"One step at a time"

"Hurry up and wait
So close, but so far away
Everything that you always dreamed of
Close enough for you to taste
But you just can't touch...

To take one step at a time
There's no need to rush
It's like learning to fly, or falling in love
It's gonna happen when it's supposed to happen
And we find the reasons why
One step at a time"

- "One Step at a Time" - Jordin Sparks

Day 115

The "council" has voted me in... yay. I feel like a Survivor contestant -- this week they didn't vote me off the island. :)

The bad news is no surgery date, yet... sigh. The infamous letter that I will likely receive in a week (amazing how long it can take to travel less than 5 miles -- it goes to the hospital in Pleasanton, then to the hospital in Livermore and then into the actual US postal system it seems) has few requirements thankfully and all but one have already been fulfilled:

1. Fax pap smear test results to the Valley Care Weight Loss Surgery Program (VC). I called my gyn's office and the results just came back today. Thankfully the sample was good enough and even more thankfully the results were favorable -- woohoo.
   
2. Start taking calcium citrate with vitamin D 3x/day. Started. It turns out my vitamin D levels were low in the test the old surgeon ordered but no one told me to do anything about it until I joined this program. Since this is a supplement that I'll have to take forever anyway I have started. This will be retested in 3 months and adjusted if needed -- not a surgery show stopper. They also recommend spending 15 minutes/day with your face and arms in the sun -- sounds like fun!
   
3. Maintain weight loss. Love that! Maintain vs. must lose more is good, but I am going to continue to try to lose what I can -- I want that darn liver of mine to be small enough for the retractors to be able to lift it out of the way and came the procedure laparoscopic.
4. Take their 8 online classes and pass each with 80% or higher -- just finished. Interestingly enough the focused primarily on psychology, behavior modification and exercise -- a lot of nutrition and pre-op/post-op stuff as expected.
5. Letter of medical necessity from PCP. Holy cow -- how retarded is this. My endocrinologist referred me into this process to start with -- they've tested me from the top of my head to the tip of my toes and know every little issue I have or have ever had -- all well documented -- and now they want a letter from my PCP too? Seems like a bit of overkill at best. I know this won't be an issue, but it does seem like an absolute waste of time for all involved.
6. Keep records of exercise.
7. Attend a support group session -- done, and will continue to do.
   

All in all, not too bad. I do love the VC administrator -- she's great. I sent her an email asking her to confirm she'd received the fax from my gyn and the confirmation of my "passing" all the classes and she responded within a very few minutes with lovely affirmation and some very kind words of support.

So now I guess I'm back in a hurry up and wait mode. The VC administrator did note that my insurance company generally responds very quickly, so my original hope of hearing next week about a date range is possible. They declined me within a day from the last group... the administrator said they are generally almost as fast to provide acceptances too, so we shall see.

On a different note, our first laptop was delivered today. I suspect we'll be spending part of the weekend trying to figure out how to install the new wireless network that was delivered yesterday. I'm thinking that during the first couple of weeks post-surgery it will be hard to use our steep stairs to get to and from the office where the wired network currently resides and you know me -- I can't go too long without a computer. :) We've been thinking about getting a laptop for a while for traveling and photography so this provided a great excuse. This one should be pretty cool -- it's more powerful than my desktop! Maybe Photoshop will actually run consistently without crashing on it. It is amazing how technology improves exponentially in such short periods of time -- good thing, else I might not make such a good living in the industry.

I hope you all have a great weekend! It looks like the weatherman is predicting much more comfortable temperatures for us. At 7 PM here it's still 98 degrees and humid as all get out -- something we definitely are not accustomed to in the Bay Area.

“What seems to us as bitter trials are often blessings in disguise”

“What seems to us as bitter trials are often blessings in disguise” - Oscar Wilde

Day 113

What a wonderful visit I had with my new surgeon this morning! She was even better than I remembered!! The epitome of quiet strength, an excellent communicator and highly empathic. Perhaps this insurance fiasco has been a blessing in disguise. Although I'm not sold on their program all the way, I am 150% sold on her, and in reality she is the single most important member of the team, right?

We had a great discussion. Their statistics have improved. Here are the numbers for post-op complications:

• Leakage: <1%>
• Blood clots: <1%>
• Death: <1/500>
• Major complications: 3-6% vs. 10%
• Gallstones: 2-3% vs. 30% (she'll put me on medication for 6 months to try to prevent)

They've had 2% of their patients develop ulcers and less than 1% have blockages -- and she noted the blockages can be fixed laparoscopically.

As for my girth -- no worries. She said if I were male she'd feel differently, but my stomach is soft and I've lost more than enough weight so far to have her feel confident about this. She's also confident that we can do this all laparoscopically (although no guarantees of course). The last time she had to open someone up was several years ago and it was because her stomach was higher up than usual and she couldn't get the liver out of the way so had to partially open that patient up.

She also did a better job than the last surgeon evaluating me as an individual I think. She set the goal of getting me off of insulin, but said it's likely I'll be on oral meds forever because I've had the condition for so long. Same with blood pressure -- likely to always be on meds, but should be a lower dosage. Likely good bye to several others though. A nice dream!!

She also went on to say that there's a 97% chance that without the procedure I would be unable to sustain the weight loss and that it has nothing to do with willpower but rather hormones. A person that's 20 pounds overweight has different chemistry than someone like me -- the fat wants to protect itself at my level and yet with the surgery the chemistry is changed such that the hormonal balance changes to somewhat closer to a normal person's. Still not the same, so don't expect to ever be svelte, but do expect to be able to maintain a loss of at least half of my excess body weight. Not too bad I'd say!! And if I can exercise on top of that I should be able to do even better than that.

The final assessment is that I'm ready. She sees no need for more testing -- she felt the other surgeon was very thorough. I do have to spend $200 and take those darn classes. Oh well. She sees no reason why I shouldn't "pass" the "council" vote on Friday after which they'll submit the paperwork to my insurance company and schedule this thing -- with any luck for some time in September. That will lead to one more class for all of the patients that will have surgery in the next two weeks to get us ready for the big day and the first month thereafter.

Time off work will be 4-6 weeks -- perhaps 3 if I feel strong enough and/or work part time and/or from home. This is because I have such a short commute -- any longer and she'd stick to a minimum of 4 weeks. She recommends the full 4, so if I can "stand" it -- you know me -- I actually like working! -- perhaps I'll actually take the full 4 off. We'll see. It's too soon to think about that now.

John and I attended their support group last night. It was great to see so many post-op patients there! There were only a couple of pre-ops so we were able to ask lots of questions. One I asked was whether anyone had any ah-hahs after the procedure -- things they hadn't known or thought of but wished they had. Some interesting answers. One suggested not buying baby food -- it was awful. Puree my own. Good excuse for a new Vita Mixer! :) Another said don't do it the week before Thanksgiving -- the smells were awful for her. Another said she wasn't prepared for the emotional response she had when the reality that she'd never be eating the same set in. She got through it with the help of friends. I feel most fortunate knowing that I'll have all the help I'll need in you guys too!! Another said be ready to think differently about what you order in a restaurant -- not just the nutritional value, but the reheat value -- plan to eat that thing you order for 2 or 3 meals.

And the success stories were fun to hear too! One lady who was 3 months post op had just gotten back from Florida and not only did she fit in her airplane seat, but she didn't need a seat belt extender and she actually had 5" to spare on the regular seat belt! Another lady had just gotten back from a day at Disneyland where she went on all of the rides, fitting in her seat and having no problems securing the safety bars. Another more mature woman (one year post op) just rode on the Napa Wine train and was thrilled because she had no problem climbing in or out of the train. No wine, and she skipped the starches in her entree, but she ate her creme brulee. ;) One gentleman who was 5 years post op admitted he doesn't exercise "formally" but noted he's a lot more active overall than he was pre-op -- and he looked great. It was a good session overall -- and great having John's support there! :) 3 spouses attended which was nice.

“I do the very best I know how, the very best I can, and I mean to keep on doing so until the end”

“I do the very best I know how, the very best I can, and I mean to keep on doing so until the end” - Abraham Lincoln

Day 108

Kismet? I remembered the name of the gynecologist that helped me with my horrible ovary problem 12 years ago at 4:59 PM last night. I had really liked him, but he stopped taking HMO coverage shortly after the procedure back then so I had to leave him. This year we switched to an EPO (Exclusive Provider Organization -- kind of like a PPO, but although more restrictive, way lower out of pocket costs). Tried calling but of course the staff had already switched the phone over to their answering service.

I tried again this morning shortly after they opened, and although he wasn't in today his Nurse Practitioner (NP) was and had just had a 10:30 AM cancellation -- else I'd have to wait a few weeks. Thankfully I was successful today (for a change!) in my quest to keep Fridays meeting free to catch up on email and other work, so was able to jump on the opportunity to go see her.

She was great! I know computers are wonderful too since they help me earn a decent paycheck, and in this case they came through for me again as the office had automated patient records -- even those from 12 years ago -- so she knew my ancient history and I only had to update her on recent developments. The bad news is we only have a 50/50 chance of having gotten a good enough sample for the Pap smear as my anatomy's challenging to work with -- for once not because of my weight, but because of just plain old aging and how I'm built. She was so encouraging though!! We have to wait about a week for the results, (here we go again!), but if it wasn't good enough she'll make sure I can get into the doctor quickly and we'll figure out a plan B. I love her confidence -- she said (although I realize she has no real influence) that we won't let this stupid test be the one thing that gets in the way of moving forward. A woman after my own heart!! :)

My new PCP just called with the latest Lab results. Creatinine still normal, BUN still a little high and sodium almost normal (134 vs. range of 135 -146). Directions are to keep on keeping on -- continue eating per the plan, liberalizing salt slightly and sticking with the high protein diet.

I thumbed through the binder that I was provided with yesterday describing the Valley Care program and was pleasantly surprised to see all of the slides for the $200 class were printed and included. Of course I'm even more irritated because as suspected it is all duplicative, but at least I can read through it over this new week and take the test (have to pass with 80% -- worse than my PMP!) as soon as they accept me into the program officially (or as yesterday's RN would have put it "if" they accept me).

I forgot to post a couple of other new action item yesterday.

1. I have to contact my pharmacist and go through my meds with them to make sure the form is proper. I can't swallow anything over 10mm for the first few months. If they're too big and not cutable or crushable I have to contact my PCP and get the delivery mechanism revised.
2. I have to start practicing extending every meal's consumption time to 30 minutes -- even liquid ones. Apparently this is a guideline for all of us -- it takes 30 minutes for food to hit our stomachs and for us to know we're full.
   
3. I have to start practicing eating without an accompanying beverage and waiting for an hour to start drinking again. The new pouch will only hold 2 or 3 ounces of food at first so a) there's not enough room for food and water and b) you don't want to risk washing the food out and losing the sense of fullness or nutritive value it provides.
4. I have to start practicing chewing food to the consistency of applesauce -- any large particles are likely to cause a stricture -- not a good thing obviously.
   

Rules, rules, rules! I suspect my love of rules is going to change through this process. But hopefully I'll get a chance to find out in the not toooooooooo far distant future.

“The key to everything is patience. You get the chicken by hatching the egg, not by smashing it.”

“The key to everything is patience. You get the chicken by hatching the egg, not by smashing it.” - Arnold H. Glasgow

Day 107

I'm beginning to wonder if I am supposed to be learning a lesson about patience through this process. Smashing a few chickens sounds like more fun right now!!

It is so hard to move from a facility that I loved and trusted to a new one. And having to repeat some of the process is so frustrating!! I had a somewhat discouraging afternoon. I had such high hopes as the office administrator was great on the phone (and in person today)... but that was the only big highlight. I saw the RD first and clearly she has her spiel down pat -- and God forbid she miss a moment of it. She started off by acknowledging I probably learned all this already, but... and then launched in an hour telling me everything I already knew. $120 for that hour -- yikes. Had I not already been through 3 classes and paid for a one on one with a different RD (who by the way only charged $90) it might not have been so discouraging -- this RD was obviously knowledgeable and a clear communicator, but I have been.

Next an hour and a half with the RN that runs the program. A former bariatric patient herself, you'd think she'd be empathetic and helpful... not my impression of her at all I'm sorry to say. She didn't share the fact she'd been through the procedure until about an hour after I got there -- I would have sworn she had no clue about how it felt to be sitting on my side of her desk. Thankfully she blew through the "formal" presentation; however, then she spent seemingly forever reviewing my medical history and sharing all of their center's rules with me. OMG. She kept saying how hard it was to fast track anyone and threw up roadblocks all over the place. By the time she'd gotten through all of the clearances my prior surgeon had required she backed off a little and actually acknowledged how thorough the other program had been.

They're even more thorough though it seems. We'll see if the surgeon adds anything to the list, but right now these are my "new" prerequisites that have yet to be met:

1. "Prove" I've lost enough weight to date. Thankfully this was easy thanks to my wonderful endocrinologist's staff -- they faxed "proof" of my April weight over late this afternoon. The other facility had actually believed me.
2. Do some more bloodwork (sigh). Easy enough, but what a pain. Literally!
   
3. Start recording daily exercise.
4. Increase daily exercise. (OK, this one's fair, and hopefully with that darn wound healed now this won't be as hard as it was).
5. Meet with the surgeon as planned (thank Heaven!) next week and see what else she may require.
   
6. "Pass" the "council" vote for my suitability for the procedure next Friday. The "council" comprises the surgeon, the RD, the RN and the psychologist (at least I know I already passed the psych screening a couple of months ago).
7. Spend $200 to take their on line class (and pass the exam) to make sure I understand what I'm getting into. This is probably the single most annoying part. Like I haven't already been to 3 classes in Oakland (that were free by the way) and hadn't just sat through another 2.5 hours of lectures and hadn't already read several books and talked to several people who have had the procedure performed... And oh by the way, I can't give them my money an start on this unless (that word was used several times) I "pass" the "council" vote.
   
8. Get a Pap smear. This is likely the second worst roadblock -- every GYN in the area seems to be booked solid for a month. Tomorrow I'll try to recruit some help from my PCP and/or endocrinologist in recommending a colleague that they might help plead my case with. One can't help but wonder what the $(@% my cervix has to do with a gastric bypass though...
9. And the worst roadblock of all -- totally impossible in a short period of time and one of the main reason's I'm doing this in the first place -- lose 7" from my girth. Holy cow!! Might as well be 7' (and no, I'm not 7' in circumference yet!). NONE of the literature I've read anywhere has had a maximum girth requirement -- and of course this wasn't a requirement for the Oakland facility. My reaction to this elicited the only moment of semi-empathy she exhibited. She stated that "sometimes" the surgeon makes an exception if everything else is OK and your abdomen is "soft" enough. My widest girth point is below the point where most of the incisions are made on the charts and videos I've seen, and fairly soft IMHO, so hopefully the surgeon will "let me get by" with this. Sheesh.
   

And yes, I know I will get over this frustration and associated anger over the afternoon shortly, but smashing a few chickens really does sound good (at least in theory) right now... perhaps I'll do some mental smashing as I ride my recumbent bicycle for a while later tonight!! And record it!!!

..."the medical-care system is second to none in the world..."

“We Americans live in a nation where the medical-care system is second to none in the world, unless you count maybe 25 or 30 little scuzzball countries like Scotland that we could vaporize in seconds if we felt like it” - Dave Barry

Day 106

Good news on the surgeon front: her assistant called this morning to let me know that the surgeon is letting her "squeeze" me in as a "rescreen" vs. a new patient. She had me have the Oakland folks fax everything to her to plead my case for this and was successful. It's great working with people who know the system and are willing to help you navigate it, isn't it? :)

I'm retesting my kidney functions and sodium this afternoon (assuming I can make it out of the office by 4 PM as lab closes at 5). Fingers crossed!!

"The prompter the refusal, the less the disappointment"

"The prompter the refusal, the less the disappointment" - Publilius Syrus (Roman author, 1st century B.C.)

Day 105

The insurance company outright refused my surgery at Alta Bates/Summit. They said my "contract" allows me to go to one of two places in Northern California -- either Valley Care in Pleasanton or UCSF -- and the AB/S staff shared with me the news that the surgeon at UCSF just quit. Oh well, I guess it's good it only took them a day to let us know -- of course what I'm really wondering is why the AB/S staff didn't determine this back in May when the initially sought approval for me to have the procedure. My "contract" has been the same since 1/1/09.

And before you ask, yes, I asked if there was any possibility of an appeal. The answer was a very direct "no." It seems crazy to me -- the surgeon's covered and the hospital's cover, but even thought they're a certified Center of Excellence (COE) for Bariatric surgery, they're not explicitly called out as approved in my "contract." (big SIGH)

The only upside is that the surgeon that started the COE at Valley Care in Pleasanton is Mary Estakhri and I met her 12 years ago. She was an awesome surgeon then and likely is even better now. I had a fortunately benign breast tumor that she removed for me back then, doing such a great job that you can barely see the scar if you know where to look. Unfortunately her reputation precedes her and she's booked for new patient intake visits all the way until 9/16 -- 6 days after I was hoping to have the surgery. I spoke with her assistant and she is going to try to get me in earlier -- hopefully I will know tomorrow.

I have to see the VC COE nurse and nutritionist also before I can proceed. Thankfully there are openings to see them this Thursday afternoon so I will do so then. Hopefully those are the only repeats I’ll have to do. Best case scenario I think I can hope for now is October or November surgery again... I hope my original December target doesn't become reality.

I guess there is one more upside -- that is that this is so close to home -- no more trips to the big, bad city.

On a different couple of notes -- best news all day: I have been officially discharged from wound care treatment and am officially designated as healed. The skin is very tender and I'll have to be careful, but else-wise all is well.

I have officially survived one year with my employer now as of today too -- something in this economy that I can say I am very happy about. I am hopeful that things will continue to get better and all of us that want to work can do so.

"Be careful what you ask for because you just might get it."

"Be careful what you ask for because you just might get it." - Unknown

Day 104

I have a tentative surgery date: September 10. Woohoo (I think!)!!

Key dependency is insurance approval. The scheduler/coordinator noted my insurance provider is pretty good. Apparently they turn these around in about 5 working days and she is sending it today. So perhaps next week this will become un-tentative.

Wow. This is really exciting, but the reality of what I am planning has just become a little scarier too.

"All the knowledge I possess everyone can acquire, but my heart is all my own."

"All the knowledge I possess everyone can acquire, but my heart is all my own." - Johann Wolfgang von Goethe

Day 101

And my heart is "normal" -- woohoo!! I received cardiac clearance for the surgery yesterday -- conceivably, insurance company and surgery-suite availability notwithstanding, I may have this procedure performed in September. This was the last major milestone. What a relief!! The cardiologist's office sent the clearance letter to the surgeon's office yesterday, so with any luck at all this may be scheduled next week -- we will see.

I also received my blood lab results. Not awful, but not perfect. Creatinine at 0.91 in range of 0.6-1.1 -- perfect! The BUN (blood urea nitrogen) still high at 33 (range of 7-25). Not awful, like I said. A new anomaly showed up -- low sodium now. My PCP's prescription is so doctor-like, I love it, "Liberalize salt slightly." Never in my life did I think I'd hear a doctor tell me to increase my sodium intake!! It's great though. John made a wonderful high protein dinner last night with zucchini and peppers straight from his garden. I thoroughly enjoyed grinding a few sprinkles of some lovely sea salt on top of it!!!

So I will have to continue drinking water and peeing like crazy!! I am really enjoying the Smart Water a friend suggested -- it does taste wonderful. I found it on Amazon with free shipping so I don't have to haul those heavy cases home from the market. It's great having it delivered right to our front door.

Thanks to everyone who keeps providing me with such wonderful encouragement and support. Please continue to keep your fingers crossed and keep good thoughts coming my body's way for rapid scheduling now. It would be great to be able to be through some of the worst of the after-surgery re-learning to eat by the holidays. If it's not meant to be, it's not, but I sure can hope now! :)

"Sleep is like the unicorn - it is rumored to exist, but I doubt I will see any"

"Sleep is like the unicorn - it is rumored to exist, but I doubt I will see any"
— Anonymous

Day 98

I picked up my new demon bi-pap machine yesterday morning and started using it last night. I fear sleeping in bed is going to be as elusive as those unicorns I've always loved... if last night is any example.

I found it "OK" in my recliner. I experienced some useful sleep there... and then in the middle of the night I made my usual transition to the bed and it was all over. John was great, encouraging me and giving me some advice from his own original few nights, but unfortunately that didn't help. I struggled to calm down enough to breathe a little while lying on my back, but as soon as I rolled over (and I am a side-sleeper) I felt like I was suffocating.

I think I may pass on the attempt tonight in hopes that I can acclimate myself sufficiently in the recliner to the sensations of forced breathing through my nose in hopes of feeling a little more refreshed tomorrow morning. It's a darn good thing that I have motivation in the prospective surgery or I'd probably exercise the 30 day return option and keep on with my seeming inability to breathe properly while I sleep.

I went to the Lab today and had blood drawn for the kidney function retests and the tests the sleep doctor ordered (iron and B12). The tech was able to draw on her second attempt after digging around a little too long on my hand the first time. Ouch. I drank tons of fluids today (as I have been), so fingers crossed that the kidney function is good this time and I don't show any signs of dehydration.

I am looking forward to Thursday and my return to the cardiologist for the results of the stress test. This is the last major hurdle for my approvals, so keep your fingers crossed on this one too please!! :)

"A miracle drug is any drug that will do what the label says it will do."

"A miracle drug is any drug that will do what the label says it will do." ~Eric Hodgins

Day 94

Part 1: Drug-induced stress test

Ativan is not a miracle drug -- at least not for me. And if it did work, OMG -- I can not imagine how impossible it would have been to get through the drug-induced stress test and PET/CT scan!!

I dutifully took the little pill an hour before the procedure and kept repeating to myself "you are going to relax. This is no big deal. The stress inducer is not going to create a heart attack. The machine is not going to be claustrophobic..."

Oh well. I did survive, but with lots of help from good vibes from friends and a cool tech named Erik. And in spite of the less than cool tech Steve!

John and I walked into the facility -- the whole building was pretty impressive for the East Bay. It was in Walnut Creek/Pleasant Hill area and is a huge cancer research center. We found our suite and walked in and a reasonably competent person checked us in while Erik jovially greeted us. A few minute wait and then he came to get me to start this particular journey.

Lovely changing room with a very cushy recliner. Amazing. Reasonably attractive fake flowers and not-too-bad mass produced wall decor. A hospital gown that actually fit!! And he brought me a big cup of water (no doubt to aid in hydration for IV insertion) and told me to change, drink it all and meet him in "the room" with my empty cup.

"The room" had the scanner -- rather like an MRI. Long, narrow conveyor belt -- and Erik had be climb aboard. It was all I could do not to run out of there screaming... it was obvious this was not going to be the two four-foot square panels circulating around me taking pictures as the cardiologist described -- it was going to be a ride into a tomb.

Bolsters for head and knees were put in place -- thankfully, else I don't know how I would have been able to lay flat for half an hour on my back. Erik inserts the IV (getting it right the first time -- yay) and tells me all about what's going to happen. I let him know(many times I confess) that I really didn't want to be there and that the Ativan didn't do a damn thing for me. He cracked a bunch of jokes trying to help me relax. I ask him if my head really has to go into that great big machine and of course he admits it really does. He also promises to be in the room with me all the time he can (which was about 95% of the time and he did come through with that one!).

The first part of the scan is with the heart at rest -- so all he injected the first time was the tracer. We start the ride. I feel like a lamb going to the slaughter. And then my head goes into the machine and it stops. Yikes. I hear Erik's voice in my ears (great stereo inside the machine) telling me I'm doing great, blah, blah, blah... just a few more minutes. Thankfully before he started my "ride" he gave me a panic button to push and promised he'd pull me out if I couldn't handle it. I did believe he would -- I doubt Steve would have. He just wanted to get the job done and go home, you know the type.

I remembered Fern's trick and kept my eyes closed and tried to listen to the music -- Frank Sinatra. Finally the first part of the first half is done and the conveyor belt moves me further into the machine, taking my head back to the room and locking my torso in the machine. Again, I almost came unglued, but gold old Erik came back and joined my head at the back of the room. I joked about the music and said I wish I'd brought my own and he asked me what I wanted to listen to. Eric Clapton came to mind and sure enough he put Eric on the PA system!!

This part lasted about 10 minutes. Next came the scary part -- the drug to stress me. Erik warned me it would feel like a panic attack but promised it would only be for about 5 minutes. We'd spoken earlier about this also and he shared how much better this new drug was than the old protocol with adenosine. I truly don't think I'd have been able to handle that. He said it was insidious -- it took several minutes to start to affect you and then kept building and building up the stress affects and once they hit their peak they lasted about half an hour. The new protocol hit me within a minute of the injection. The worst part was breathing -- it felt like an asthma attack. Accompanied with a hot flash, some gas, and a little bit of a rapid heartbeat. Thankfully it lasted less than 5 minutes.

The conveyor pushed me back to the beginning and then repeated the same process as the at rest process. I tried to rock out to Eric as best I could. I opened my eyes when my head was in the machine and a disassociated me thought it was kind of cool in a space wars kind of way -- big white dome with lots of flashing lights including a series that counted down when the machine was going to move my head out and my torso in. I focused on that countdown to keep calm.

Finally it was all over. Yay. I get the results next week on Thursday. It was really hard to get up after lying flat that long - my back and my head hurt. The guys were obviously used to that as both were ready to help. Erik told me to have a diet pepsi if my headache didn't clear soon, so I broke my caffeine-fast of three months and had one about an hour later. It was like magic -- instant headache elimination.



Part 2 - Sleep Study Update

I met with the sleep doctor this afternoon. The data was fascinating. No question but that I don't know how to sleep -- right there on chart after chart. Someone without sleep apnea stops breathing 0-5 times per hour. I stop breathing almost 90 times per hour -- amazing!! I asked him how I could possibly be reasonably well rested and not display all of the symptoms of someone with such severe (his word) sleep apnea and he said that some people simply have the drive to sleep -- clearly I must be one of them. And I do love sleeping!!

I was afraid I might have a battle on my hands getting a bi-pap instead of a c-pap machine. As soon as I told him how I felt when I woke up coughing (rather like I was suffocating) he said he'd request the bi-pap. Yay. In case you're into the numbers on this thing, he noted that I didn't get into REM until the air flow was at 11. He suspects my optimal place will be 12. He ordered a smart machine for me -- one that measures how I'm doing and self adjusts throughout the night. He ordered a top setting of 14 to give the machine proper flexibility. Whatever that means, but it does seem to make sense. It has a card in it that I'll bring in when next I see him in September with data he can download. Cool. I love technology!!

The machine provider called this afternoon and I have an appointment Monday morning to pick it up. So Monday night will start the 6-week countdown to the earliest date I can have my surgery -- that would thus be September 21. Wow.

Hopefully I passed the stress test. After I see the cardiologist next week I'll call the surgeon's office and with any luck we can proceed to the next steps of final insurance authorization and truly schedule the surgery. The other little wrinkles are my kidneys -- I moved the retest to next week (Tuesday) so I could hydrate a little longer. I need to have a couple of other things tested too for the sleep doctor -- apparently my legs move while I sleep and that could be due to iron or B12 deficiencies so he wants to test those. My last couple of iron tests were a little low, so we'll see.

Amazingly enough, it seems that all of the pre-requisite procedures are all wrapping up finally. I can't help but wonder if a fork in the road will be presenting itself or if the path will continue on as it has so far. With any luck I'll know in another week or so.

"Reality is the leading cause of stress for those in touch with it."

"Reality is the leading cause of stress for those in touch with it." - Jane Wagner

Day 91

OK, so I'm a wimp. I freely admit it.

I received the patient instructions in the mail last night to prepare for my drug-induced cardiac stress test coming up on Thursday. OMG! It turns out that it's not a PET machine, it's a PET/CT machine (bigger and thus scarier to me). It goes on to read "Sedation is almost never needed (wanna bet); however, if you are extremely claustrophobic (and I am!) or tend to have difficulty remaining still (while lying flat on your back I do!), consult your doctor about the advisability of taking a tranquilizer before coming to the facility."

So you know who was on the phone to the doc's office first thing this morning groveling for drugs! It took a couple of hours, but the nurse finally called me back to let me know the good doctor has ordered some Atavin for me. I hope it works!!

Another instruction was to call the facility and let them know if I have asthma for further instructions. So I called and it turns out they want me to bring my rescue inhaler just in case. The med I take is non-steroidal so I can continue to take that before the procedure. While we were chatting I asked why the scheduled exam didn't refer to the adenosine the doctor ordered. Some good news here: they use regaenoson instead of adenosine. I did some research on that and this sounds like a good thing - equally good image results with fewer patient side affects of shorter duration. Can't beat that!

So, it sounds like I may actually be able to go forward with this procedure. I may be a wimp, but hopefully I'll at least be a more relaxed wimp now!! With any luck, the Atavin will have a memory wiping affect on me as well as the relaxation. I have never taken a tranquilizer, and reading about this one it notes that a potential side affect is short term memory loss. Apparently this is one of the drugs they can inject into you when you're undergoing anaesthesia to help forget the experience. Fingers crossed!! With a lot of good vibes from my friends, the joy of drugs in action and knowing the side affects will be shorter I think this just may be doable!!

"Never awake me when you have good news to announce..."

“Never awake me when you have good news to announce, because with good news nothing presses; but when you have bad news, arouse me immediately, for then there is not an instant to be lost.” - Napoleon Bonaparte

Day 89

I have good news and bad news to report from the sleep study. The good news is that I don't have to go back for a second night's torture. The bad news is that it's because I failed so abysmally there's absolutely no question but that I have severe sleep apnea and must start using a sleep machine. Wow. It's difficult to assimilate this on so many levels. One, hard to imagine I have had such crappy sleep benefits; another that even a sleeping pill didn't make it any better, another that I'm going to have to learn to sleep with a machine that makes me feel like I am suffocating and finally that this puts my surgery at least two months out now. Wow.

The tech was great - a guy named Al which is my father's nick-name. I arrived at the sleep center about 5 minutes early and not a car was in sight. I was all-a-jitter, not looking forward to the "experience" in the least. Per my instructions I rang the ominous after-hours bell, and out walks this very jovial man saying, "Hi, you must be Gail. I'm Al. Welcome." Clearly he's done this before. Anxiety level considers minimal abatement. We walk into the center. By day it's an outpatient surgery center, by night cavernous rooms with lots of scary equipment and empty hospital beds. "Oh great, I think... I'm going to have to do this darn thing in a surgical suite in a hospital bed."

He finally stops the tour and invites me to follow him into a room that although still rather clinical turned out to be not half-bad. Similar to John's sleep study experience of a couple years past there's a queen size murphy-bed made-up with a cheery yellow blanket and two amazingly fluffy looking pillows for a sleep center. And to my great delight a large black recliner that looks fairly squishy (and yes, I was able to convince him to let me sleep there so my shoulder survived the night admirably) and a nice-sized flat screen TV mounted to the wall. Anxiety abates slightly... and then I notice the seemingly endless pile of connectors neatly lined up on the bed awaiting attachment to various body parts. Ugh.

Al was cool though. He had me fill out a pre-sleep survey (as though I hadn't already filled out 100 pieces of paper prior to the evening) and change into my jammies and then came back and started the almost 90 minute process of hooking me up to all those wires. It probably could have been done in half the time but Al was chatty and I had warned him I was anxious so he was doing all he could to help me relax. About two-thirds of the way through the process his other "guest" for the evening arrived - an 18 year old man with his parents and older brother. Boy were they rowdy! I heard Dad telling his son all about the experience and not to worry after his brother pointed out the cart that had all of the ointments and tape prepped on it in anticipation of his hook-up session.

Al had told me earlier in my hook-up that the 18 year-old was coming. I told him that I was amazed someone so young was there and he said sadly he's had a number of 10 and 11 year-olds in the center. Typically they didn't have apnea - they couldn't sleep because of stress generally related to parents getting divorced. How very sad. I heard the 18 year-old's mom asking the tech to try to do a split-study for him because they were taking him to his college on Thursday for some early training and they didn't want him to come back. So now I'm envisioning there must have been an athlete in that room - an anonymous person who may someday be famous and I could have said I'd spent the night with him - except for that anonymity thing. Oh well, I guess the Enquirer article isn't an option after all.

Before the family arrived I also pleaded for a split study. Al explained the criteria for it to me in more detail than the doc had. He said that the only way he could do a split study was if it was clear in the first 3 hours of the evening that I had sleep apnea. If unclear, or if seemingly I didn't, then they'd have to do a two night procedure. He told me about the guy he'd had the night before that had a horrible time for the first hour of his sleep but finally fell into a good REM sleep with no breathing issues for the next few hours... and then back into the "bad" sleep pattern. By then it was too late to move him to the machine. I asked him to put me on it 3 hours in if it looked possible that I had any issues. He woke me up after 2 hours and said "I just couldn't stand to see you suffer any longer. You were literally gasping for air." No doubt at all about my condition. OK then. Bring it on.

I breathe through my mouth - a lot. I have for as long as I can remember. I've always had upper respiratory junk - allergies to everything in our environment, a little asthma, blah blah blah. Because I "admitted" this he had the "special" mask holder all prepped for me. I was very light weight - that's about the only good thing I could think of to say about it. It was fitted around my head and had a chin strap so that when you tried to breathe through your mouth it wouldn't fall off - also helped remind you to keep your mouth closed. This turned out to be a very good thing because with the mask in place and the air turned on if you do open your mouth you can't breathe at all. It was all I could do to keep myself calm and out of full panic mode when I had to cough - at one point I ripped the thing off when I did need to cough because I was sure I was going to suffocate. They only had a c-pap machine. John uses a bi-pap. I'm going to have to ask the doc about the latter because his seems a lot better. The c-pap blows air in and you have to exhale on your own. The bi-pap both blows air in and helps you exhale.

When he first put it on I was OK - not loving it, but OK. He had the air flow really low. As he increased the air flow I found it difficult to breathe. I wondered how on earth I was ever going to be able to go back to sleep. The mask itself is effectively a small piece of plastic fitted over your nose with holes the size of your nostrils and a protuberance that hovers over your lips - perhaps 1/4 of an inch away - hence the inability to breathe through your mouth. As soon as you do there's this feeling of almost like reverse air pressure sucking air out of you instead of putting it in. Very odd - add very scary. One of my phobias is fear of drowning - and it made me feel like that.

So good old Al reduced the air flow for me and I thought about beaches (no doubt with those lovely visuals I mentioned yesterday from one friend and in yesterday's comments from another). The sound of waves crashing on the shore in my mind overcame the sound of this thing pushing air into my nose. But then Al turned in evil, nefarious Al! As soon as I fell asleep he cranked that air flow up. Of course I didn't know this until I woke up coughing - no doubt that's why I ripped the mask off then.

He was a cool guy though. He came into the room right away. Turned the air flow back down and repositioned the mask. I was sure I'd never be able to fall back asleep (it was around 3 AM then), but did so within a few minutes. The evil, nefarious Al kicked the air flow back up high again and for the first time in the night I actually went into REM sleep. Amazing. Maybe I do need this damn thing after all! Of course the ever-wishing-to-be-in-denial part of me wants to blame it on total exhaustion after a night in the catacombs... but...

Around 5 AM after I came out of REM the good Al came back and released me from all of the medieval torture devices. He commented that he was going to encourage future victims, I mean patients, to try sleeping in the recliner because it worked so well -- they want you on your back and most of us are side-sleepers). I refused to admit it but I did wake up amazingly awake if that makes any sense. No grogginess at all, just suddenly awake. Another clue perhaps that perhaps I do need this thing.

I was home around 5:30 (it as a lot faster detaching the multitudinous devices that it was attaching them!!). After setting off the house alarm and reassuring the alarm company that we were OK (John had set the alarm to go off immediately upon an exterior door opening instead of the away delay) we both went back to sleep. I didn't get up until around 10 - about 4 hours later than my usual weekend wake-up time.

The only residual challenge to deal with this morning was my hair. Four of the connections of the EEG to my head were on my scalp. Al used a gross gooey, waxy product to attach them. He warned me last night that it wouldn't be fun to get out but that as long as I used the hottest water I could stand and no shampoo that I'd be OK. And once again Al came though for me. After figuring out how to bypass the shower's safety thermostat (I do love the new shower tower we put in with the remodel a couple of year's ago!) I spent about 20 minutes melting the gunk away. My hair still felt icky and then I spotted the clarifier my stylist had recommended a year ago when I had some product build-up on it so decided to give it a try. After two rinses with it I feel much better -- bless you Rene Furtier!! His products are outrageously expensive, but worth every penny at a crisis time like this. :)

OK then... this has to be more than enough gory details for anyone, even me, by now! Thank you kind friend for ploughing your way through this endless blog today. Once again, it's been very therapeutic for me to write my way through the angst and into acceptance. Thanks for all your support.

One last anxious milestone to deal with now - this coming Thursday's drug-induced stress-test and PET scan. Can't wait (for it to be over). I'll let you know how it goes! Please thing good, calming thoughts for me and send your positive vibes my way around 12:30 Thursday afternoon.

Counting French premiers or sheep?

Sleep is perverse as human nature,
Sleep is perverse as legislature....
So people who go to bed to sleep
Must count French premiers or sheep,
And people who ought to arise from bed
Yawn and go back to sleep instead.
~Ogden Nash, Read This Vibrant Exposé

Day 88

Well tonight's the big night... sleep study time. Shall I count French premiers or sheep? What a silly thought... thanks to Ogden for the giggle. And thanks to my friend (who shall remain un-named to protect the innocent) who sent this great sentiment to me this morning:

Don't have any dreams about any hot dudes or anything that would push your heart rate up and affect your breathing!!"

That brought me an even bigger giggle! I shall try to remember both when sleep anxiety hits tonight! I still don't know how they can expect you to actually fall asleep hooked up to all that apparatus knowing you're under observation... I hope to heck that sleeping pill the doc gave me is a strong one!

Next Thursday I "get" to have the induced heart stress test with PET scan. Can't wait (not). John is taking some family sick time so he can join me and provide some moral support. I am truly blessed to have such a wonderful partner.

It will be nice to have both of these hurdles behind me - hopefully they're the last two major tests I need to get through before we can actually seek a surgery date. And even more hopefully I pass both of them so there are no impediments to having the surgery.

I am beginning to feel like I am going to float away from all of the liquids I am consuming. I will retest my blood either Wednesday or Thursday this week, depending on when I can break away from work for a few minutes. I expect next week to be crazy as we're reporting on our July results and kicking off 2010 planning and officially starting a swap in portfolios we are managing between a colleague and me. There won't be a lot of dull moments, that I am sure of.

Sweet dreams everyone...