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It has been almost a year since my Duodenal Switch surgery - time for a quick update!

The good:
I have lost 143 lbs and now weigh 234!
I have not been at this weight since high school
I now fit in any chair, movie theatre and airplane seat. Fears of not fitting are gone!
I now naturally, comfortably and gracefully cross my legs - something I have *never* done!
I can now wear high heals no more painfully than flats. I wore some real skyscraper shoes the other day no problem at all!
I can eat a small quantity of whatever I want to
I determine what I will eat based on nutrition (protein content) and the effect it will have on my body (killer gas if too many carbs)
My cholestorol level is now excellent

Not as good:
Losing weight has opened my eyes to the degree of prejudice against obese individuals
This year I won multiple awards for my performance. Would this have happened if I was still super morbidly obsese? not sure.
I had multiple surgical complications (leak and a large hernia at top of my abdomen). At the end of the day I look like I am 6 months pregnant with an alien baby.
My arthritic pain (knees, back, neck) have not yet improved as a result of weight loss.
A recent blood pressure test revealed my bp is on the high side again. I have not eliminated BP meds.
I had open surgery and my long ropey and unattractive scar are bothersome to me. I should have insisted on laparoscopic surgery.

Overall
I am doing well and have bright prospects for the future. My weight loss seems to happen in spurts... I stay the same for 3 weeks then *poof* I have lost 10 lbs. I hope to still lose at least 50 lbs. Even this amount would be a miracle and a gift. In fact, it is a gift to say I am hoping to lose 50. I don't remember a time when I had less than 100 to lose!

The last few months have been a whirlwind at both home and work.

Exciting:
I have lost 103 lbs putting me at 274
BMI is down from 56 Super Morbidly Obese to 40 Morbidly Obese
I definitely notice the difference in my body comfort and mobility.
It is much easier to do things like put on my socks or even walk around the mall for a few hours.
Almost everything in my closet fits

Not as exciting:
I am not yet at a weight that is a WOW for me. In the past, I maintained a weight right around this range off and on. I know more loss is coming, but it is much slower than it was at first
I am starting to experience some of the usual "loser's bench" challenges (where did my boobs go? OMG I am losing SO much hair!)


I am in general good health with improved blood pressure. I do lack energy sometimes so I have kicked up my protein and vitamin regime over the last few weeks.

In other news, my husband had VSG surgery w/Dr. Cirangle in April and is firmly planted on the loser's bench with me. Yay! It's so great to have a pal do this with me. We are also a very cheap date! Between the two of us, we eat less than 1 person.

Til next time - Cheers!

I am scheduled to return to work next week. I am somewhat anxious about this. I am still not fully recovered after all. My stamina is much lower than I would like it to be. I went to the mall with my husband last week and walked only about one quarter of the way through the corridor and had to sit down. I decided to leave the mall after walking only about half of it because I was so tired! This is not like me. Normally I am a super trooper and my friends regardless of size or fitness level complain because I walk their feet off.

In addition, I am still so much more tired than normal. Even if I sleep through the night, I still fight off napping during the day and often don't win.

My job is very demanding - I normally manage over 150 people. I don't feel like I am ready to face it yet. Luckilly, I won't have a team to manage upon my immediate return but I am sure I will be expected to quickly get from place to place, give lectures, attend long meetings etc...

On Friday, exactly 30 days after my surgery, I had an abdominal CT Scan to check to see if my leak is healed.  Great news, the leak is gone! Dr Keshishian decided on the CT rather than another upper GI because he was also looking for infection since I had been re-admitted to the hospital for a high fever (up to 104) and extreme nausea. When admitted, he had my picc line removed as he expected it was the culprit.

After a short 1 day stay, I was able to control my fever with Tylenol and was pronounced leak free!

So far, this does not seem real to me. I am able to drink, eat for the first time in 22 days. Nothing I have tried yet has settled wrong. Also, with no drains and no ivs attached to me, I almost feel like a "normal" person who might be capable of recovering. I feel better and better each day.

I want to send a big thank you to those of you who were pulling for me and sending me your prayers and well-wishes. I feel like without your support, that leak might just still be there and I am SO happy it's not!

I am pleased to share that I have some good news.

I went to see Dr. Keshishian today and he took out my drains! YAY! I feel so free without those things hanging down from me. He swore it would not hurt and I am glad he told me that because I was very nervous about it and it helped me make it through it.
The first one felt just really "weird", like a giant worm wiggling through my insides. The second one hurt... bad! At first, he said he was going to leave the second one in but just adjust it, but I guess he changed his mind when he saw it was completely empty and I was yelling and complaining so much he just pulled it out.

My fever went away and he didn't think the rash on my legs was anything to worry about. He did tell me no more tape on my dressings and gave me some towels to wear over the gauze and under the binder (much more comfortable)!

He said I will need to have another upper GI study next Friday and we will decide if I can stop the TPN and eat at that time. The best part about this is that I will have the upper GI somewhere in Orange County rather than having to go all the way to Glendale again - YAY!

For the first time in a few days I feel a little hopeful and I smiled.

I have been home about a week now on 24 hour TPN IV therapy through a PIC line in my arm. Since I have been home, I have left the house only twice - once to go to the pharmacy and another time to go to the lab. Both were a huge ordeal.

I am feeling somewhat miserable - tired all of the time and restless from being in the house. I haven't felt up to doing much - even watching tv seems like a chore. Strangely, a cethartic time passing activity for me has been looking at online recipies. I guess since I can't drink or eat, at least I can dream of food.

I have also chatted with my sister a few times about going on vacation together once I am recovered. It is giving me something to look forward to.

Tonight, however, I developed a mysterious itchy rash on my legs and trunk. I took my temperature and it was 101. I called Dr. Keshishian and he asked me to come see him first thing tomorrow am. I hope this does not mean another hospitalization for me!

Published
Dr Keshishian is currently doing his surgeries primarily in Verdugo Hills Hospital in Glendale, CA. The following is a Brief review of the hospital itself based on my 10 days in the facility from the perspective of a morbidly obese person.

The good:
Throughout the hospital there are a multitude of large chairs comfortable for a person of larger stature
Lab: blood work chair is very very large and accommodating. At 370 lbs almost two of me would have fit in that chair. The phlebotomists are very good at finding veins on the first try - yay!
The admissions and pre-surgical process is very smooth. Patients are guided through like celebrities.
Plenty of extremely large hospital gowns are available without asking.

The not so good:
The radiology department does not have equipment to support most morbidly obese patients. I needed to have an upper GI study and it took convincing from Dr. K to have them give me the test. We had to do it standing instead of laying down as their table supports only 300 lbs. I also had to have a central (PICC) line installed. The table for that procedure supported only 250 lbs. At the time I weighed 344. Again, Dr. K had to talk to them into completing the procedure. They ended up putting a tripod type device under the machine to hold the table up. I was quite angry and frustrated about the hoops I had to jump through with radiology due to my size.
There was not an adequate scale in the entire hospital. The one they rolled into my room went up to 350 lbs and did not do a good job weighing me when I was close to this weight. I also weighed more than this pre-surgery.  There were digital scales on other floors but they only went up to 250 lbs.

Some good/some bad:
The nursing staff was inconsistent. Day and night shifts lasted 7 to 7. Some of the nurses were very compassionate, helpful and gave good patient care - France, Rosemary and Janice were among the best. Some of the CNAs were also very good. Angelica and Maria were always ready to do whatever they could for me and were very nice. A couple of the others ranged from not so hot to dangerously bad. One of the nurses in particular smelled like alcohol (was she drinking?) Worked only the night shift and was always sleeping on the job. She hurt me several times through being careless. For example, one day she decided to un-tape my iv line and even though I urged her to be careful because my iv was so fragile, she dropped it on the floor, causing it to infiltrate a few hours later. She also acted confused all of the time. Once I took a shower and asked her to help me with my dressing afterward. I waited forever for her to wake up enough to come help me and when she got there, she said after I take a shower she would help me and asked if I needed towels. This made no sense as she had been the one who covered my IV site before I showered and I had obviously wet hair and was wearing a towel. I made a complaint to the nursing supervisor. I think she may have a drinking problem. Another (tenured) nurse began panicking about my iv and all of the medications I was on. She said multiple times "I don't know what to do! I don't know what to do!" I advised her to call my Dr. immediately and talk to him about whatever she was unsure of.

Overall, I would give this hospital a B-.

**Update** I told my surgeon about my concerns and dissatisfaction with the hospital's readiness to help obese patients. He immediately brought in all of the higher-ups for me to talk to. I spoke to the head of nursing (somewhat dismissive), and the Bariatrics program coordinator (appropriately concerned). They re-assured me that my concerns will be addressed and I feel somewhat confident they will be.

I had my surgery on 2/24.
I woke up in more pain that I could ever imagine possible.
My Incision was also much longer than I anticipated - from bottom of my ribs to my belly button.
The Dr. said the surgery was very technically challenging but a complete success.
I was in the hospital 4 days then released to go home.
After just 4 days at home, I noticed after eating green jello that it appeared in one of my drains. I called Dr. Keshishian right away and he said - don't worry about it. The next day, I ate French Onion broth and I saw that in my drain. I called Dr. Keshshian and he said to come to his office the next morning - 3/4. I did so and he took one look at my drains and admitted me to the hospital saying I had a leak.
I have now been here in the hospital 7 days with no food and no water on IV fluids.
Yesterday I had an upper GI test and my leak is still there.
Today, I had a PICC line installed and liquid IV nutrition will be started.
I anticipate going home tomorrow... yay! I really can't wait.

My surgery is tomorrow - that's right! Tomorrow!
Today I drove up to Glendale from Anaheim. It took about 1.5 hrs due to heavy traffic. I left here around 8:30am and got there at 10am. I5 between here and there could really use some updating. I was in a traffic snarl nearly the whole way.

I first checked in at Dr. K's office. I filled out some paperwork and after a short wait Dr K came out to the waiting room. He said there was no one in the office that day so he sat down with me in the waiting room to chat. He was wearing a funny dinosaur bowtie that he said his son picked out for him. That made me smile. He chatted with me for a long time about personal interests until I steered him back to the topic of my surgery. He asked if I had any questions. I confirmed that my umbillical hernia will be repaired during surgery and my gall blader and appendix removed. He assured me the hernia will be taken care of. He always takes out the galblader and does the appendix usually if he has time.

I then paid for my $3000 program fee and $1000 co-pay using a combination of medical flexible spending and Care Credit. After that, the receptionist put together a packet of my test results and walked me over to admitting. It was a confusing maze of a walk so I am really glad she took me there. I might not have found it.

Next, I worked with admitting lady Cory who helped me fill out a bunch of basic paperwork. Then she called over to nurse Chet who was really nice and really flamboyant to see if he had time to chat with me - he did. Chet has his own office and he walks each surgery patient at the hospital through the neccessary paperwork and goes over expectations. He was very efficient and upbeat and we made it through that paperwork in a breeze.

Finally, I had to have more blood work. Apparently, my PCP's office did not fill out the lab order correctly so I did not get all of the tests I needed. I went down to the lab where they drew about 10 more tubes. They were also upbeat and made the experience comfortable. I noticed that the blood drawing chair was really huge. Two morbidly obese people could easily sit side by side on it. This was a nice change of pase since that chair is usually kind of scary.

I honestly felt like a celebrity in this hospital. Everyone was super nice, personable and welcoming. They did everything they could at every step to make it easier for me. For example, Chet walked me to the lab and gave me directions on how to get back out. I asked Chet if Verdugo Hills is a fancy hospital? He said it is like a botique hospital - smaller, more casual and more comfortable. That was reassuring the day before my big surgery. He also said the big hospital in town is Adventist.

After my blood draw, I left and drove back home. It only took 45 mins on the way back. I ate some miso soup for lunch and rested a bit before I drank my Sodium Citrate bowel prep. It is all becoming quite real since I won't be eating "normally" for quite some time now.

Tonight I think I will go in the hot tub, take a super good shower, double check my packing and maybe watch a movie on Netflix. The Sodium Citrate has not kicked in yet so I may change these plans!

It's all coming together and it's really happening!

Yesterday I had a mini-stress cow/breakdown w/tears. I was a bit overwhelmed with the prospects of everything I have to do before my surgery on Thursday. I needed to make sure all of the pre-op tests were done and sent to my surgeon. At work, I was struggling to get everything done and hand off to someone who is supporting my team in my absence. I still hadn't filed my state medical leave paperwork and realized I had jury duty next week that I certainly won't be reporting for. I was foiled on getting some of these done due to the President's Day holiday. To top it off, my husband had a sleep study scheduled for last night so I would be home alone. It was my last day eating. On the way home from work last night, one of my bottom front teeth spontaneously broke. Finally, I am in the middle of dealing with scheduling a maintenance appointment for a broken hot water heater.

It all came to a head about noon yesterday when I had a little freakout cryfest on the phone with my poor husband. I told him how terribly stressed I was. He agreed to deal with the hot water heater guy for me and even picked up my prescription from the pharmacy. I then made a list of the things left to do and when to do them. When I got home from work last night, we went out to dinner at our favorite restaurant which was nice.  Then I bid DH adeu for his appointment and spent some time on my own surfing the forums on what to expect in/after the hospital. Somehow, the reality is still not quite sinking in for me. I do know I will feel like *crap* right after the surgery.

Today, I successfully made all of the needed phonecalls, all of the paperwork made it to the right places *whew*! I got ready for work (really dolled myself up today to go out with a bang I guess) and thought I had better record this moment of semi-content for those who go after me who may also have a last minute freakout.

I can give this advice - If you are proactive and persistent, you too can make it happen on a short schedule. It will take multiple phone calls - to your PCP to ask them to fax paperwork, then to your surgeon to see if they got it, then to your PCP to ask them to fax it for you again. It will take creativity - stop by a previous dr's office to fill out records requests on your way to work, take photos of your insurance card and email if you don't have a fax. Finally, it will take passion. Energy and passion to research and learn about surgeons, expectations, set goals. I have always told myself I am a modern woman and I can do anything I set my mind to. For me, this will now include permanent weightloss - my final frontier.

Today is my last day at work and I am on a full liquid diet. I will grab a milkshake on the way to work, attend some meetings and bid my team adeu. I will fax some final forms for medical leave then wil be off for six weeks - mind boggling.

Tomorrow I will drive to Glendale by 10am for a pre-op surgeon appointment and pre-registration for the hospital. I will then rush home to drink my Sodium Citrate bowel prep and spend some time with my hubby and puppy.

Thursday, I am to be in Glendale by 7:30am and at 10am I have my surgery.