"What greater gift than the love of a cat."

"What greater gift than the love of a cat." - Charles Dickens
(Today's quote is offered in memory of Susan and Tom's beloved Boots. He'll be missed.)


Day 84

Another see-saw kind of day on the journey...

Started off at the wound care center. Two of the three wounds are officially considered "healed" now - hallelujah!! He minimally debrided the third and commented that it's shrunk signifcantly - fairly good news. He is definitely on the AR side - nothing but "perfect" skin will do for him. I guess that's a good thing. I'm off the hook for two more weeks now before having to hike back to Walnut Creek to visit the center.

Received a call with mixed news from my new PCP. The creatinine level was in "normal" range - yay. The urea nitrogen was not - 30 vs. the normal of 7-25. Not too bad I suppose. Orders: continue with high protein diet for two more weeks and re-test, consuming more fluids along the way. OK then. I suspect I'll float away - please send me a lifeline if you see me in the middle of the Pacific, OK?

Received the call back from the GI specialist who confirmed the lab report was not in error, , but not to worry... 90% of us have hiatal hernias and unless they're a big problem we'll never know it. Interesting. "If" it bothers me, go on the low acid diet... and if not, don't worry. That was good news. I love my citrus, tomatoes and fresh crisp apples!! I realize I won't be able to tolerate any of those post-surgically for a while, so I really don't want to cut them out earlier than I have to. I must confess that I do feel a bit more motivated to avoid the temptation of those yummy pizzas now. I mentioned earlier that the wound care doctor did his fellowship with the same practice my surgeon is in I think. He always asks what's new in the journey and when I mentioned this to him he said it was no big deal - anything that looks out of whack will be repaired just as a matter of course by the surgeon performing the bariatric procedure. Seemingly they do this all the time. Gotta love it - one stop shopping! :)

“It's not denial. I'm just selective about the reality I accept.”

"It's not denial. I'm just selective about the reality I accept." - Bill Watterson, author of Calvin & Hobbes

Day 83

I like that: selective reality. I guess I've had a lot of that over the last decade or two. This journey keeps unveiling new issues I never even knew I had. The latest: a hiatal hernia. What a surprise that turned out to be. You may recall me noting earlier that the physician that performed my EGD said there were no issues with my esophagus, stomach or duodenum, and that worse-case-scenario was that I might have to take some antibiotics if any of the cultures he took turned out to show a bacterial infection. I received the final results Saturday (didn't read until last night) and guess what: no bacteria, but I have a hiatal hernia.

Recommendation: lose weight (ha!), continue any acid reducer medication for 3 months and then discontinue (I've been on that stuff for over a decade), and change diet -- no citrus, no mint, no caffeine (thankfully I'm off that already), no chocolate (ditto to the caffeine), no fatty or fried foods (ditto again), no garlic, no onions, no spicy foods. Yikes... what's left? And then it goes on to say avoid the following: peas, lentils, beans, many vegies (including artichokes, asparagus, broccoli, brussel sprouts (that's an easy one at least! -- I knew those couldn't possible be good for you anyway), cabbage, cauliflower, cucumbers, green peppers, radishes, raw potatoes), many fruits (apricots, bananas, melons, peaches, pears, prunes, raw apples), wheat and wheat bran, eggs, carbonated drinks, fruit drinks, beer, red wine, sugar and sugar substitutes, and if you're lactose intolerant (thankfully I am not), no milk or other dairy products. Sheesh!!

Anyway, suffice it to say this report was inconsistent with what the doctor told John and I after the procedure, so I called his office first thing this morning to see if there could be a potential mix-up. I should have predicted that he'd be out of town today, shouldn't I? Hopefully I'll hear back from him tomorrow. I think I'll be selective about the reality I accept to this until I talk to him.

In the meantime though, you know me, I did do some more research. Turns out that a lot of us are walking around with small hiatal hernias and they don't do anything about it unless they interfere with swallowing or breathing -- any good stuff like that. It's defined as a loose connection between the esophagus and the stomach with some of your stomach protruding into it. Can cause lots of nasty things like internal bleeding if severe... I have to believe if my selective reality is discounted tomorrow that it's not severe given how I feel.

I also called the surgeon's office to see if this could be a roadblock and was reassured by the coordinator telling me not to worry -- the surgeon will ask for a copy of the films and if it's a potential problem, and if I am elsewise cleared for the bypass, he'll just fix that while he's re-routing all of my plumbing. Fascinating.

In the meantime I read up more on the "PET Myocardial Perfusion Study / Adenosine Protocol" also. The good news is that as of 2004 there had only been two reported deaths from the procedure and both were with patients that had severe pre-existing heart issues. And as advertised, side affects (80% of the population experience, higher for women (another thing I should have predicted no doubt)) include a 30 minute long hot flash accompanied by nausea. Other things he failed to note as potential side affects are headache and chest pain. They administer the adenosine in a six minute infusion and assuming three minutes into it you're reasonably OK, then they add the radioisotope. I can hardly wait.

Speaking of waiting, I am going to have to hurry up and wait to see if my insurance company approves the PET study. I called the woman that coordinates insurance approvals for the cardiology group, and she hadn't even received the request from the doctor yet, even though I say him 4 days ago. The practice is huge -- lots of cardiologists working together, no doubt to afford all that expensive equipment they have -- and in 3 locations. The woman that does the insurance auths is in a different location and the courier runs between locations Wednesday nights. I let her know the doc noted on the request that he wants me to have it in the next 2 weeks. It remains to be seen whether she'll do anything about it before the courier shows up this Wednesday... I think perhaps I will not hold my breath! This is one case where denial would likely work against my psyche.

Back to the wound care doctor tomorrow. John said this morning my lower one looks great and the big upper one looks pretty good. I am hoping the doc doesn't feel the need to debride it again tomorrow... time will tell I suppose. Another place where I think I'll be selective about my reality until I have to be otherwise! ;)

Stretch your heart

"Today, see if you can stretch you heart and expand your love so that it touches not only those to whom you can give it easily, but also those who need it so much." -Daphne Rose Kingma

Day 81

Yesterday turned out to be OK, but a little less than fun. I am thankful that my boss is supportive of my working odd hours because I had to miss some normal working time in both the morning and the afternoon yesterday.

Morning found me back at the cardiologist's office, this time in one of the procedure rooms, having my echo cardiogram. A wee tad uncomfortable, but no biggie. When the tech started looking at my valves I asked her if that was the one that leaked (I've had a murmur since childhood), and she said no. It figures that it was the last one that she got to that turned out to be the leaky one. I asked her how big the leak was and she said "it doesn't leak... it spits." Oh joy -- not only is my heart sideways but it spits. There must be some kind of symbolism there, but heck if I can work it out!

Late afternoon found me losing my battle with the sleep doctor. Although I have very few potential sleep apnea symptoms he is insisting on a sleep study. At least he approved a split-study (meaning only one night instead of two under a sleep microscope), assuming I qualify with my initial readings that night. The big night will be 8/1 -- next Saturday. I am hoping I will pass as this will delay my surgery at least two months if it turns out I do have an issue since if I do I'll have to get a sleep machine of some sort and get used to it before the surgeon will work his magic. The procedure itself sounds odd. The prep instructions are simple -- no alcohol after noon that day (and since I have been off wine for 2.5 months now that's easy) and a shower before going -- no hair products, no body lotions. After I get there I am to change into my pj's and then they'll spend 45 minutes hooking me up to seemingly endless pieces of equipment!! There's a heart monitor, an oxygen monitor (the finger kind), a nose breathing monitor, an eyelid monitor and a brain monitor -- yikes. How the hell can anyone sleep with all that crap on, let alone knowing you are being filmed and observed? When I expressed my concern to the doc about this he said no worries... and proceeded to provide me with 2 sleeping pills -- one for that night and one for another, in case I don't qualify for a split study and have to return for a second night. The split study requires waking me up half way through the night and putting on a c-pap machine to see if that improves the quality of my sleep at all. John has one and it's saved our ability to sleep in one room. Although a bit Darth Vader-esque, it completely eliminates his snoring by rhythmically pushing air into his nose every time he is supposed to breathe. It makes a little white noise while it does so that I find quite soothing. That being said, I still don't want one!!! Not because I care about the Darth Vader image, but because I don't want another 2 month delay. You know me, I am the instant gratification queen.

"...with a little help from my friends"

Day 79

Saw the dietician Friday and she has some great ideas to modify the diet pre- and post-surgery if needed. I have been back on the high protein diet for a week and so retested my blood today. Saw the cardiologist today too. He had another EKG done while I was there and noted it looked pretty good but my heart may be lying a little sideways in my chest... don't laugh now!! There are no issues with that. He's ordering a new echocardiogram (performing tomorrow morning) and a cardiac PET scan -- can't wait for that -- he said it'll take about an hour and you have to lie flat without moving the entire time. Ugh. First half hour is a straight scan. Second half hour is after they inject you with a radioisotope and another drug -- effectively to intentionally stress your heart -- he likened the experience to a 30 minute hot flash without relief accompanied by nausea... sounds like too much fun. Need to get insurance company approval for that so hopefully that won't slow things down too much. Tomorrow afternoon meeting sleep study doctor. The thrills just keep on thrilling!

Saturday I accompanied John for a lovely evening with our favorite casual wine tasting group, the Pompous Twits. The event was at the home of some wonderful friends on their terrific backyard patio. They were so thoughtful -- knowing of my "sitting challenge" they had a special chair with a lovely padded cushion waiting for just me. I would never have gone had it not been for the encouragement from two dear friends who were in the non-drinking section with me. It was nice visiting with everyone, but I confess really hard to pass up the home-made barbeque-grilled pizza and a really decadent looking dark chocolate cake dripping with dark gooey chocolate icing... but I managed to do so somehow. One of my friends brought her own dinner, as did I, so I didn't feel quite so much like an alien.

Weighed in Tuesday evening -- down 48 pounds now! I hope I can stay on this diet. I imagine I'll hear the results from today's blood work next Monday... fingers crossed. Maybe it was worth passing up that pizza and chocolate cake after all. Naw. ;)

Wound pain finally negligible... woohoo. Looking like we're on the path to true healing now. Fingers crossed on that too! The newest wound did break open again when I spent all day Tuesday in awful conference room chairs -- I guess I need to still be careful where I sit.

I don't know where I'd be today without all of the help and support from my friends. You have been awesome. It's great to receive all of your words of encouragement and I truly appreciate those of you who've helped to pick me up when I was feeling particularly down. This experience is definitely producing a see-saw of emotions!!

Thank you.

"Oh I get by with a little help from my friends
Mm going to try with a little help from my friends
Oh I get high with a little help from my friends
Yes I get by with a little help from my friends
With a little help from my friends" - Lennon/McCartney

"Getting to know you, getting to know all about you. "

"Getting to know you, getting to know all about you." - Oscar Hammerstein

Day 72

Thanks to my (wonderful) endocrinologist, I just might have a wonderful new PCP!!! I had my initial visit with her today and what a breath of fresh air! She may just have given me the very best new patient visit I've ever had with any MD short of the gynecological oncologist I met in 1987 (he will be hard to ever top). We spent an hour together. During the visit she called my (wonderful) endocrinologist to consult with him since he knows me and my history pretty well. He wasn't available so she left him a message.

Results from initial visit: a referral to a real cardiologist for real cardiac clearance (vs. the cardio in a traveling box I had been scheduled for at the old PCP's office yesterday -- I'm so glad I canceled it). I'll be seeing him next week. She spent more than an hour with me. Performed an EKG. Looked at my wounds. Thoroughly reviewed my last two sets of labs with me. Concurred that she feels I am a good candidate for the surgery. Gave me a lab slip to test the kidney functions again in a week. Told me what to ask the nutritionist about tomorrow. Gave me some tips to try to help with the leg pain I've been having. Had a real dialogue -- give and take -- trying to get to know me. Yay!!

The old PCP finally called me yesterday to report on the lab results from last Friday -- the same ones my endo was copied on and he had called me Monday. The ordering physician often receives the results a day earlier from the lab than anyone that's copied... so why did he call me two days later than my endo, especially since he knew how upset I was by the first set of tests? Wouldn't you think a doctor would at least have his staff call to let someone in distress know that there was good news? I am so glad that I don't have to see him again!!

The (I am hoping will be wonderful) new PCP just called to share the discussion she had with my endo. Follow up -- and the same day no less! :) It is a wonderful thing. I may just have that primary care partner that I have been hoping for now.

“In these matters the only certainty is that nothing is certain.”

“In these matters the only certainty is that nothing is certain.” – Pliny the Elder

Day 70

Hooray. The re-test results are in and tah-dah: no kidney function problems noted! And who do you think I got the results from? My PCP who ordered the tests? Pshaw. Of course not. My (wonderful) endocrinologist had his office call as soon as he read the copy he received to let me know. Yippee!

Since last I wrote I’ve seen a couple of other docs. All have re-validated the quest for this surgery. It’s great to see the medical community in consistent agreement with something for a change!

I saw my wound specialist last Tuesday morning. He opened both wounds again – ouch. Warned me that he’s giving them another month and if not better he’ll excise all the tissue and sew me up. Ugh. He decided to add some new meds and cover the wounds up this time. I saw him again this morning and he only opened them a little today – thinks now we’re on the home stretch and both are finally responding. Culture came back with strep and staph… yikes. Treating with silver now – yes, the element! Amazing. Talked about the kidney test results. I mentioned before that he did his fellowship in bariatric surgery I think… he said the surgeon’s nuts. Advised me that if the surgeon won’t do it to let him know and he’ll find me someone who will… yay!

I saw my endo last Tuesday afternoon. Shared with him the PCP saga of the day before. He gave me a card of a new PCP who I’m going to meet this Thursday morning – yay! Can’t wait! I called and canceled the physical and echo-cardiogram that were scheduled for tomorrow with the old PCP – I can’t wait to work with someone new! Am hoping she’ll have a different sleep center recommendation – more to come on that. My endo said the only criticism anyone’s ever had of the new PCP is that she tends to get very involved with her patients and cares about their health… wow. What a delight that could be after this old guy!! And back to the surgeon – my endo echoed the PCP and the wound specialist. He said the surgeon’s nuts. If he won’t do the surgery, my endo will call him personally and tell him why he should! Yay!!

Saw the GI specialist for the EGD consult last week and was able to schedule the procedure and have it performed yesterday. Talked about the surgery and again, validation. Yay!!! EGD turned out to be no big deal, other than the RN that shot my systolic blood pressure (bp) number up to 190!! – I have a little bit of a sore throat today, but other than that no side affects. Back to that RN – OMG – if you ever have an EGD, you need better knowledge of the procedure going in than I had if you have an RN like her. Here I am on the gurney, can’t move more than a couple of inches… IV on my left hand, bp cuff on my right arm, oxygen blowing in my nose held onto my head with loops around my ears, and 4 connectors to the heart monitor. The anesthesiologist and I exchanging notes so he can take me under and bring me back… and then with no warning or explanation the nurse shoves this thing in my mouth and wraps it around my head and tightens it up so it can’t move – and mind you it looks like something out of an S&M shop (and like John’s mom, I’m into M&M’s, not S&M) – and I can’t talk and I go into a lovely panic wondering what else are they going to do to me pre-anesthesia. The anesthesiologist notes my bp and asks me what’s wrong. Like I can answer? He has the RN remove the mouth piece and finally gets it when I explain. He goes on to explain they have to put it in before they put me under else they can’t do procedure as jaw will clench once I’m under. I’m cool now – I “get it” once explained. He realizes it was too late so says “We don’t need to put it on until just before I add the happy juice to your IV – would that be better?” Duh!! Way better! He timed it great then – stuck the needle in the IV and told the nurse to put it on and that’s the last I remember – thankfully. Saw the GI guy afterwards and he reported no anatomical anomalies – no ulcers – no reason he can’t clear me for the surgery. Yay!! Took a couple of cultures – said I might have a bacterial infection and he might have to put me on some antibiotics but that’s very normal and not to worry. Double yay again! Another deliverable from the checklist signed off.

So what’s left? Still need by dietician consult, cardiac clearance and sleep study. I’m thinking the cardiac clearance will be easy with the new PCP. Dietician and sleep study a little more challenging. There are no providers for either in my new insurance network – amazing. Spoke with insurance company last week and thankfully they said they’d approve out-of-network exceptions. Got the letters Friday and they weren’t properly filled out (didn’t note approved providers or procedures) so asked for new ones yesterday… hopefully they’ll be here soon. Have dietician scheduled for this Friday and initial consult with sleep center next week. Spoke with billing person at sleep center and she said I need that letter – $5K to have a sleep study conducted. That seems outrageous to me – hence the above note that I want to check with the new PCP to see if she recommends someone else. This sleep center says you have to go back three times! John’s study (at a different center) was all done in the one night – and they selected the device he’s still using today right then and there.

Speaking of insurance, wow. We truly don’t appreciate it enough! We’ve been in an HMO for years so haven’t seen any of our bills other than hospital stays. Now we’re seeing them all. And I don’t know how anyone could be expected to have good medical care without at least the rates that the insurance company negotiates – if not the actual coverage. One example that still has me stunned is my first visit to the wound center – total clinic bill (excluding MD billed separately) $1,400! I pay $20 and insurance company is having clinic write off $500 per their contract!! Holy guacamole!!!

So my biggest learning from last week? Pliny the Elder summed it up: “In these matters the only certainty is that nothing is certain.” It seems it wasn’t certain that my kidneys were messed up and my surgery no longer viable. It seems that bills are just bills until the insurance company decrees what you’ll pay. I’m still not there – but it’s definitely not hopeless.

Wish me luck with the new PCP and the insurance company this week!! In the meantime, thanks for your continuing support… just knowing you’re here with me is a wonderful thing!!

Believe in yourself

"It's so important to believe in yourself. Believe that you can do it, under any circumstances. Because if you believe you can, then you really will. That believe keeps you searching for the answers, and then pretty soon you get it." - Wally Amos

Day 63

My belief system in general has been challenged today. I was close to devastated during the noon hour when my surgeon called me and pronounced that due to the kidney function test results I'm no longer a candidate for the gastric bypass. Holy crap! Here I FINALLY get myself into this mode and on the path and he pulls the rug right out from underneath me.

Not to worry though... you are still eligible for either a sleeve gastrectomy or a lap band. They don't work as well, but they're better than nothing. And the insurance company may not cover either of those options because the former is still considered somewhat experimental -- look up costs and they're $20-25K! OMG! Thank God for good friends at work else I don't know how I would have been able to make it through the rest of the afternoon. You guys are great.

But I get ahead of myself. Shortly after 8 AM this morning my PCP's assistant calls and asks me to make an appointment to come in today so we can "take care of everything all at once today." This makes me worry since the PCP's been so unresponsive. Surely he must have finally looked at the Lab results and decided that yes, I am having a problem and he'd better attend to my medical needs. Or so I thought at the time. Imagine the further panic I feel when the surgeon calls around 4 hours later and tells me he can't perform the procedure. This was followed by a call from his RN who says the dietitian will call me Wednesday and probably put me on a renal diet. OMG - are my kidneys going to fail today? Trying to be rational and realizing if it were that bad my endo would have sent me to the hospital Friday instead of referring me back to my PCP, but having a hard time rationalizing.

Finally 4 PM rolls around and I see the PCP. I like the way John refers to him -- he says he's so blaise about everything he would probably just casually in passing mention you had a terminal illness but not to worry... sheesh. In any case he comes in, looks at my labs and says he still doesn't see what the big fuss is. The numbers aren't that bad. What is wrong with the endo and the surgeon? I look at the labs -- the ones he ordered, vs. the ones the surgeon ordered, vs. the ones the endo ordered. And you know, maybe he is right! While out of the normal range, they're not all that far out of the normal range and there is variation on the same tests performed 3 different times (due to overlapping orders).

So here it is Monday evening and now I'm wondering who should I believe? The PCP calmly says if this surgeon won't do the procedure we'll just find another that will -- he's had a patient with congestive heart failure that the procedure was performed on because of the overall health benefits. And who says if the high protein diet is the cause that they can't modify my post-op diet, and even if they can't, there's no reason to think I'd go into kidney failure as a result of a slightly elevated creatinine level. So there. Neaner neaner neaner.

So who to trust? I see my endo tomorrow so will certainly discuss with him. I have a lot of confidence in him and appreciate his conservatism and caring attitude. I'm also done with this PCP, very done. Have to live with him this month, but will definitely move on to someone I have more confidence in, even if he is telling me what I want to hear today. But I have gone from feeling somewhat hopeless at noon to hopeful once again.

And I know you're dying to ask about the referrals... you know me, so you know I left with them, but OMG, what a pain to get them! The PCP starts down the path of, "Well, if this guy won't do the procedure (even though I think he's an idiot) then maybe we should just wait. He's way too conservative. I've known other surgeons that haven't asked for all this stuff." I jump in and tell him I've done a ton of research and these are standard protocols. He stops arguing and starts producing finally. I have the prelim visit scheduled now for my EGD on Wednesday, a call into the local dietitian to schedule a consult, am waiting for a call from the local sleep center to schedule a sleep study and an appointment for an echo cardiogram next Wednesday. Yay. Progress at last! And it only took a mere 12 days. Can I say "sheesh" again?

And yes, I'm redoing my labs again this Friday. Just the kidney function stuff. The PCP said to drink tons of water and he's willing to bet I'll be back to normal. If I am, then we'll try the high protein diet again and retest again. Fingers crossed.

So at the end of the day, who should I believe in? Myself. Wally's got it right. I have been living with this body longer than anyone else. I've never had kidney problems before. If I have them now I guess I'll have to figure out how to deal with them, but I really don't feel like I have a problem with them, you know? And if I do, I'll keep searching for answers and with a lot of help from my support network we'll figure this thing out, right? RIGHT!

"Our job is not to straighten each other out, but to help each other up."

Day 62

"Our job is not to straighten each other out, but to help each other up." - Neva Cole

Who's Neva Cole? I have no idea... but I surely am blessed to have so many friends that think like her... thanks to all of you who responded to my first blog entry with such wonderful, caring words of support. I know I'm going to need a lot of help on this journey, and I feel very lucky to know deep in my heart that you are all out there ready to help me up as I need it.

One of the questions the shrink asked me during the pre-op psych eval was, "Who is your support team?" This was followed by, "Who will be your saboteurs?" I am still humbled by the thought that a number of people come to mind in response to the first question (John being number one on the list of course!) and only a couple in response to the second.


PCP saga continued...

It's definitely time to get a new Primary Care Physician (PCP). He finally called me back Friday night and started the conversation by chastising me for bugging him on a holiday, only lightly backing down when I asked him if he heard me state in my first message that I was doing so because my endo directed me to do so because he was concerned. Then he went into a tirade about specialists only wanting to take care of the health issues related to their specialty rather than the whole person... sheesh. After 10 minutes of useless blathering he finally said, yeah, you had better do what you've already been told to do and "I'll call you back Monday afternoon after I return to my office." When I asked him again whether I should stop the diuretic I'm on in the meantime he paused and said "I guess it won't hurt -- you won't blow up over the weekend." Such great words of encouragement... I wish I were still in an HMO so I could complain to someone about him. Unfortunately, I need him too much this month so will deal with him as best I can until August 1 and then switch PCPs.

Suffice it to say no status changes on the checklist from Friday. Who would have thought your own PCP might be one of your saboteurs? I never did!

"Do, or do not. There is no 'try.'"

Day 60

Introduction

Fear not: today's entry is catching up on the last 60 days so is very long... I promise later entries will be more concise!)

What am earth am I doing here, starting a blog? Who cares about my journey? Maybe no one else in the world but me. But here I am... taking a leap into cyberspace -- wondering if I've set my privacy settings properly so no one can see this unless I let them... and then wondering who cares if anyone does see this? I've been thinking about this for a while -- weighing the pros and cons of a hand-written journal vs. one on the Internet. Cyberspace won.

What is this? I think this blog is going to be about my journey to a new physical being -- a stronger, healthier body. I wonder if it's going to get any deeper than that? I have spent a lot of energy shutting myself away from others -- is this just a way of building a window into the walls around me, or is it a way of opening a door so I can come out and others can come in?


"Do, or do not. There is no 'try.'" - Yoda, Jedi Master

Master Yoda's words of wisdom sum up the realization I've finally come to about my physical self. I can't "try" to be healthy anymore; I have to "do." After lots of soul searching I finally acknowledge that the first thing I have to do is lose weight -- and in a way that ensures I can sustain the loss.

After lots of research, I've decided the only way I can do this successfully is to completely change my physical self. And the only way I think I can be successful at this this time, once and for all, is with a Roux-en-Y gastric bypass.


The journey begins

This trip "officially" started several months ago with a visit to the endocrinologist (a wonderful man I might add). My weight had reached an all new high, exceeding a milestone I never wanted to have within my reach, let alone exceed. My blood sugar control was barely hanging on and I'm sitting there blithely thinking, "Guess I'll have to start upping my insulin doses again," when he pronounces I'm at the maximum dose he considers safe and removes the option. Bubble burst. I swore I had been "trying" to lose weight -- but I wasn't "doing" it. The increase from my prior quarter's weight was so great he thought perhaps I had a new condition to add to my seemingly endless list of chronic health issues. I eagerly embraced the thought and was sincerely disappointed when the test results came back negative. How crazy is that? To actually hope there was a problem!!

I have had doctors throwing weight loss surgery at me as a suggestion for years. I started listening to the thought a couple of years ago. The above endo visit put me over the edge -- time to "do."

So, my darling John and I went to a seminar about the procedure on Cinco de Mayo. We joked about having great Mexican food afterwards on the way to the seminar. We weren't joking by the time it ended. The surgeon was great -- concisely described the procedural options for weight loss surgery in good layman's terms -- concisely described the rewards and concisely described the risks. Death. Yikes. That's a term I understand at some level but really don't want to become intimately involved with yet, you know? That's what I'm here to postpone. The inevitability is inescapable, but I feel like my time's not quite up, yet.

We are given a bunch of hand-outs including a health bio and a checklist. I filled out the bio and sent it back the next day and then started the long hurry up and wait process they warned us of.

I'm going to start counting this journey looking at May 5 as day 1. That makes today day 60. They told us that "if we qualify" for surgery to plan for it to be 3-6 months out.


The checklist (my interpretation) - including status

1. See a shrink - get a sign off that you are not going to commit suicide when you have to totally change your relationship with food and learn how to eat all over again as an infant would learn. And oh by the way, no carbs. No alcohol. No alcohol? Not even an occasional glass of wine? No alcohol for 18-24 months after the procedure and then if you can tolerate it know you'll be a cheap drunk and 1/2 a glass of wine may well put you under the table. (Do I believe? Not at first! Denial!! Investigate and learn it's true. My sister-in-law had roux-en-y several years ago and can't handle a single glass of wine -- she can do one beer. Woohoo... and we used to be the margarita sisters! What a difference a little re-routing of the plumbing can make). No carbs? Yeah. Not for 18-24 months. Did you ever think about the fact that rice expands in your stomach as it's digesting? I never did... and lord only knows after going through all of this to bypass some 95+ percent of your tummy, you certainly don't want to expand the size of your new "pouch" as they refer to what remains useful. And then when you add carbs back later only allowed in extreme moderation -- better to try not to add back! Status: done.
2. See a nutritionist - notes above - need to learn how to eat all over again. Status: see today's frustrations below.
   
3. Lose 10% of your weight - you've got to be kidding. That's why I'm having the surgery! Then learn that the first thing in your body that loses size when you lose weight is your liver. Your liver has to be small enough for them to use retractors on through some of the 6 abdominal incisions you're going to have with your surgery to hold out of the way so they can get to your stomach and intestines for bypassing. If it's too big, you have to have open surgery greatly increasing risks and recovery time. Yeah, lose 10% of your weight. Status: done, but see today's frustrations below for caveat.
   
4. Get a cardiac clearance from your PCP (primary care physician). Status: see today's frustrations below.
5. Get a sleep study done. Status: see today's frustrations below.
6. Have a million blood tests performed Status: done, but see today's frustrations below for caveat
7. Have doppler ultrasounds of your carotid artery and your leg veins done. This one was a little of a surprise. That was until I found out the surgeon's had a couple of patients lately that had post surgical blood clots that almost killed them. As a matter of practice they give you blood thinners with the surgery, but if you have problems in these areas they need to know ahead of time. Makes really good sense to me now! Back to that I'm not quite ready to die yet thing we were talking about above. Status: done, pending results.
8. Have an EGD done - don't I sound cool throwing around these medical acronyms now? This one is short for esophagogastroduodenoscopy. No wonder they've shortened that! eMedicine describes this as "a procedure during which a small flexible endoscope is introduced through the mouth (or with smaller caliber endoscopes, through the nose) and advanced through the pharynx, esophagus, stomach, and duodenum." Thinking about it it makes sense... most of your stomach is getting stapled off and cut away so they have to make sure that it and your duodenum are healthy because there will be no easy way to see them ever again. Status: see today's frustrations below.
9. Start exercising. I almost forgot about putting this on the list -- Freudian slip? For me this is and probably always will be the hardest thing. Now that I've lost 38 pounds (as of last week) I can walk about 100 steps without wheezing (I was down to about 10). And they want me walking 12,000 a day! OMG!! When Scott and I were in our best condition walking around the lake at the Lab regularly we killed ourselves to get to 10,000 in a day -- and that took months -- and I was a good 50-75 pounds lighter than I am now -- and I didn't have the ridiculous wounds that just won't seem to heal that I have now. Whah whah whah... Thankfully they won't prevent the surgery if you don't get to this before then, but it remains the goal before and then daily after surgery. Status: see today's frustrations below.

Today's frustrations

My longest standing frustration is with my PCP. I am ready to scream!! John and I saw my surgeon for the first pre-op visit last Wednesday morning (9 days ago). Since my surgeon's in Oakland and I hate going to the big city, he provided a couple of letters and a checklist to share with my PCP requesting I obtain referrals to local resources for items 2, 4, 5 and 8 above. I faxed all with a letter from me to my PCP that same morning. I called to confirm it was received and legible. I've been calling every day since for the referrals and am continually told the doctor's busy -- sorry -- the staff's doing all they can. Argh! My PCP's been one of the doctors that's encouraged me to follow this path, and now he's putting up major roadblocks. I have a physical on the books with him for the week after next. I am also seeing my (wonderful) endocrinologist next Tuesday. I am hopeful that he'll help with some of the referrals if I don't have them by then, and if worse comes to worse the PCP will have to help me when I'm in his office face to face in a couple of weeks, but this is ridiculous... and it gets worse.

Bringing me to my newest frustration -- the good news and the bad news. Remember those millions of blood tests I mentioned in 6 above? Well there were also some urine tests. Three docs ordered things -- my PCP, my endo and my surgeon. My endo called this morning (yes, as soon as I heard his voice I was worried, wondering why he was calling me on a holiday at 9 AM). He proceeded to share the great news that my A1C test came back at 6.5 (hip hip hooray -- down from 7.0 last quarter -- and you want this number under 7 if you're a diabetic). And then the reason for the call. My kidney function tests came back not so good. Protein in the urine. High potassium. Uh oh. He's immediately withdrawn two of the meds that I'm on. Directed me to call my PCP and suggested I also call my surgeon and let them know that he's faxing over the lab results he received and wanted my PCP to fax to him the urinalysis results that the PCP should have that he didn't. So at about 9:15 this morning I left a message for my PCP telling him all this and asking him to call me -- and now 8 hours later no call. Argh. I called the surgeon's office and left a message a few minutes later and his RN called back within the hour to have me stop my current pre-op diet. She was great -- very reassuring. Said that since I've never had kidney problems before they should bounce back. And oh by the way if you're taking any diuretics you should ask your PCP if you should stop. So I just left him another message. I am not holding my breath waiting for him to call back...

Final frustration of the day: these ridiculous wounds that refuse to heal! Given how much pain they have me in, it really speaks to my the frustration level I have with my PCP -- that this is subordinate to that on the list. I've been seeing a wound specialist for the last week and a half and his treatment seems to be helping from a visual aspect (or so John tells me -- they're in my groin area so impossible for me to see well) but the pain aspect ain't so great. It hurts to sit forward -- the only chair I'm comfortable in is a recliner in a semi-reclined position. The last 3-4 weeks at work have been miserable. One day I got out of my car in tears -- I couldn't even handle the short drive to work. It seems crazy, doesn't it? If I weren't feeling it I wouldn't believe it either... It hurts to walk too so checklist item 9 above isn't making a lot of positive progress.


Successes of the day

OK, let's end with some good things!!

• They've finally fixed the wheel in "Vampire Wars" on Facebook! :) Who could ask for anything more?!
  
• I've started reading the fifth book in the Black Dagger Brotherhood series and it looks to be another good one (thanks Belinda for turning me on to these -- I hope Puerto Vallarta was grand!).
• John has been enjoying his day puttering around in the cellar rediscovering wine treasures long since forgotten.
  
• The upside of changing my diet is that I had real food for lunch (chicken vegie soup) instead of a protein shake for the first time in around a month.
  
• It's a beautiful day -- didn't get quite as hot as predicted. Great breeze right now -- gotta love living in a canyon.
  
• I started a blog! How wonderfully cathartic it has been to finally share some of this experience.
  

Thanks to my family and friends for your support on this journey. Farewell for now... /gailz