, egg whites, extra-lean seafood, and fat-free dairy. But again, why would you want to pay for an app to tell you to do that? I guess it's great if it helps but I just don't get it.

I have a group PPO plan through BCBS of Michigan/my large employer. Customer service is pretty terrible when I call. They're often not able to answer questions about plan coverage accurately or give conflicting answers. If you have a specific procedure code, they can be more helpful, but it's still not great. On the other hand, they cover virtually everything at 100% without too much fuss. I'll end up paying a few hundred dollars out of pocket for my surgery and most of that is copays for seeing my $%@^ing dietician. If I have complications, that could go up relatively quick, because there's a significant ER co-pay, but it's all flat rate for in-network providers. And the network is basically every provider. I don't love them, but if I have to deal with an insurance company, they're probably as good as it gets.

Here's a genuinely weird NSV: I have new stretch marks! Really red angry ones on my shoulders. Looks like I was mauled by a big cat. How could stretch marks be a victory? They're from weightlifting. Not something I was anticipating, but definitely not something I'm mad about.

2 NSVs to mention. 1. I just got my annual labs drawn and the lab has those chairs with the padded lap bar that comes down, presumably to contain surprise fainters. The last time I had labs drawn, maybe 7 months ago, the bar rested on my stomach and couldn't come down all the way. Today it came all the way down and there was room to spare. 2. I'm a side sleeper and at my highest weight, my hips were so wide that my body was kind of a slope and my top arm would fall down with my shoulder pressing into my neck. Now, not only is my arm horizontal and not choking me, but my elbow is dipping down into my waist. I don't find this comfortable, but it's definitely a victory. I'll be experimenting with pillow placement to deal with being poked by (still very buried, but now detectable) hip bones.

That's a BMI of 18.3, which is considered underweight. I wouldn't trust whatever site you found this information on.

Everyone is so much happier with me now that my eating disorder isn't the wrong eating disorder.

To some extent, sarcasm, but to some extent not. One of the issues discussed in the sparse literature on post-bariatric restrictive eating disorders is that it's difficult to distinguish someone complying with bariatric program behavioral advice and someone with atypical anorexia nervosa on the basis of behavior. New standards need to be set for post-bariatric patients because just because someone is cutting everything on their plate into bean-sized bites, taking two minutes between bites, counting the number of times they chew, and only eating a few ounces of food through a full meal doesn't mean they have AAN. They could just be a very good bariatric patient, who will definitely be counted among the surgeon's success stories.

I don't know that there's a lot to say. Like, the only response to talk about disordered eating is "go to therapy". Which is great for the people for whom therapy is accessible and effective, but for most people it isn't one or the other. I've been in therapy for literally decades. I've been hospitalized in an ED ward. Still have an eating disorder. Also, you really don't want to talk about disordered eating on a bariatric forum. What is disordered eating, after all? Weighing and tracking everything you eat? Getting upset if you break a diet rule? Avoiding social situations where food is going to be present? Exercising no matter what? Refusing to eat food for any reason but the bare minimum necessary to fuel your body? That's compliance. That's a good bariatric patient. That's a success story.

All. The. Damn. Time. It doesn't help that I'm not, like, wrong. I am, in fact, huge, just not as mind-numbingly enormous as I used to be.

I'm really looking forward to losing my buoyancy. I was a swimmer all of my childhood and getting in the pool again after gaining weight was such a shock. I couldn't stroke properly because my arse and everything else was popping up out of the water. It felt more like I was paddling the fat canoe of my own body than swimming through the water. I can't wait to swim laps again and have it feel normal.

I got cleared by my program to go ahead with surgery! They're submitting prior authorization to my insurance now and I should be getting my surgery date sometime in January, with the actual surgery sometime between February and April. I'm just sort of in shock; deep down I figured that they would decide for some reason that I wasn't a good candidate, like last time. I'm excited. Still have a lot to lose before surgery though. My goal is 50% of EBW lost by my surgery date and I have a ways to go for that, but it feels doable now!

Yep, I hear that. I'm in my first real stall since starting to lose weight. (Fake stalls are where it's obvious why you're not losing weight and it's cheeseburger or couch-shaped.) Trying to just stick with the program, keep up my activity and not freak out, but trying not to freak out is like trying not to breathe for me. 😂

I'm in mourning. Had to throw away my favorite pair of leggings this morning. They got retired to the "only wear around the house and not to the gym" pile a few months ago when they threatened to fall down during weightlifting. (I'm okay with everyone in the class see me fall on my @$$, not them seeing my @$$.) But today I put them on and the waistband wasn't even touching me and I was like... even if I just walk slowly downstairs, my family is gonna get a show. So in the trash they went. 😭 I can't even just buy them in a new size; the company stopped making them years ago.

I'm planning on a lower body lift of some sort, an upper body lift of some sort, and probably brachioplasty. I'm hoping that I can find a surgeon who is able to combine top surgery with a back lift, but it seems like the sorts of surgeons who do top surgery are often not the same ones who do skin removal well. Judging from the way things are hanging now and the extent of my stretch marks, I'm going to have extremely bad loose skin most places on my body, so... yeah, definitely planning on plastics.

I laughed out loud. My eyesight also saves me the same way.

I finally fit into straight sized t-shirts. At my highest weight, I was in a 4x or 5x. Now I'm sitting here in an XL. Now I can wear the t-shirts I got from walking races that I couldn't even put on when I finished the race. Can't wait to see where I end up after surgery. Mixed emotions though, because I have some t-shirts that I really like that I could go camping in. I think I'm gonna make them into throw pillows.

Depends on the goal weight you're talking about. The one I tell my team to prove that I have a realistic understanding of what my surgical outcome is likely to be? I punched in my numbers to an online outcome calculator, rounded down so that they had the opportunity to gently adjust my expectations. I don't remember what this number is, because I could not care less about it. The one I use for my usual calculations and plans at this stage? I used an ideal body weight calculator (there are a number of different equations) and picked the highest version to be realistic. The secret one that I rarely admit or factor into planning? It's the one above, minus 10% of the amount of weight I would have lost at that body weight to buffer against expected weight gain. I doubt I'll reach this one, it depends on how I feel and whether plastic surgeons have a minimum weight requirement. I dunno, it doesn't really matter all that much at this point. I have no idea how much weight will come off from plastics and top surgery, how much weight I'm stuck with because it's extra bone or organ tissue that supported my fat body, and how my transition would realistically affect those calculations anyway.

Okay, here's a weird one and an unclear "victory": I was going through airport security and after they did the backscatter screen, the one where they look at your naked body through your clothes with X-rays, they called me aside and did a very invasive and thorough pat-down, focusing on my groin area. This has never happened to me before, save at the Kathmandu airport where I'm pretty sure everyone just gets grabbed by the crotch as part of standard procedure. As far as I can gather, I've now lost enough weight that my panniculus looks less like a fat belly and more like a low-slung bum bag full of drugs/explosives on their machine. Hoping that as it deflates, it looks less alarming and triggers fewer groin probings.

This is not the case. NSAIDs don't increase the risk of ulcers because they go through your stomach and irritate it directly. They work, in part, by blocking an enzyme called Cox-1, which is required for your stomach to produce its protective mucus lining. Less lining, greater risk of ulcer. Injectable NSAIDs do this the same as oral ones. If you can't find any other alternatives that work, there are prescription NSAIDs called Cox-2 inhibitors which don't do that. They might be an option if you take them with another drug to reduce the risk of ulcer, but I haven't found any research in the long-term use of these meds after bariatric surgery. (As in, there's a single study where they used celecoxib peri-operatively for pain control was published in 2019 and that's the sum total of PubMed results.)

When I was at my highest weight, it felt like my body was just running out of places to put more fat and I started getting pads of fat in weird places. Today I noticed that my "buffalo hump" (fat pad between my shoulder blades) is gone and my back is a more normal shape. And also my "hotdog bun" (rolls of fat at the nape of my neck) is basically gone. The pad on my shin just below my kneecap is almost gone. I'm still fat as of now, but just in the usual places.

This is just a rant. If you have a good deal of faith in medical science, just skip this one. Keep that faith, you'll sleep better at night and the placebo effect will work better on you. I'm intensely frustrated by having to deal with the arbitrary nature of the bariatric surgery process. So, I'm a scientist and I work in medical research. I know from the back end exactly how arbitrary and non-evidence based much of medical practice is, from the trivialities to treatment of life-threatening conditions. (And boy howdy, you would not believe it and it is frightening.) I'm at peace with it; we're working on it and we know that we're all doing are best. What I am not at peace with is knowing this on one hand (and my dietitian openly admitting this), but having to pretend that it's not the case. I hate lying and pretending. It's very difficult for me to pretend that I believe that it's critical that I don't eat consume any fiber during my pre-op diet, which has to be liquid because reasons. (I'm dumb and I asked why it has to be liquid, curious what the justification is. I was a little surprised to find that they don't even make something up. Honestly, disappointed, low effort guys. If you're going to torment us, at least have a plausible rationale.) It's very difficult for me to be presented with an arbitrary set of rules and just... follow them, because. Not because there's a reason to follow that rule or because there's research backing it up, but because people who have power have chosen that set of rules, for no particular reason, and if I don't follow them, they will stand in my way. I understand that this is how the system works. We are noncompliant, untrustworthy, stupid, and, most of all, we are unworthy. I'm losing over 1% of my body weight weekly, pre-surgery, by dieting and exercising, but If I don't stop drinking a cup of caffeinated tea with 15 grams of sugar in it (the only added sugar I consume at all) 6 months before my surgery date, I'm going to be denied. My dietitian was very explicit that she would not approve me. I mean, there's really nothing else she can put on her little goal sheet for me to show that I'm worthy and compliant. And I definitely need to prove that I'm worthy and compliant, even beyond what is necessary because I'm fat, because during my first meeting with the dietitian, she told me to seriously consider whether I wanted to go through with the surgery, because research showed that, unlike with weight lost through diet and exercise, people who have bariatric surgery have radically slowed metabolisms afterward. They did a study with the Biggest Loser people! I was stupid and impolitic and I questioned this, because that study is one of the (many) reasons I'm seeking bariatric surgery. (It showed the exact opposite of what she told me it did, and even more so with the follow-ups.) So naturally I was very concerned that I had gotten my facts wrong and instead of being smart and shutting the $#%^ up and looking it up on PubMed when I got home, I questioned her. (I wonder how many people she's talked out of surgery because she doesn't understand it. Best not think about that!) It chaps my hide extra knowing that her next patient will probably be someone who is barely maintaining their weight, is being coaxed into giving up their multi-can-a-day soda habit and doesn't know what a protein is, while I'm worried about eating too much fruit and having a teaspoon full of sugar set as an ultimatum. And that person will have less difficulty than I do accessing surgery. Obviously, I understand that the answer is to either follow the arbitrary rules or to lie my increasingly saggy butt off like a psychologically normal person. And obviously I'm going to do that, because that's what I need to do to get what I want. But I don't have to @#$ing like it!

Re: does it really matter I mean, yes. There are other possible bad outcomes besides literally dying. If the effectiveness of bariatric surgery comes down in large part to microbiomic changes, for example, suggesting that I remove all fiber from my diet until over 6 months post surgery and introducing large amounts of artificial sweeteners into my diet could in fact work against positive changes to the gut microbiome. If my ability to lose weight pre-surgery comes down to emphasising foods that extend satiety (fiber, protein, fat), dramatically reducing my fat and fiber intake before surgery could cause me to overeat or binge eat and my weight loss to stall or reverse. If long term success comes from following one's hunger cues, teaching myself to eat according to the clock they've set, whether I'm hungry or not, in order to meet arbitrary goals could limit my weight loss long term or trigger binge eating again. They're not suggesting I take a spoonful of arsenic at bedtime, but that doesn't mean that their suggestions are neutral. They have no systematic evidence that their program creates success for the average patient or not. (The great part of this sort of program, from the practitioner perspective, is that you can almost always blame poor outcomes on non-compliance.) Some of the program requirements for the pre-surgery diet are literally impossible to follow at the same time. I can't take one or two bean-sized bites per minute, finish meals in less than 30 minutes, and eat 2200+ calories per day without a significant portion of those bites being high fat meats, full fat dairy, or, I dunno, peanut butter straight out of the jar, all of which are verboten. So regardless of what I'm doing now, I'm not compliant. It's not possible to comply fully. (The handwavy answer was "healthy fats". I have no idea how much avocado my dietitian expects me to be able to eat. I suppose technically if I ate just chicken breasts with avocado and nothing else...) I'm also not the average patient anyway (it's probably pretty clear at this point that I'm not neurotypical, for example, I understand that people with regular would either comply or lie without much difficulty either way), so even if their arbitrary program did create success for the average patient for whatever reason that means very little for whether it would work for me. The arbitrariness and the ultimatum annoy me. The fact that I'm being asked to disregard everything I know about how I personally deal with change to adopt a post-surgical style diet (low-fat, regimented, and frequent) half a year before any potential surgery date with an intact GI system, that I'm expected to throw away everything I know about what I need to lose weight, stop binge eating, and have the energy to do intense exercise frightens me. I'm terrified that I'm going to gain weight or relapse into binge eating (thus getting denied for surgery) and I feel like they're pushing me into that direction. All because Typical Tammy deals best with gradually introduced changes over a long time period and simple, unambiguous, authoritative instructions from medical professionals she sees as trustworthy experts? Nah. I mean, I'm sure there are, but this is the only one I have access to. And, ultimately, it doesn't really matter, as long as I can jump through their stupid little hoops, I can get what I need from them. It's just.... a long and irritating process of circus training. I'm not really looking for advice or anything, I understand the options and am resigned to them, this is a rant and rave.