michelle57

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Naes Wls J. 22 years, 10 months ago

Hi there, CONGRATULATIONS on your approval, you are on your way now. Best wishes to you on your wls. may you have a speedy recovery and NO complications what so ever. Hang in there and remember everyday is a blessing. ~*~Huggybear hugs~*~

michelle57 22 years, 10 months ago

DOIN THE APPROVAL DANCE! Got a call from my surgeons office and in only 2 days was approved from John Deere Health!!! I am still in shock and can't believe this is actually happening. Dr office said approval could take up to a month! Guess they don't want to get anyones hopes up! Have to see a pulmonologist in a month and then surgery can be scheduled if everything looks ok. Anticipated surgery in mid-August. Have started on low carbohydrate eating and am feeling much better. Am starting to try out some of the protein drinks. Tried one yesterday that has 42gr protein, 0 carb, 0 sugar. It was grape flavored and really filling but you can't only drink so much of that stuff at a time cuz you get a funny aftertaste. My surgeon does not push the protein drinks. He says you can get adequate protein from regular food. I am surprised also that I do not need a bunch of preliminary testing. No psych eval, no endoscopy. Just EKG and regular labs plus the pulmonology.

Sharon Neva 22 years, 10 months ago

MICHELLE~~BEST WISHES ON YOUR WLS JOURNEY~~ May the world hug you today with its warmth, and love.....Pray it whispers a joyful tune in your heart.....And may the wind carry a voice that tells you there is a friend sitting in another corner of the world wishing you well!~~

michelle57 22 years, 10 months ago

WLS PROFILE 06/04/03 Michelle M. Hurlbut Dr. Robert Keating •CO-MORBITIES: Sleep apnea, hypothyroidism, family HX of diabetes(mother was legally blind and died from complications of diabetes/brother currently has it), family HX of heart disease(high blood pressure/father had mitral valve replacement), GERD(controlled since using c-pap), back and knee pain, urinary stress incontinence, suspect beginning stages of uterine prolapse, chronic fatigue, stasis(causing itching, cellulites and leg ulcers), weight is an aggravating agent for carpel tunnel. •MY HEALTH HISTORY: DOB: 05/57/03 I was born the 5th child with normal pregnancy. Birth weight 6#4oz. Prolonged labor(36 hrs). I remember my mother telling me I was baptized in the hospital because they didn’t think I was going to make it but she didn’t elaborate why I was in distress. 1962: At age 5 I underwent an appendicetomy. Resulted in severe staph infection which kept me hospitalized for 3 weeks. Remainder of childhood I had normal childhood diseases, good health, no broken bones or stitches. Menses occurred at age 11. 1974: (age 17) Married first husband 1975: (age 17) first child born with uneventful pregnancy and vaginal delivery 1977: (age 20) second child born with uneventful pregnancy\induced vaginal delivery. 1977: (age 20) Laproscopic tubal ligation. 1978: (age 21) Divorced. 1978: (age 21) Wisdom teeth removed. 1979: (age 22) Gall bladder removed. Conventional surgery. 1980: AA degree in Cosmetology. Self-employed as beautician for almost 7 yrs.. 1986: BA degree in Sociology. Went into field of disabilities where I stayed for 15 yrs.. 1990: (age 33) Married present husband. 1993: (age 36) Reanastomosis attempted on tied tubes at UIHC. Operation had to be discontinued because my heart almost stopped on the operating table 2x. After much testing, no specific reason could be found other than a sensitivity to having my vegus nerve manipulated. Spent 2 days in ICU. Receive morphine for incision pain which was ineffective. Cardiac testing and sleep study done. No cardiac implications found but I was diagnosed with a mild form of sleep apnea. Doctors recommended that if I ever had surgery again, I must receive atrapine prior to procedure. 1994: (age 36) Second attempt at reanastomosis was successful. Pain medication provided during surgery provided ample relief upon awakening. I believe Tordal(?) or Tordon(?) was used. The surgery did not result in pregnancy and about a year later after a dye test it was determined that my left tube was totally blocked and my right tube was only open far enough to give me a 20% chance of getting pregnant. 1995: (age 38) Non-malignant fatty tumor removed from left breast. Reacted to esophageal irritation of having breathing tube removed with chest pains that were controlled with nitroglycerine. Used for a few hours and then no further problems. 1995: (age 38) Proceeded with in-vitro for pregnancy. First cycle success. 1996: (age 39) Daugher was born after uremarkable pregnancy with the exception of developing gestational diabetes detected at 6 month prenatal visit. Controlled with diet. Fetus was relatively inactive. Labor was induced at 42 weeks resulting in c-section due to evidence of fetal distress, however baby tested at 9 apgar. She now has some developmental delays, mostly cognitive. 1997: Diagnosed with hypothyroidism. Began taking Synthroid(175 mg daily). 1998: Diagnosed with SAD. Began taking Prozac(20mg daily). 2001: Moved to Cedar Rapids area after living in Northeast Iowa all our lives. Moved due to job stagnation and lack of opportunities in rural area. From then on until present, we have moved twice, I had two management jobs that were extremely stressful prompting me to change careers, and we have had significant financial difficulties.As a result of all this stress, I was diagnosed with depression and changed my anti-depressant to Effexor(150mg daily). The Effexor has been much more beneficial than Prozac. Underwent new sleep study and started using c-pap (@ #10 pressure) successfully within the past year. •HOW DOES OBESITY IMPACT MY LIFE? Unable to exercise to therapeutic level due to foot pain, back pain, and fatigue. Public humiliation re enduring people staring, unable to fit into booths, bus seats etc.. Experienced weight discrimination in hiring despite a 15 yr career in the field of disabilities including documented history of multiple office and people skills. Inhibits sex life. Menses and toileting hygiene are difficult. Chafing, yeast infection, urinary tract infection, varicose veins, swelling. Unable to fully participate in activities with my children. Low energy and fatigue. Low self-esteem. Inhibits movement. •PSYCHOLOGICAL STATUS 2003: We now live in an apartment in Cedar Rapids. It is large, cheerful, and affordable. The stresses of owning and repairing a home are gone. I have time to do things for myself such as reading and crafts. We have realigned our financial goals and expectations which has relieved an enormous amount of stress. I now work part-time instead of full-time. Instead of management in the field of disabilities, I work in ER registration at St. Lukes. I have consistent hours, a great supervisor, and am around people all day. I have the opportunity to move into full-time if I want in any number of departments. My daughter has behavioral problems which cause my husband and I extreme stress but we are working with a child psychologist to hopefully find some answers. We also take advantage of respite through the Arc of East Central Iowa. Throughout all this my husband and I have maintained a solid and stable marriage. Neither of us are substance abusers or smokers and have weathered many emotional crisis together. My husband is totally supportive of my efforts to pursue WLS and in fact he has helped me research vitamins, food plans, and protein drinks. He also plans to lose weight with me. Other family members are also supportive. I am an active member of Obesity.com which has been invaluable in educating myself about the many facets of WLS as well as providing contact with people who have actually experienced it. I want to participate in life, not just sit on the sidelines because I am too heavy or tired to move. My 6 yr old doesn’t realize I am unable to play ball with her because I can’t move around without huffing and puffing- she just interprets it as “mommy doesn’t want to.” That has to change. I want to increase my odds against a family history of diabetes and heart disease. I don’t aspire to be a movie star or to wear a bikini; I just want to enhance my quality of life by learning how to eat to live, not live to eat. I am fully aware that WLS is not a “quick fix” but a tool to help me achieve these goals. •UNDERSTANDING OF SURGICAL METHODS I have spent many hours researching the various WLS methods, post-care issues, and risks and am totally comfortable with the changes it will require in my lifestyle. I initially chose the VGB method, however, the more I read, the more I felt I needed the restrictions of the RNY. The VGB is primarily a restrictive method which involves stapling the stomach into a small pouch. (about the size of a walnut) The RNY involves restriction by means of a pouch but adds a malabsorption factor by connecting the pouch directly to the small intestine. Distal or Proximal refers to the length of the intestine that is bypassed thereby regulating the degree of malabsorption . People undergoing this type of surgery must be very careful about the amount of food that is eaten, how well it is chewed, and must eliminate sugars to prevent dumping which (a physical reaction to eating sugar). To enable weight loss, the patient must ingest a high level of protein(at least 60 grams a day) and very few carbohydrates(less than 20 grams a day) to prevent the body from breaking down muscle instead of burning fat. This should be accomplished during several small meals per day. Coordinating solid food with fluid intake is also helpful in establishing maximum weight loss. Food and drink should not be taken together. The fluid can wash the food out of the pouch giving you a false sense of fullness. Staying hydrated and supplementing the loss of nutrients caused by the malabsorption factor, especially iron and calcium is most important in maintaining good health post-op. Although people are generally not able to eat the same amounts they did before, maintaining old eating habits will result in minimal loss. Greatest weight loss will be achieved during the first six months when appetite is significantly depressed. Exercise is very important to success. •FAMILY HEALTH HISTORY RELATIVE AGE @ DEATH CAUSE OF DEATH HEALTH ISSUES xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx •PREVIOUS DIETING ATTEMPTS DATE WEIGHT PLAN DURATION # LOST 1971 175 1000 cals 6 wks 28 1973 165 Stillman Diet 4 wks 12 1973 167 Banana-Milk 1 wk 3 1974 168 Ayds Candy 2 wks 6 1975 175 1000 cals 8 wks 28 1976 160 Grapefruit 1 wk 4 1976 165 TOPS 5 wks 7 1977 178 1000 cals 12 wks 31 1978 175 Scarsdale 3 wks 6 1978 178 Fasting 2 wks 10 1979 180 Atkins Diet 2 wks 5 1980 185 WW 12 wks 15 1982 225 1000 cals 4 wks 12 1984 220 WW 6 wks 15 1985 235 OA 10 wks 8 1985 235 Herbalife 6 wks 15 1986 235 1000 cals 2 wks 3 1988 230 R.Simmons 5 wks 14 1992 235 Diabetic(dr) 5 wks 5 1993 240 Cabbage Soup 1 wk 7 1996 265 Diabetic(dr) 12 wks 7 1998 260 Slim-Fast 3 wks 12 1999 295 Atkins(dr) 12 wks 38 2000 280 Rotation 4 wks 11 2001 285 Atkins(dr) 2 wks 5 2002 290 Mayo Diet 4 wks 7 2002 295 Vegetarian 3 wks 4 2003 325 Current weight XXXXXXX XXXXXXX As you can see, I have collectively lost over 300 pounds during my lifetime. This is only a sampling of the plans I have tried. The dates and losses are approximate. The chart also shows that despite my efforts, I have steadily gained. I discussed several of the plans with my doctor but since weight was generally not the primary reason for my visit, it is unclear if any plans were mentioned in documentation other than my weight. Exercise attempts have included: calisthetics, yoga, walking, weight training, exercise bike, and swimming. I generally have the most success with highly structured limited calorie plans, high protein/low carbohydrate plans, and using walking and\or weight training for exercise. I am a “binge” eater, not a grazer. My binges consist of starchy carbs rather than sweets. I can do with or without caffeine and pop. •GOALS and STEPS RNY choice of surgical method John Deere Health Plan criteria of acceptance: √18+ yrs old (46 yrs old) √ Greater than 40 BMI or 35 w health problems (54 BMI) √ Willingness to comply w lifetime plan ( (Yes) √ History of 5+ yrs of obesity (Yes) √ History of weight loss method failures for past 5 yrs (See previous page) Surgeon submits recommendations to ins co which are reviewed by a committee and approval given or denied.(To be done) Referral from Dr. Throndson sent to surgeon and ins co. 05/03 05/03 All releases signed and past medical records sent to Dr. Throndon’s office and weight related records faxed to Dr. Keating’s office. Attended Nutrition Meeting 05/03 pre-requisite for surgeon consult. 06/04/03 Initial consult with Dr. Robert Keating. 08/10/03 Eligible for paid leave at St. Lukes. Able to schedule surgery after that date. Post-op recovery: Since I have a sedentary job and have had previous surgeries, I hope to be back to work within 2-3 weeks. GOAL WEIGHT: 140# (requiring a loss of 185#) In the future I hope to have a tummy tuck. My belly is already asymmetrical from past surgical scars. The “apron” pulls on my back causing chafing and hygiene problems. Waistbands rub on old scars causing sores. Michelle M. Hurlbut QUESTIONS 1. Where would the incision be made? (5" above belly button) 2. Since my appendices scar causes sores due to waistband rubbing and causes my belly to bulge out on the left side, could that incision site be resected during WLS or would it be better to have redone during a TT? What are some medical justifications for a TT? What kind of success have you encountered with insurance paying? (Too traumatic to body to attempt both procedures at once. Refer to plastic surgeon post-op) 3. How will I take my medication post-op? (Effexor capsules, Synthroid small tablet, vitamins(liquid?) (refer to pharmacist.liquid meds ok) 4. In some cases I read that doctors recommend that antidepressants be discontinued 2 weeks prior to surgery because their effects may interfere. Is that true? (no- do not stop taking anti-depressants. will need them post-op because depression most evident up to 6 wks postop) 5. Do you recommend doing keto sticks post-op to check for keotosis? (not necessary) 6. Will I need a g-tube? Will there be drainage tubes post-op? (no, only if complications) 7. Pre-op liquids only? For how long? 12, 24, or 48 hrs? (NPO after midnight prior to surgery) 8. Do you recommend wearing a binder post-op? Will they give me one at the hospital or do I need to purchase one prior to surgery? (Talk to nurses. Wear if you feel it is more comfortable) 9. Will I need to donate blood preop? (no need) 10. Which is better- soy or whey protein? (refer to dietician) 11. What might some post-op complications be? (covered in appt) 12. What kind of post-op vitamin, supplements, protein powders/drinks are recommended? I need a detailed list of recommendations and costs. (get at least 50gms protein daily. do not need expensive drinks, protein supps, good multi-vitamin is adequate w iron and calcium. can get protein from natural foods) 13. With the stomach pouch, if I were to need intubation in an emergency is there a risk? Should I wear a medical bracelet saying I have had WLS? (not a problem. might want info on you just for doctor's info) 14. Do you give out medical cards stating I have had WLS to get child-sized portions at restaurants? (you can make up your own and I will endorse) 15. How can I tell the difference between a serious problem post-op and dumping? (serious problem keeps reoccuring) 16. How soon can I start exercising post-op and what would you recommend? Health club/machines beneficial? If so, include in post-op costs(see #12) (walking as soon as comfortable) 17. What kind of restrictions post-op (re lifting/activities) (no more than 10# for 6 wks, off work for minimum of 3 weeks) 18. Do you sew or staple the pouch? (staple) 19. Are chewable Tums adequate for supplemental calcium? (yes, 2 per day enough) 20. How about iron? Shots or have your heard about the B12 sublinguals? (either one if there is a need. a good multi should cover that) 21. Distal or proximal procedure? (long limb) 22. Can cost of any of the OTC protein powders or vitamins be absorbed by insurance? (no- is considered a food product) 23. How long will I have to be in the hospital? (1 day in ICU/3-4 days in inpatient) 24. Will I have to undergo a psych eval? Endoscopy? Another sleep study? Cardio work up? (possibly a cardio if EKG shows abnormalities but nothing else{I already have c-pap}) 25. What about my c-pap? I read that using the c-pap post-op can cause stomach pain due to the air being forced into the stomach. I need my c-pap or I develop massive morning headaches caused by oxygen-deprivation. Alternatives? (will have to play it by ear. may eventually be able to stop using cpap) 26. I read that some people can’t have the surgery because of how previous scars have wrapped around certain organs. What is the likelihood of that? Alternatives? (it happens but have not seen it yet) 27. I plan to go back to work within 2 weeks- is that a problem? I sometimes have to sit during an entire 8 hour shift. May need some recommendations in writing for activity every x# minutes. (need to move around periodically. my not be able to tolerate more than 4 hours at a time at first) 28. Will I have to wear tet-hose post-op? For how long? (no, only compression hose in hospital)

michelle57 22 years, 10 months ago

6-4-03 Had my surgical consult with Dr. Robert Keating today. I was very impressed with his knowledge and compassion. He was equally impressed with the "essay" as he called it that I had brought with me. Basically a summary of my past health and weight loss history, my motivations and expectations for surgery. I will post it for others to see- he said he wished all his patients would be that thorough. My PCP had not yet sent my records to Keatings office so I had to make a quick trip over there to remind them of that. Other than that it sounds like everything has been submitted that is needed at this point. In fact the nurse called me later in the afternoon to tell me that Dr. Keating had already dictated his letter to the ins co and she would be gathering all the info to send to them by the end of next week. He said it may take up to 6 weeks to get approval. So now it is a waiting game. But I feel confident because I called the ins co myself to find out their criteria of approval and I meet all their guidelines. Surgery could be as soon as mid August. I can't wait- I am so excited!

michelle57 22 years, 11 months ago

05/21/03 I was all set for my initial surgical consult tomorrow with Dr. Nielsen who only does the VGB but the more I read about that method the more I think the RNY may be a more permanent and effective method. So I called and switched my referral back to Dr. Keating who does RNY. Dawn from Duncombe, Ia: Even after my reading volumes on both surgeries, you explained the VGB in a way that made the most sense to me. The thought of going through the surgery and still being ravenously hungry terrifies me! Although the alternative(dumping/vomiting) is pretty gross, it might just be gross enough to keep me on the straight and narrow! My PCP has finally received all my medical records so they can start sifting through them to find the weight-related entries. I hope there is enough to qualify- I have done most of my weight loss efforts totally on my own and may have only mentioned it to my doc in passing. Probably not enough for him to mention it in my records. But the secretary says my insurance(John Deere Select) is one of the better insurances about approving it so I will hope for the best. My new appointment is June 4.

michelle57 22 years, 11 months ago

05/25/03 My husband and I are planning a trip to the Carribean next year hopefully to celebrate a slimmer me. Right now we have been researching all the islands and are finding that some have accommodations that are reasonable but the restaurants are VERY expensive. As we were trying to figure out the food budget end of vacation savings(THE most important facet of vacation!) IT HIT ME! I will probably be able to get by sharing my husbands meal and/or just having a kids portion so actually the food budget will be half of what we thought it would be! so we WILL be able to afford to eat at the nicer places once in a while. I wouldn't be able to eat a full portion anyway! The thought crossed my mind of all the exotic dishes and drinks I will miss out on but the idea of wearing a bathing suit again without hiding under a 4X t-shirt greatly overides that small sacrifice! Michelle

Julie D. 22 years, 11 months ago

I hope all goes well with your choice of surgery. My weight loss surgery has changed my life for the better and also my relationship with others, including my husband. God bless and if you every have any questions, please email me anytime!! Take care!

MommaAngel 22 years, 11 months ago

HI MICHELLE I just want you to know that I am praying that everything will go smooth as you journey to the losing side. LORD BLESS