I'm Home!

Well, it's all over, and it went very, very well. I arrived at Good Samaritan Hospital at 11:30 am, as I had been informed that surgery was at 1:30pm. They took me right back to the short stay unit (SSU) where I was told that it was pushed back to 3:30. The nurse went over Dr Hong's schedule and noted that he was doing about 5 GB's before my lap band case. I made a mental note of that--GB definitely has the potential of going longer than expected, and knowing as I do how surgery schedules change as the day progresses in the OR, I figured it could be later than that. Indeed, I was brought back to preop holding at 3:30. The SSU nurse had trouble getting my IV, but I think she might have just psyched herself out--she saw I was a fair skinned redhead, obviously bariatric, and didn't have the biggest veins ever (although not the smallest either), plus she knew I was a nurse. She tried only 1 time and then called the IV team, which was fine but I think she could have gotten it if she just hadn't worried so much. Oh well, the IV went fine and lasted the whole hospitalization.

Anyway, I stayed in preop holding for 2 hours. 3 people were brought back there after me, and 1 was left when I went to surgery. I met Dr Hong again, who basically just assured me that everything would be fine and looked to make sure that I was getting my antibiotic and my lovenox that was ordered preop. I didn't see my anesthesiologist until about 5:15. He was very friendly, and probably only 5 years or so older than me. Shortly before I was wheeled back, I jokingly told him that I would tell him a "secret": that I was going to Gonzaga for CRNA school. He took it well. :) Not long after that, I was wheeled to the OR by the surgical techs. Stopping in the hall where Dr Ford was talking to a colleague, he gave me some Versed (sedative) in my IV, and I was asleep before I got to the OR.

I'm not sure if I remember PACU or not--I don't think so. I do remember waking up in my room around 8pm. I felt okay. They set up my PCA, and I asked them to call my husband into my room. I was groggy, but not too painful, and very happy to see hubby. I could tell he was fighting the urge to get into my bed with me. :) He was so sweet. Thanks honey! My nurse showed me my incisions when she checked them. They were higher up on my abdomen than I expected. The port incision is just to the right of midline, and it looks to be just over 1" long. I have 2 just left of midline, one over the other, and I have one all the way right and one all the way left. The steristrips are a bit bloody, but covered with clear dressings, so I can shower before they come off.

I got incredibly itchy around 1am, and requested some benadryl (IV). It worked a bit, but I kept getting itchy. I don't know if it was all the stuff that was put on my skin, the sheets, or the dilaudid, but I stopped using the dilaudid around 3am and it seemed to get better. At that point I was only using it to help me sleep anyway. I really had surprisingly little pain, just a bit when I moved or tried laying on my sides. They had ordered Toradol for me as well, which is a strong anti-inflammatory drug, so that was helping a lot with the pain.

I stopped trying to sleep around 4am and just read my book for a while until I got sleepy and dozed off. I slept a little off & on the rest of the morning, but mostly have been awake since then. My hubby came back around 10am. I spent the morning waiting for my swallow study in radiology to make sure that the band was in place and was patent. It didn't happen until 1pm, most likely due to all the surgeries the day before. The band was fine and I started drinking water when I got back. They had me write down my 1 oz. of water (or fluid, including the lortab elixir, which was NASTY!) that I was supposed to drink every 15 minutes. Then I just had to wait for the dietician, who was also held up due to the large number of surgeries on Tuesday. I saw my surgeon around 2:30, who told me everything had gone smoothly and he had used the smaller band (the 4cc band) and even that was pretty loose on me. He said there wasn't a lot of fat around my stomach which had a lot to do with that. I guess when you are on the low end of high BMI, that happens.

I finally saw the nutritionist at 4pm, and she had my personalized Stage 1 diet, which said I should be taking 45-52gm of protein per day. She had some more specific requirements for the first 2 weeks: to use protein shakes, and to use 2% milk instead of my nonfat I have been drinking for years, since I won't really be getting much fat otherwise; and to use full strength fruit juice when I do drink it because I'll need the carbohydrates. She said to use milk based soups and blend them rather than using broth based soups, since those are mostly salt water when you remove the solids. She went over the stage 2 diet (purees) and made sure I knew to use some fat and some sugar so I'd get the needed fats and carbs while my caloric intake is so low. She went over vitamins a bit. Then I was free to go.

It was just great to get outside where it was sunny (although a bit nippy at 54 degrees). Being off the drugs and out of bed, I had loads of energy this evening. The only issue I'm having is after several hours of drinking my required water, and 2 oz. of protein drink which was OK'd for today, I feel FULL. I still am supposed to drink more but I'm just full and uncomfortable and don't want to test my vomiting limit just yet, 24 hours post op. Not sure what to do about that...? My instinct says to trust the fullness and hope it's gone soon.

There it is, post op day 1. Tomorrow I walk!

Live in such a way that you would not be ashamed to sell your parrot to the town gossip. --Will Rogers

T-minus 16 hours and counting...

Today I rolled out of bed around 9:30 am. What a luxury to be able to sleep in still at the age of 33! Today has been my day to wrap up any loose ends before surgery. My only appointment was my pre op class and my blood draw. I did not intend to take my pre op class just one day before surgery, but when I scheduled the surgery it was the last class left before 3/13. No class, no surgery! I also had to have my blood drawn. My surgeon requires a serum B-HCG (a blood pregnancy test) within 72 hours of surgery. Most surgeons I've read about online just do a urine B-HCG in preop. I don't know why he does it this way, but whatever.

My dear hubby came with me to the class. We were a little late, and the class was waiting for me and a couple of other stragglers who did not end up coming. (What happened there?) The class was pretty general, nothing really new based on my research but specific to my surgeon's preferences: how long on liquids, which liquids, details about purees (or "mushies" as the bandsters online call it), etc. I can't say it was really interesting, but it was good to go to. Because I was later than I had planned, I got my blood drawn afterward rather than before.

We were late because we went to a favorite local restaurant for a late breakfast: The Cup & Saucer on Hawthorne. I had 2 eggs, one large blueberry pancake, and some vegetarian sausage. I LOVE blueberry pancakes! I hope I can still eat them postop eventually, even if I can only manage a few bites. :)

Much to my surprise, at the class we went around the table introducing ourselves, saying how much activity/exercise we get, and when our surgery date is. Most were soon, but I was the only one there having surgery tomorrow. The NP who led the class asked, "Oh, so you're on liquids now, huh?" I said, uh, YEAH. No one told me to be on liquids the day before surgery! I mean, lots of surgeons put their patients on liquid diets for up to 2 weeks prior, but the only instruction my surgeon ever gave was NPO 12 hours before surgery. WTF?! Anyway, I'm not gonna stress too much about it. My last solid food was almost 24 hours before my surgery, which is at 1:30 pm tomorrow. I'm on liquids now!

Weight loss surgery is not the only thing going on in our household, just the only thing this blog is really going to address. We have some other things going on right now that are sort of beyond our reach at this point, but it's kind of calming to just focus on the surgery and recovery today. All of the things I will need for the hospital will fit into the nice little bag that my CPAP travels in. I'm not bringing much--most people bring too much stuff to the hospital. I'll go home in the clothes I arrive in. I'm just bringing clean undies, a real toothbrush, a book, a magazine, my earplugs, my CPAP and my iPod. I'll bring my pills just in case I need to or can take them, but I'm hoping I stay sleepy on a PCA and don't have to worry about sleeping medicine! (I had a breast reduction in 2001 and slept FINE on the dilaudid PCA, did not need my nortriptylline at all!) If I did take them, they would have to be crushed anyway, and I probably won't have my swallow study before 5pm anyway since my surgery is so late in the day, which will mean I stay NPO all night. On second thought, maybe I should leave them at home after all...

I made sure to have my advance directive signed by my good friend Lori before surgery too. I've gone over my wishes pretty extensively with my husband, family and friends, but having something in writing is reassuring for people when they have to make decisions for you. I don't think anything bad is going to happen in this surgery, but I am an ICU nurse and we've all seen people have simple procedures (simpler than laparascopic gastric banding) and not do well for one reason or another. I needed an advance directive anyway, so this was a good excuse to get it done.

I also went through my photos over the last 5 years that show my weight fluctuations. Hubby took some pictures of me the night before last, and as always they are incredibly revealing. I don't see myself as obese as my photos show. I need to do some final measurements tonight so I have some point of comparison for later when the new me is revealed.

What else can I say? Time to get cut! Wish me luck.

Look out for the fat chicks!

Ok, so I was thinking about the idea of telling friends and family about the surgery. I did tell my family after a lot of thought. I have told a couple of friends...ok, 2. I'm sure I will tell more people afterward but I've just been wanting to get it done first and then after it's obvious that I'm losing weight and I took time off from work, let people in on it if they ask. But there's a missed opportunity there, to tell other people that this option is out there and it works and makes your body healthier. And I was thinking of all the cool women I know who might include themselves at a "fat chick"...maybe not, maybe only in private, I dunno. But what would the world do if all the fat chicks suddenly weren't fat anymore? I mean, we've all developed the rest of ourselves so well, personality and intelligence, education...we're funny, smart and cool...and suddenly not fat anymore? LOOK OUT WORLD!

I was accepted to OHSU's CRNA program. Yay! This weekend my husband and I will look at some numbers and decide for sure which program I will enroll in. My gut tells me Gonzaga, even though it means moving to Spokane. It's nice to have a choice, anyway, and it would be strangely gratifying to turn OHSU down. :)

I continue to prepare for surgery, which is next Tuesday, just 3 days away. I have ordered more protein powder, organized the kitchen, and have just 1 more shift to work before my leave starts. I'm reading lots of band blogs. Some are full of gems and some are irritatingly whiney. Some people seem to "get it" and some don't, which shouldn't come as a surprise to anyone. The worst are the ones who go on and on about how they aren't losing as much weight as they want, but they are eating whatever they want, and still ARE losing weight. Grr. I just doubt that would be me.

I'm getting more used to Pappy (the CPAP). I don't find myself waking up during the night now. I do sometimes take it off in the morning and sleep without it for another hour or so. That's ok, according to the sleep lab people. I still get sleepy midday but it seems a little better. I also had another appointment for my eye, which my doctor says is 99% improved. Yay! No drops for now, but also no contacts for another week. And my vision in my left eye is still much worse. He'll recheck the refraction in 3 weeks. I've been wearing my glasses only for the last 5 weeks, which is frustrating since my left eye doesn't see as well as it did when I had them made just a few months ago.

I'm making lots of beads and still having fun with it. I don't particularly enjoy getting my oxygen tank refilled every 3 weeks, but it's okay. I may look into an oxygen concentrator that can handle my big torch at some point. One with the right capacity will cost me around $1000-1500. First I want a new kiln with a digital controller. The one I want is also about $1000. I think I will get one after my debt is all paid, which should be this summer. Right now I am sticking to one bead that I particularly like. I want to make an entire necklace of these beads, and the repetition should help me build my skills. I'm already much better at encasing from making the same bead 12 times. I bought lots of new Italian Moretti glass but I can't break myself away from the Bullseye, I love it so much! And their store is blocks from my house, I just cannot get over that. :)

Today I brought my violin to the violin shop down the street from me. I haven't played it in years but want to get it back in shape and start playing. So, I'm having the bridge slightly reshaped, getting new strings, having the bow rehaired, and then I'll take the case to a luggage shop to have it repaired. A few hundred dollars that will have my most prized possession ready to use again. I might buy a new carbon fiber bow to play with also, but that would be down the road a bit.

Things are changing, and it's a good thing.

"When you blame others, you give up your power to change."~Douglas Noel Adams

"The meaning I picked, the one that changed my life: Overcome fear, behold wonder." ~Æschylus

Some tools for the Journey

Here are some things I picked up recently to aid in my new way of life:

1. Tiny utensils at Crate and Barrel
2. Ginko leaf plates. I love all the stuff in this line, but we have enough dishes already and I love my Fiestaware, so I'll just get these 2 plates for daily use.
3. Stainless steel shakers for protein powders (see below)

I'll need to get (at some point) a digital kitchen scale.

It seems, as I read all these wls blogs out there, that everyone has a clever name for their blog and a cutsie nickname for their band. Should I have one? I can't stomach another weird "band" pun. But maybe a name for my band...dunno. I'll keep thinking. Suggestions are welcome!

The best protein powder

I read someone's WLS blog (was it Kate Ford's?) which recommended Unjury protein powder as the BEST tasting and dissolving powder out there. The flavors are good and the unflavored is really unflavored. So, I ordered some samples (and a full can of the Unflavored, that can definitely be useful) and I've tried the Vanilla and Chocolate samples. That stuff is really good. It's a little sweeter than the stuff I'm used to from Costco, so I might end up cutting it a little bit with the unflavored, but it's tasty and not chalky or powdery at all. Thanks for the tip! Check out www.unjury.com for more info.

Kate's blog is really great, a good read and useful info. I loved her suggestion of putting the powders into those shakers you can buy with the handles. You can shake the unflavored on veggies, into soup, anything that you can think of. The vanilla or chocolate can go on top of sugar free jello, coffee, drinks, desserts, yogurt, whatever. Extra protein! I love it. I went out and bought shakers for that purpose. (While I was at it, getting the shakers at BB&B, I got some small utensils for taking small bites, and I went to Crate & Barrel and found these really adorable small plates shaped like ginko leaves. Should make the small meals more fun--especially when made bento style. Check out www.cookingcute.com for suggestions!)

Getting too much protein can be a problem for lots of people eating the standard American diet, but as a vegetarian I don't get too much. I get enough for now, especially since I started eating fish again, but the powders can put too much stress on your kidneys if you take too much. You can only absorb about 30 gm at a time, so I'll be careful to stick to that (no more) with each meal.

Good ole Pappy

I've had the CPAP here at home since Friday. I can't tell if I'm sleeping any better with it on, but my hubby's having a hard time sleeping with it on. It's not very loud, but loud enough when the house is quiet and you're trying to sleep. He tried it on last night (cutie that he is) and I know I couldn't sleep if he had to wear it...except that I wear earplugs every night to sleep, so I probably wouldn't hear it. Not everyone can, or will, sleep with earplugs. I feel terribly for my man. For one thing, sleep is vital, and he already doesn't get enough sleep without the Pappy going all night. For another, it's something I really should use for my health, so he feels bad if I don't use it. I googled it hoping to come up with some useful suggestions, but all I got were these recommendations: sleep in separate rooms, make a soundproof box for the machine, have him wear earplugs, or get longer tubing and put it away from the bed. The last suggestion is the only viable one and I'll look into it, but it would have to go into the hallway, and the kitty likes to chew on the tubing. So I don't know how we will work this one out.

It takes me a little while to get to sleep with it too; despite the fact that it is pretty quiet and I wear earplugs, the fact that it is on my face and vibrating my facial bones means that I "hear" it in my head anyway. I can't sleep with ANY noise or light, so it makes it a little challenging, but once I get to sleep I sleep pretty soundly. In fact, I can't remember waking up during the night like I do without wearing it. So maybe that IS why I wake up so much during the night.

So, it's a love/hate relationship with the CPAP. I don't know how this little story will end, except that after I lose about 50 lbs I hopefully won't need the darn thing anymore.

Surgery is one week away!

For those interested, a brief recap

Here is the process I have gone through to be approved for lap band surgery:

1. December 2006: Attended an informational seminar by the Legacy Obesity Institute (Portland OR) which is a Center of Excellence for bariatric surgery. My insurance specifies that it will only cover surgery from a Center of Excellence. At the end of the seminar, which was about 45 minutes, you may receive a binder which includes an application to have surgery. You cannot get an application without going to (and listening to) a seminar.
2. Completed and submitted an application to have surgery, which included some basic information about myself and my nutrition and exercise history. In addition, I submitted a typed history highlighting my particular reasons for wanting surgery.
3. Early January 2007: Appointment with sleep medicine doctor, Poh Leng MD. He got my sleep history and recommended a sleep study, as he felt it was likely I had some sleep apnea.
4. Mid-Janurary 2007: Scheduled and attended two consultation appointments at the Legacy Obesity Institute (LOI). These two visits entailed taking a psychological assessment (the Minnesota Multiphasic Personality Inventory, 264 questions) and a nutrition assessment, meeting with the nurse practitioner, dietician, psychiatrist and physical therapist, having a 12 lead EKG and a body composition analysis, and having a lot of blood drawn. The MMPI assesses whether or not you have some hidden psychiatric issues that might interfere with long term complience with instructions or ability to make decisions. The psychiatrist reviewed the MMPI with me and told me I was not psychotic. (yay!) The nurse practitioner did a physical assessment to get a sense of my general health and extent of comorbidities and obesity related health problelms that I might have. The nutritionist talked at length with me about what to expect nutrition-wise after surgery and what to do to prepare for surgery. The physical therapist discussed exercise post op and assessed my flexibility and ability to perform basic physical tasks. She declared me one of her fittest and most flexible patients. (Not that there is much competition for that title, I'm sure.)
5. Early February: My paperwork was forwarded to the surgeon's office (Oregon Weight Loss Surgery, or OWLS). About 2 weeks later they called me to make an appointment to view an informational video about the band and see the surgeon. Although I wasn't sure yet if my insurance would cover the band, we tentatively planned for it pending insurance approval. I thought they would only cover gastric bypass, so up until this point was planning on having that surgery.
6. I also had my first sleep study around this time. Although I barely slept and kept waking up every hour all night, it did show some mild sleep apnea according to Dr Leng. There is lots of info available online about how sleep studies go, so I won't go into much detail there.
7. It took a little over 2 weeks to have my surgeon's dictation sent off to my insurance to get official approval. I was approved just last week and was able to schedule surgery almost immediately.

I'm lucky that this has all happened on a quick timeline. I thought about doing this for a long time, but once I decided I didn't want to wait around too much. I do think that the entire process is important to know where you stand from a complete physical standpoint, and to be sure that nothing is missed.

I also think the Centers of Excellence program is the key to the recent dramatic improvement in patient outcomes with bariatric surgery. After the horror stories from the late 90s and early 2000 until about 2005, something was needed to stop surgeons who made easy money off of desperate obese people willing to do anything. The requirements to become a Center of Excellence are strict and are almost entirely outcome based, that is, a surgeon or program has to be able to document and prove a long track record of short and long term positive outcomes to become a Center of Excellence. Usually these are hospital based practices that can do this, but some are free standing surgery centers.

Interestingly, everyone I met at the LOI and OWLS asked why I wasn't having surgery at OHSU, my employer, which is the other Center of Excellence in Portland. Well, I work in one of the ICUs there (the Trauma ICU). Every night the surgery schedule is printed and gone over so each ICU knows what cases to expect the next day post op. I would be on that schedule...so even if I managed to get through the OR and PACU and short stay unit without meeting anyone I knew, the chances are that everyone would still know what I was up to, and it's just not everyone's business. I had a hard time telling my FAMILY...I'm not going to announce my surgery to all of my coworkers and friends. The OHSU obesity clinic assured me that they would give me an alias and protect my privacy, but word spreads in hospitals, and I just felt better knowing my privacy was a little more secure in a hospital where I knew no one. Plus, OHSU doesn't do many Lap Bands, so it's better to be at a practice where half of their cases are bands.

BandAid: A Weight Loss Journal: Test Kitchen Series: Oatmeal-Yogurt Crunch

BandAid: A Weight Loss Journal: Test Kitchen Series: Oatmeal-Yogurt Crunch

Cranky, crabby, sad...

At the beginning of this year I could forsee all of the changes 2007 would bring: interviews for anesthesia school, weight loss surgery and subsequent weight loss, possibly moving, quitting my job at the hospital, moving on. Exciting stuff, all. Here it is, early March, and things are moving right along: I've had 2 interviews for anesthesia school, am accepted to at least 1 program, and am mere days away from Lap Band surgery.

Why am I such a cranky bitch?

OK, that was at least a little bit rhetorical. Obviously lots of things are changing in my life. But still, I feel something weighing on me. I had a bad GERD attack last night requiring me to go to the couch and sleep with my head propped up. All day long it's been slowly resolving but still feels sour and yucky. I got back to March Wellness (my gym) a few days ago and did great but couldn't get the lead out and go back today, somehow. Just wanted to sleep and do nothing. While I was reading and napping off & on, I had a bowl of vanilla ice cream with caramel sauce on it, and it occurred to me: Maybe the sugar contributes to the problem?

Anyway, whether it does or not, I've been crabby and not very fun to be with today. I have had ongoing problems with my left eye ever since my Gonzaga interview a month ago. I had another appt with the optho and I have ANOTHER infection requiring a whole new set of drops; I think I have 7 or 8 different kinds of eye drops around the house now. That kind of sucks. And I got my CPAP machine today, about which I have mixed feelings. Perhaps I will sleep better with it. Hopefully I won't feel so tired when I use it at night. But man, that's some good birth control, strapping that puppy on. I made some jokes about trying to add some sex appeal to it: some ribbons or black lace or rhinestones on my mask. It's a little depressing, anyway.

Emotions: fear, apprehension, doubt that this Lap Band will work and that I won't be hungry all the time. Excitement that it might work. Anger that I've gotten to this point and that I need this kind of intervention. Some concern that I might have future health problems or complications with the band (like the band eroding or slipping). Loneliness that I don't know anyone else going through this exact thing (one friend had GB, but no one with the Band that I know of.)

Challenges in the future: Getting enough water, chewing enough, dealing with "head hunger." Those are the things I anticipate being the biggest problems, but perhaps it will be something else entirely that proves to be the biggest challenge.