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.

March is Here

Tomorrow is March 1. I have my OHSU interview for CRNA school at 1pm. While I don't plan on enrolling there if I am offered admission, I am curious how their interview process might have changed, how the curriculum has changed, and what they hope to do to help their students graduate from their new program.

It is also just 12 days before surgery. I've submitted my request for medical leave to extend until 4/3. I might be able to come back earlier on light duty, but at least I'll have the time off to get well & be ready to work when I come back. Maybe I'll fit into my scrubs a little better by then, too.

I get my CPAP on Friday (oh boy), and have my preop appointment with the hospital on Monday. I still have to schedule my preop class...and then I'm ready to go.

Ready. To. Go.

How cute are these?

Let me say, I am a glass beadmaker. Someday I will be able to say "bead artist" but not just yet. :) I took 1 beginning bead class about 5 years ago, from Kim Miles in Taos, NM. I feel very fortunate to have been able to take that class. She had just moved from Seattle to Taos and I had just moved to NM for a travel assignment. I spent a whole day with her as her only student and I learned from the best!

She sells her beads on her website exclusively. She's started making these cute "Cupcake beads" that are so adorable! She says to use them as "evil eye" beads to ward off evil calories. I don't think I can make a cupcake yet, but I might try to make a donut, just as a reminder of my journey...

go to www.kimmiles.com and click on Taos Cupcake Diet for the cute pics...and order one while you are at it!

An Important Date

The magic number is...3/13.

The surgeon's office called me today to let me know that my Lap Band has been approved by Regence. I scheduled my surgery an hour later! They actually had 3/6 available, but that is NEXT WEEK which I thought might be just a little too soon. I do still need to arrange medical leave, take a class and do preop stuff, plus work some. And March 13 is one week before my scheduled time off anyway, so I thought it wouldn't be too tough to get that week off and then have my vacation week off. If it works out the way I think it will, I won't be going back to work until March 31.

I'm a little nervous. Mostly I am nervous that I won't lose weight doing this. What if I go through all of this surgery and money and time off and emotional energy and it doesn't work? Or what if I regain the weight? I've been seeking out some other band blogs (cute, the terms folks come up with...BPD/DS folks are "switched"....lap band people are "banded") to learn a lot more about what to expect. So far it's been pretty evenly split between big losers (in a good way) and little ones. A lot of the little losers blog a lot about making some poor choices and then not losing. But I'm sure some of them do the right things and still don't lose as much as they expect. As hubby says, I need to respect my own decision making. I chose this path because I didn't want to completely rearrange my guts and because I have less than 100 lbs to lose. I also didn't want to be tethered to taking 4 extra supplements a day for the rest of my life. And most importantly, I didn't want the 5 year complications that some RnY patients have who don't diligently take their supplements or eat healthfully: intestines that disintegrate, twist or otherwise kill them. I've seen these people with my own eyes, they were my patients, and the visual is unforgettable. So, in my mind, lap band is safer, plus it's slower...I have to stick to it and do the work to make it work. (Mind you, I know RnY people who follow all their guidelines diligently and are fabulously healthy...and if my insurance hadn't covered the Lap Band, like I originally thought would happen, I would have done the RnY myself. It's been done on so many patients, the safety is really quite high now and people do great with it. I am not disparaging gastric bypass at all...I'm just glad I have a less invasive choice.)

One thing I'm trying to make more of a reality for me now is the idea of "head hunger". It's something I've been aware of for a long time, but people really struggle with it after WLS. I'm sure I will too. Eating because I'm bored, lonely, tired, sad, happy...not because I'm (duh) HUNGRY! I'm trying to prepare for that mentally, come up with lists of things I can do instead of eating.

So, I now have just 2 weeks until surgery and there is much to do: arrange my medical leave, take my class and my preop appt, plus I'm working, of course. Most importantly, my food free-for-all is over, and I am starting NOW with making the changes I'll need to make post op. My goals:
1. Drink my water, 64 oz/day
2. Eat my protein first
3. Avoid sugar and high calorie stuff
4. Eat more veggies
5. Work out every day

I still have to plan my "executioner's dinner" as hubby likes to call it. What do I want that I won't be able to have for a long time? I'm not sure how totalitarian I am going to be about food rules when I am closer to my goal. Maybe, as some do, I will be able to live a life of moderation and maintain my goal weight. Maybe, as others do, I will have to be more restricted in my food choices forever. This all remains to be seen. But I've been eating whatever the hell I wanted for the last 2 months, and I'm kind of tired of it, to tell you the truth. So the "final meal" will be...I don't know what.

It's Real

I haven't gotten a surgery date yet. I called the surgeon's office the other day to ask about the status of my insurance approval. I was told by the surgeon and the front office staff (girls about 19 years old, I think) that the dictation would be complete the next day and mailed to the insurance board right away. Well, I spoke to a nice lady named Cami, who is in charge of the insurance approval process at the office. (What a horrible job THAT must be.) She sighed, and said something like, "I wish they wouldn't say that." She then explained that the dictation was made that day (2 weeks before), but it went to India or China to be transcribed (I can't remember which), and a week later or so it arrives back, has to be verified by the surgeon, and THEN goes to her desk and she can send it to the insurance company. In other words, instead of being nearly DONE with the approval process, it actually hadn't even really started yet! I was a little freaked. But then she added, "It's okay, though, Blue Cross is really quick about approving it, and you don't have to meet any conditions, so it should be very quick." So, after all that, I guess this coming week I should expect a call from their office to schedule surgery.

That is the same approximate time as my OHSU interview, by the way.

Anyway, in the meanwhile, to distract myself from what's not happening yet, I have continued to seek out great blogs from other WLS vets. Right now I am poring through a lovely blog called Attraversiamo, and came across a list (or the reference to a list) of things to bring to the hospital with you. At first (ever the RN) I thought, you don't need to bring ANYTHING, the hospital has all the crap you could need for 1 night. But then I thought of a couple things, wrote them down (in MS One Note, thanks honey) and realized: Whoa, it's real. I'm going to do those things, and actually have surgery, and actually lose weight. And in all likelihood, keep it off.

That's heavy, man.

Here's the list so far:
List of things to take to Good Sam
1. Uno
2. Magazines
3. 1 book
4. iPod
5. Earplugs
6. Robe
7. Picture of hubby

We're gonna make it after all! (with apologies to Mary Tyler Moore)

an unrelated note...

Local and national news has recently been focused on the successful rescue of 8 climbers on Mount Hood here in Oregon. The unofficial spokesman for those climbers is my friend Trevor Liston, who works with me in the Trauma ICU at OHSU. All of us at work are grateful that he and his fellow climbers are safe and sound, and that they planned well for the trip and knew what to do when they ran into trouble. Trevor apparently joined the group at the urging of a friend who wanted the benefit of his extensive experience mountaineering on Hood as this group practiced snow cave camping on the mountain. Little did they know that they would come to rely on everything they had trained and prepared for. And although I personally feel that pet dogs shouldn't be brought in the kind of conditions of a winter climb on a mountain like Hood, the presence of their dog Velvet helped save the lives of the 3 climbers who fell down a cliff (a fall of about 500 feet according to rescue team members). The top 2 things that were felt to have saved the lives of those 3 climbers who fell were their mountain locator devices and their dog Velvet. Add to that the quick thinking of all 8 of the climbers, and we have a successful rescue.

Trevor is a great nurse and a swell guy, full of fun and adventure, playful, smart, and caring. We're glad he is safe, and we're sure his expertise contributed to the many things that went right for this group. Way to go!

Still waiting by the phone

It has been about 10 days since my surgeon's dictation and request for insurance coverage has gone out. I am patiently (!!) waiting to hear that my coverage has been approved so I can schedule a surgery date and move on with life. I have that same feeling that I have always gotten when I am ready to do the work to lose weight: I live with a certain amount of underlying tension and impatience to stop doing what I am doing at that moment, eating unhealthy foods and being sedentary, until that tension boils over and I commit to my chosen plan of weight loss. I'm saying goodbye to old foods and old ways. I've found that as I seek various foods that I haven't had in a long time and may never have again (I probably will, but hopefully infrequently and in moderation) that certain foods are losing their charm for me. This is good. I think as soon as I have a date, I will end the "eat anything" phase and enter the changing-my-ways phase. Somehow, this is how I have to do it.

Meanwhile, I DID finally hear from the sleep lab, with their orders from Dr Poh Leng (I love that name) to fit me with (drop dead sexy) CPAP. I can't wait. I'm thinking about blinging it up with some of those stick-on rhinestones for cell phones, in a perfectly ironic way of course.

Today is a free day...I requested comp today and actually got it (comp on call, that is, but as of RIGHT NOW I am no longer on call and get to spend the rest of the day in bonus time bliss). I'm going to get dressed, spend some time at my torch, and then perhaps go to the gym.

I leave you with this, today's WLS blog du jour: Kate Ford's blog.