My Favorite Four Letter Word F-I-L-L!!!

[Band_Groupie 3]

***This is an excerpt of my current writings for the LB Book I'm writing***

For those not following my blog; I lost 100lbs. and reached my goal of 148 lbs. in June...then I had a 2cc unfill in June, 1cc back in Oct. (I'd gained 15 lbs. back, but was still barely in the Normal BMI range), and then my doc's practice shut down. I've been maintaining my weight (not easily), but waiting for a small fill since Oct. I went last week (Feb.) to the new Doc ((that took over their practice at my old hospital) for a fill and I was expecting to have to make a separate appointment for the fill (IF he'd give me one).

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Bottom line…I got a F-I-L-L yesterday and I couldn't be more happy about it!

I either got a fill…because I was incredibly lucky…OR…because I was incredibly prepared.

I'm choosing to believe that it was a little of both.

The "Preparation"…

Me and my 'almost OCD' have gotten better at preparing for Doctor visits. I don't know why I always get nervous going to the Doctor's (especially a new Doc visit), but I still do. I can remember what I want to say and give a speech in front of a room of several thousand people, but send me into a Doctor and I get nervous and have come away forgetting to ask about some of the main things I planned to ask about…yes, kicking myself all the way home.

In my 'Year of getting Healthy' (the year I started the LB process and also went to every other Specialist for other health issues besides the LB ones), I knew I had to improve my Doctor visit skills if I really wanted to improve my health. After all, I'd tried addressing most of these health issues in the past (without much success) with many of the same Specialists. I decided that my main problem is that I'm not a complainer (with as much whining as I do here, you're not believing me, are you), and I hate whining about my health issues…I hate asking for personal help…the worst thing would be for a Doc to think I was a hypochondriac (Mom, it's all your fault again…you're the same way). I've always gone to the Doctor when I was sick enough, but I tend to play-down how bad things are and I only focused on the one or two most pressing issues…I thought it was up to the Doctor to put all my health history together. If the treatment didn't solve everything then I accepted that my growing health issues were 'just a part of getting older…and fatter', and that I'd just 'learn to live with them'.

You'll remember that it all started with a physical at my PCP, where, for the first time, I planned the agenda for my visit and took in a list of all my health issues (OK, that one got a little derailed by my PCP first sending in a brand spanking new med student-who didn't own a pen, and I think didn't shave yet, but it was a good starting point). The planning was a result of my DH's insistence as he was in on a few prior Doc visits where he saw first hand how I didn't give them ALL the health issues and he was shocked how much I downplayed how bad things were and how he had to bring things up for me. He reminded me that my last job in business process improvement, I spent a lot of time designing meetings, leading groups through mapping processes, managing their focus, and getting to ALL the issues and details so you could see, analyze and improve things…not exactly what I was doing in these Doctor meetings. So I started using my old skills for ME.

I think yesterday's Doc visit is a good example of all the changes I've made, how far I've come, and might have some things you can use:

- TAKE CHARGE!

- When I called my old practice last week and was told the first date available was 2 months out at my hospital, I didn't schedule it. It was unacceptable timing after already waiting 5 months for them just to set up new Docs. Instead I decided I'd go to the new Doc's office (further away), and got his name and phone number there.

- Don't accept things you aren't happy with, whether it be timing, a second opinion, or even moving to a new Doc if you're not happy with your care (reminding you that after a hysterectomy and bladder sling surgeries both for incontinence, it came back and I'd just accepted it for years…a new Specialist and one daily pill and I'm cured). I'll also remind you that in Bandster Hell, I changed my appointment for my third fill to much sooner than my old Doc's fill schedule (from 6 to 2 weeks). I certainly wasn't sure going in that I wouldn't just be thrown out (on my unrestricted Band), but I knew that at the very least, I'd created the opportunity to plead my case for how I'd done my research and at this point there was no good reason to delay another fill, and I was going to make him explain to me 'why not' (no one seemed to notice and I got my fill). BE YOUR OWN PATIENT ADVOCATE! CREATE YOUR OWN DESTINY!

- DO YOUR RESEARCH!

- I found out everything I could online about the new Surgeon's practice. I knew that he was the Doc I'd wanted to see at this hospital way back when we attended their WLS Seminar (another Doc, we hated, gave the seminar and that was that). I found out that a few years back he'd been rated the best Bariatric Doc in Pittsburgh and his practice was rated best in PA.

- When I called to set the appointment I was prepared…I had all my info together and knew what answers I wanted to come away with. I gave the scheduler a brief rundown of who I was and why I was calling and explained why I wasn't just waiting to see him at my old hospital. When she explained that my old office was telling patients the wrong thing and that I had to come for a 'first visit' before I'd get a fill, I was surprised, but I didn't get defensive. I just nicely asked questions for clarification and by doing so I got some details I already knew I wanted; the fact that he has 'visits' in the bariatric offices (wants to get a patient history first) and does fills in the hospital led to me asking why…and that's when I found out that he does fills under fluoro (machine is at the hospital), and I also asked and found out that he does all the fills himself (no Tech's doing fills like lots of Doc's have)…building a relationship with one Doc (or one Tech if you prefer them over your Doc) is important to good long-term LB care IMO…going in to someone different each time just doesn't work well for me (and some of the larger practices just have everyone on a similar fill schedule/philosophy)…I came away happy that I was in good hands with another small practice where I'd see the same person each time who could get to know me and my LB history.

- Having researched fills, I knew what a fill under fluro was so I didn't have to ask for an explanation, which I'm not even sure a scheduler could explain or would. I'd done the research and knew that fills are always best scheduled for the afternoon when most of us are looser (or the evening if your Doc has hours)…even though I wasn't going to be getting a fill, I didn't know if there might be other testing (maybe Water chugging contests) and so I still asked for an afternoon time (when the fill came this totally saved me).

- I knew from my research that the best time to schedule a Dr. visit is first thing in the morning, or first thing after lunch (not only for lesser wait times, but the Doc's typically are fresher, more receptive and spend more time with you because they aren't behind in their schedule yet) so I asked for a day with an appointment time within the first hour after lunch. She scheduled me for a visit two business day's away right after lunch.

- MAKE IT EASY ON THEM!

- Don't waste your few precious minutes with your visit doing things you can avoid…you'll free up your time to really get to your concerns if you're prepared. Years ago, I'd bring my meds (or just remember what they were) and I'd spend time with them going over each one while they wrote them down. I now have a typed up list of all my medications and supplements (even things like Benefiber are important when your talking about LB issues) and it's broken down on a table by: Prescription's vs. OTC's, Name, Dosage/mg's, Times/Amounts per day (and don't forget the 'as needed' ones…I take several prescriptions when I get a Migraine, and even things like Tums or even Papaya enzymes can lead to talking points and let them know what's going on), and why I'm taking it (don't forget this one…remember some meds. Doc's use to treat many ailments, so it's easier for them to see that ie. I take this one for Migraines, and this for asthma). I update this list and I take in a copy for them…they always ask if they can copy it and are so happy when I say it's theirs (I learned the hard way when one Doc went to copy it so she could make any notes on it and that was 5 min. of my visit). It literally took the Resident yesterday less than a minute to scan through the 17 items I take and she had no questions.

- The Resident yesterday came in and as we got started she realized she had no pen…guess who had one ready to give her (remember that newbie med. student!).

- The Resident was going through my history (file from my old Doc) and mentioned that she was confused about a few things and that she couldn't read his writing on a few visits. She asked me 'What happened in June of 2010?'. Guess who went over to her purse and pulled out a piece of paper with the answer…I expected they'd be going through my history and with all the things that have happened since my LB there was NO way that I would remember dates or weight changes. I had spent a few minutes going through my weight loss spreadsheet (where I also keep notes on major things) and here are the things I thought were worth having on hand/wrote them down and brought them with me- Date and weight for the following events: (these are in the order they happened to me) Start of process, Surgery Day, Breathing Issue/hospital overnight, Fills 1-4 with amounts of each, Heartburn and Nexium prescription started/ended (on and off several times), Endoscopy for pain and found bezoar, Gallbladder Surgery, Goal Day, Reflux at night, Esophageal Spasms, Unfill and Fluoro test (the June visit she couldn't decipher), and 5th Fill. I also had to refer to this list to easily answer many other questions she had: she had my surgery date weight, but didn't find my actual starting weight, she also thought I was now at my lowest weight (so I corrected that…SUPER important when you're asking for a fill for them to see you've had a big gain), and I was able to answer when the regain started (unfill date), how much I'd regained, how long I'd been about this weight (since 5th fill beg. of Oct.), and what my total fill is now (she was thrilled she didn't have to add them up). Even going to the same Doc, having my basic history with dates (and weight for LB Doc) has saved me over and over with residents or when my regular Doc was out for an emergency. DON'T expect that because they have a file in front of them with pages and pages of your history that they have 1. The time to read it all. Or 2. The ability to remember everything with every patient (Even if you're seeing the same Doc every time…they see a LOT of patients and you shouldn't hesitate to remind them of what's happened!). If I hadn't had this with me, I know I would have struggled to remember many events, and dates…heck, I couldn't even remember my surgery day weight without it! The point is two-fold…it would have taken a lot longer to cover, and it gave her the feeling that I was informed about my history and confident in the details I was sharing.

- PREPARE YOUR AGENDA!

- No, I don't mean a typed up agenda (that's just full-blown OCD…and off-putting). Think through the kind of visit you'll be having, anticipate the things that may/may not happen, think hard about what you want to get out of the visit…what are the things you want to happen/come away with, and then think about whatever you can do to prepare to achieve those things.

- I expected the weigh in and knowing that I would be asking for a fill I knew I wanted to show as much gain as possible, so I ate/drank a lot prior, wore my jeans, boots and my giant heavy leather coat (the last two I was surprised I wasn't asked to take off, but as a result I weighed 7 pounds more than my morning weigh-in at home, although eventually I told the Resident that it was that much less at home). I expected the medicine and history reviews and brought my info., which set the tone I wanted that I was a Bander who was informed and in charge of their process. Then I expected that they would see that even with the regain, that I've done better than the average Bander (I even knew that they would praise me, which in the past, would have side-tracked me) and that they wouldn't want to give me a fill…I expected and knew there would be a point in the visit where it would be in my hands to have to convince them that I did…and I knew that I would only have a few precious moments to do that. I gave this part a LOT of thought before going (and this part of any Doc visit, where you get to talk and ask questions is always the part you should plan…even if you have to write your questions down). I knew that it was just as important to convince the Resident as it was the Doc (you'll see why below). Think through what the Doc's perception might be of what you're asking/saying…I had to think; Every Bander comes in here at one time (or many) and says 'I'M GAINING…I NEED A FILL!' The Doc's hear this over and over and a lot of the time the Bander doesn't need a fill…I had to convince them that a small fill…for someone who (even with the extra 7 pounds) was still (and I heard all of these things from both the Resident and then the Doc) in the 'Normal BMI group', had lost the excess weight…when 50-60% is all they expect with the Band, and is doing great!

- PREPARE YOUR DELIVERY!

- If I've learned one thing from my DH, it's that 'you get more with honey'…over and over I've seen him arrange to be there when a service person is coming to our house…he just spends time talking to them nicely (chatting them up while they're working)…going through the history of how *whatever* has happened…asking questions in a way that shows he respects their opinion…and eventually showing them that he's truly interested and has some knowledge/is prepared. He not only learns a lot (that has helped him learn to handle minor repairs), but I've also seen service people give him things for less cost, or even free…and he never even asks for any of it! While my description may sound sneaky or planned, this all just comes naturally to him…he's just a nice guy that everyone likes and they want to please. My sister was here once when I had to drop his car off to Pep Boys…she couldn't get over the fact that all the guys instantly asked where DH was and told us to tell him they'd take good care of him. My joke with him is that he probably walks into Lowe's (hardware store) and they all shout his name (think 'Norm!'/Cheers) and hand him a cup of coffee (with his name on the mug).

- So that takes me back to yesterday's visit…I wouldn't have time to 'chat anyone up', let alone form a bond in the few precious minutes that I'd have to convince them, so here was my approach: When the Resident was done reviewing my meds and health history she was getting up saying 'The Doc will be in…' I expected this. I also know that what comes next is that the Resident (or whoever sees you first) goes to the Doc and has to very briefly give the Doc and overview of my history, why I'm there, and what her recommendations are. I smiled and nicely said 'I have just a couple of questions before you go, if you don't mind?' I basically asked two questions: how the Doc determines if a fill is needed, how fluoro is used/how it helps them with fills (since I haven't had one under fluoro). There was lots of discussion back and forth that followed, but the detail I asked let her know that I respected her and her opinion and was interested and prepared. I asked details about whether the fluoro can help someone like me close to goal who only needs a tiny bit. I reinforced how I've only been able to maintain since Oct. with willpower and as a professional dieter I knew I couldn't keep that up forever. I was honest and forthright that I have some restriction. We were soon laughing about how we Banders don't always know what's best…she told me about how they just had one patient who was in for a fill and the fluoro showed that she had a very enlarged esophagus and really needed an unfill not a fill…another complained her Band wasn't working because she could eat a whole Big Mac (albeit slowly and with some effort)! I took these opportunities to show her that I knew these Banders weren't listening to their Bands and were eating around them/too much. In just a few short minutes she was saying that often Bander's come in and their 'story' doesn't make sense…but mine does for a fill…she could see the history unfold and the fact that I'd been at a lower weight wasn't what was driving my drive for a fill…I had earlier told her that I'd just love to lose 10 pounds so my clothes would fit again, not 20 and that even if I only stayed the same weight, but could maintain it more easily I'd be happy…I even laughingly shared that I only went for the 148lbs. for a day so I'd be able to say I'd lost 100 pounds…she laughed…again, the approach…be yourself , be honest, be nice, and find a way, in my case, to quickly let them know that your not some crazy Bander after an almighty number on a scale that's already lower than most. Before she left, she let me know that not often, and she couldn't promise anything, but he sometimes does small fills in the office when it makes sense and there was a chance I might get one today (blew my mind as I wasn't expecting that was even an option…I knew she was going to plead my case at that point).

- My new Doc, Dr. Urbandt, was great. After all the same 'You're doing great…normal BMI…know you want to lose 10 pounds more' (he was obviously concerned with the fact that I still wanted to lose weight and was pushing back, as he should). I started my convincing and told him I 'just needed a small tweak and some help with maintaining, even if I didn't lose, and lessening the hunger again'…He had a talk with me about how sometimes after awhile your stomach wants to shake things up and gets hungry again (I let him know how much of this battle has been about head hunger for me), and after he told me that he didn't feel that giving me the whole 1cc back was a good idea after it had been out so long…he gave me a great analogy; like a finger with a wedding ring constantly on, your Band can make it's own groove in the tissue and after loosening the tissue can re-expand and 1cc might be too much all at once. Just short of being the crazy begging Bander, I said 'I'd been waiting for a fill since Oct…had been barely managing to hang on…would be grateful for whatever you could give me!' He asked to take a look, saw how easy my port is to find, asked me if I'd been OK with fills with no pre-anesthetic (they hurt way less than a flu shot for me), and before I knew it, he was prepping for a fill…I was about to warn him that he might lose an eye from the button on my too tight jeans when I 'assumed the V' position my old Doc had us do for fills…but before I could, he had the needle in (apparently the 'hyphen' is the chosen position here for fills)…he ended up putting in .75cc's.

OK, now...

The "Luck"…

- The new West Penn Bariatric office (I didn't pick, so simply luck as they took over all the patients from my old hospital/practice) and all those I met working there were incredibly nice and receptive. Everyone I met from the reception area to the nurse, the Resident, and my new LB Doc were just nice people…more importantly, they took the time to give me the few minutes I needed to really listen to me and to include my thoughts in their decisions. Do I think I would have gotten a fill without the preparation…most likely not…at least for sure, not yesterday!

I'm happy once again with the prognosis of my long-term LB care…and I can't stress that enough…this is a long-term relationship and you need to do your part to work on it. What works for me, isn't everyone's approach…I certainly don't want a Doc that just leaves it all up to me, anymore than I want one that doesn't at least listen to me. I need a Doc that I trust to help me keep this tool (miracle) I've been given working at it's best with me. I think I've got just the Doc I need…I've lucked out.

Sometimes it takes little setbacks (or a major derail) for us to get refocused and newly appreciate the tool we've been given to work with. There's no such thing as too late with our Band. There's no such thing as a stretched out Stoma with the Band. Appreciate the fact that it can be tweaked FOREVER to keep it at just the right place for us. As much of a pain as after-care can be and chasing that 'just the right place', it's also THE major advantage of the Band...F-I-L-L Baby!!!

*Update; I'm now back in the 150's and want to get to 150-155lbs. again for maintenance.