Kaitlin N.

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*I posted this on the LW Board, but thought I'd copy/paste it here so I have it as a reminder.*

There’s an old saying that says something along the lines of, “If you let the camel put his nose in your tent, pretty soon he’s sleeping in your bed.” Well, the camel came and joined me in London, and once again I’ve had to kick his sorry butt out onto the street. But before that, I made the critical mistake of letting him inch his way into my room yet again.

I’m three months out from my RNY surgery today, and I had settled into an easy routine at home. I live alone in a one-bedroom apartment, and everything in my kitchen is “safe.” I even do fine eating out. I plan before I go and split with someone or take home leftovers. However, two weeks ago I flew across the Atlantic. I left behind my kitchen and the coping mechanisms I’d developed back home. I landed in a new city with new grocery stores and restaurants and an entirely different method of noting nutritional data. (They make you do math. Gah!) I was also thrown in with a bunch of other college students, none of whom know about my surgery.

When I got here, I was pleased to notice that I don’t stick out like I used to. I’m not the biggest person here; I’m not the biggest girl here. Sure, I’m still bigger than a lot of my friends, but I’m now overweight, not morbidly obese. It gave me a false sense of confidence, a feeling that I was like everyone else. And, despite rationally knowing differently, I had to learn that lesson again the hard way.

I did well my first couple of days, and then the camel showed up. At first it was just a little thing here or there. A bite of chocolate croissant at breakfast, a ¼ cup of ice cream after an otherwise healthy dinner. But, as most of you know, the camel isn’t happy with just his nose in the tent, and my decisions devolved from there.

Luckily, it didn’t take me that long for me to notice my slip and to get things back on track. All told, I spent a week making less-than-stellar decisions which made me feel physically awful. In the two days that I’ve been back on track, I feel so much better. I know this is a continual learning process and the chances are that I will screw up again in the future. For me, it’s all about getting in a routine that works and planning ahead of time. When left to my own devices, I am too impulsive; I go for instant gratification.

For now, it’s back to basics. I skip the cafeteria in the morning and grab a latte instead. I cannot trust myself to walk past the pastries, and the only protein option in the mornings (eggs to order), are cooked in a half inch of oil. Not worth it for me! For lunch, I know I’ll be more successful if I eat a container of Greek yogurt with fruit in my room than if I go out to lunch. And at dinner, I just have to say no to the ice cream cooler. It’s just not worth it. Even though I know that, I have to tell myself every night and consciously make the decision before I walk into the cafeteria. My rational brain just turns off when faced with food. Also, if I try to eat just three meals a day like my friends, I will overeat at those three meals. I will push myself past the point of satiety because I feel pressured to “make it worth it,” even though I know better. Apparently, it’s all a mind game with me, and it always will be. At least I’m aware of this now and know what to look for in the future. It is quite the learning curve.

There was a post on the RNY board talking about non-scale victories (NSVs), and I took the opportunity to think about some of the changes that have already happened to me. I thought I'd copy my response so I'm reminded of how far this journey is taking me.

1. No more sleep apnea. I had mild sleep apnea (UARS) prior to surgery. Within a week post-op I could tell that I was already sleeping better.

2. I walked 4.28 miles at the nature preserve yesterday. It was 80 degrees, and I was hot by the end, but I could have walked more!

3. I haven't had to use my asthma inhaler in almost two months. I had to use it once in the week following surgery, but that's been it!

4. I'm wearing clothes that didn't come from Lane Bryant or another plus-size-only store. I have on an XL Gap t-shirt and size 18 jeans from the regular section of Old Navy.

5. Related to #4 - I can go shopping with friends now and not have to buy just accessories. I didn't realize how amazing that would be.

6. I have so much more energy. I used to sleep 10-12 hours a night and still be exhausted. Within the past two weeks, I've started waking up before my alarm goes off. I used to really want a nap in the afternoon. No need anymore.

7. I went off my cholesterol medicine before surgery because of elevated LFT's. It's not a problem because it turns out I don't need it anymore. I had labs drawn a month post-op and my total cholesterol was 161 (want <200) and my risk ratio was 2.89 (want <3.22)

8. It's so much easier to move my body these days. I didn't realize what a difference 40-50 pounds could make.

9. I jogged the other day. It wasn't far and it wasn't pretty, but I did it. I'll do it again, too, once I get a better sports bra. (Anyone know where to find good, supportive sports bras for larger cup sizes? I'm a 38H now.)

10. I feel like I need a number ten because it's strange to just leave off at 9. Let's see... oh! Here we go! It's a whole lot easier to shave my legs now, which is nice because I'm exercising a lot and I don't want to be stuck wearing pants when I'm sweating. It's hot in Texas!

It has officially been one month since my RNY. I am down 24 pounds since surgery (38 total). Things have been going really well since getting out of the hospital, though the first few days at home were rough. I went through a couple of days of “What the hell have I done to myself?” Even though I knew that stage was coming and would pass, it hit me hard. Luckily as I got to progress from clear liquids to full liquids, my mood drastically improved.

My surgery was Tuesday, March 17, during my spring break. I am a college student, and I went back to classes the following Monday. While it wasn’t fun and I certainly wouldn’t recommend coming home from the hospital on Saturday and going back to “the real world” on Monday, it was doable. The first week all I did was attend classes, and that was plenty! I had my first post-op appointment with my surgeon on March 25 where he removed the drain, thank goodness. While it was definitely good to have since I did end up having some internal bleeding in the hospital, I was so ready to get rid of it. No longer having anything attached to my body instantly made me feel better. So did advancing to full liquids the next day.

I have been very lucky with food, and so far (knock on wood), nothing has disagreed with my new stomach. My surgeon’s plan calls for one week of clear liquids (which I started two days after my surgery), one week of full liquids, and one week of chopped/diced food before advancing to a “normal” diet. I am grateful that I did not have to spend a month on liquids as I’ve seen some people on OH have to do. I eat my small 2-4 oz. portions of protein-dense foods and drink one protein shake a day. Since starting last Thursday, I’ve been averaging 70+ grams of protein a day, which is exactly where the surgeon and nutritionist want me. I do sometimes have to remind myself that being able to take in food is a good thing, especially when I see some people eating so very little at the same stage. Then I feel pretty ridiculous for worrying about being able to eat 600-700 calories in a day! According to my paperwork I’m supposed to gradually work up to 1200 calories a day during the losing phase. I don’t see that happening all that soon! I already feel like I’m eating constantly.

It’s exciting because I can definitely already see some changes in my body. The only people who’ve noticed so far are those who know I had surgery, but I’m guessing that will change soon. I also realized today that at almost 40 pounds lost, I’ve lost about one-third of my excess weight! Somehow thinking that I’m a third of the way there is a lot less daunting than thinking that I still have 80 pounds to lose. I’m just going to keep following the rules and let my body do what it needs to do.

Here are some comparison shots:
Day Before Surgery, One Month Post-Op


Day Before Surgery, One Month Post-Op




 

Well, my surgery took place with Dr. Cribbins last Tuesday, March 17. I got to the hospital at the crack of dawn (6:00 AM) to register, etc., and was wheeled back for surgery at 7:30. The surgery went smoothly, and I was in my room with my parents around noon. I was hooked up to all sorts of machines at this point. I had a Foley catheter, an NG tube, a JP drain, two On-Q pumps (which supposedly help with post-op pain by dripping small amounts of anesthesia into the incision sites), oxygen, an IV, blood pressure cuff, embolism stockings, and massaging booties to prevent PEs. I was quite a site. And still pretty goggy until the anesthesia wore off. I was on fluids and morphine at this point and wasn't feeling too horrible. Ah, narcotics.

That first night in the hospital was pretty miserable. I wasn't comfortable and I couldn't sleep. I was horribly itchy and anxious. I was given Benadryl and Valium, which helped for a while, but I was up again a few hours later. Thank goodness that my mom was there with me and we had a wonderful night nurse, Ruby. Ruby worked up a plan and called my surgeon in the middle of the night. We switched my pain meds from morphine to Dilloted, and I was able to get a little sleep in.

Things started off well enough on Wednesday. My heart rate was high (~140) and I was starting to run a little bit of temperature (it would roam from 98 to 100), so they were worried about the possibility of infection. I got the Foley taken out, which was wonderful, and managed to get Dr. Cribbins to let me go for a CT to check for leaks so I could possibly start on some ice chips. The thirst was absolutely killing me at this point, and the little swabs they gave me were not cutting it. The CT showed that I had two large hematomas--one the size of a softball and one the size of a baseball. Apparently, I had been responding really well to the Lovanox (sp?) that they gave me to prevent blood clots. My blood had thinned and there was some seepage from the staple line that was collecting into the hematomas. The suspection was that this was also causing my high heart rate, which got as high as 149, and the slight temperature. So, they stopped the Lovanox, and I began to get regular visits from the lab techs, who always chose such convenient times to visit. I mean, who doesn't want to get blood taken at 3:30 in the morning every day?

In the mean time, they removed my NG tube since no leaks had shown up on the CT, but I was still kept NPO because of the worry of internal bleeding and possibly having to go back in and look around. We waited for a few hours and my labs continued to drop. I got up to go to the bathroom, and it was the scariest sight. I had lost all the pigment in my face. No pink anywhere, not even on my lips. I truly looked like a ghost. That night they started blood transfusions. I received a total of five--two Wednesday night, one Thursday morning, one Thursday evening, and one Friday morning. I immediately began feeling better on these, though the labs took a little longer to respond. Apparently it's harder to come back from too much Lovanox than from too much coumadin.

Thursday was a lesson in remembering to request my pain meds every four hours. Otherwise the pain came back quickly and took longer to get back under control. Not so fun. I didn't do much walking on Thursday simply because I still felt awful and they were still pushing so much blood and fluids and antibiotics into me. But I was finally allowed some ice chips, so things were looking up.

By Friday my heart rate was back down and my labs were showing steady improvement. I was cleared for clear liquids and spent a lot of time walking the floor. I was feeling so much better. Dr. Cribbins removed the On-Q pumps and respiratory took me off oxygen, so I was finally only hooked up to an IV and the clot-buster booties. It was looking like I'd get to go home Saturday or Sunday.

During the night on Friday, my IV infiltrated. Not a fun experience. I got a new one in my right hand, and my poor left hand was all swollen and puffy. Then the lab tech decides that the only place she'll be able to get blood is from my left wrist (never mind that they had had no trouble drawing blood from my arms until this point or after). I think it was the most painful blood draw of my life.

Thankfully I was discharged on Saturday and was home around noon. I took it easy yesterday, but I have definitely hit the "What the Hell Have I Done to Myself?" stage. I knew it was coming, but that didn't make it any less unnerving when it happened. I'm guessing being off my Paxil for the four nights I was in the hospital didn't exactly help. Hopefully being back on the meds will let my anxiety level stabilize a little. Otherwise I'm feeling pretty good. Sipping away on liquids. I'll go back to see Dr. Cribbins on Wednesday to get my JP drain removed and to weigh in for the first time since surgery. For this first week of clear liquids I am simply focusing on getting in as much fluid as possible. The protein's just going to have to wait until I go to full liquids since I cannot tolerate the Isopure or Nectar. Luckily I have a few protein powders that I do like and several more samples to try so I'll be able to reach my protein goals starting next Thursday.

On the protein note, the nutritionist at the hospital concurred with me that at almost 6'0", 60 grams of protein is probably a pretty low goal, even though it's the top of their recommended range for women. She suggested aiming for 70 grams, though I think that will be the low end of my personal goal range of 70-90 grams/day.

Well, the hospital stay was quite an adventure. I am happy to be home, and I'm feeling pretty good today. I know I'll feel better and more confidant about my decision as the days go on, so I'm just trying to stay at peace with that.

Hooray! I was approved last week! It wasn't a sure thing as my BMI is under 40 and technically all comorbidities are controlled with medication. The wording of the policy requires that comorbidities be uncontrolled. Still, barely a week after submitting all my materials, I got a call from Dr. Cribbins' bariatric coordinator saying I was approved!

We went ahead and scheduled the surgery for over spring break. Hopefully I won't have to miss more than a couple days of classes after break. But, I have a date! March 17th!

Today I spoke with Cigna to see what needs to happen so I can be approved for the surgery. The representative was not very helpful. My primary care physician (Dr. Zavodny) has to call Intercorp, a company that does work for Cigna, to get the process started. Jennifer, Dr. Z’s medical assistant, is going to call them for me tomorrow. Chances are that I will have to do six months of medically supervised weight loss. We’re not sure if I’ve done this in the past because we don’t know how long the nutrition program at Health South was. Yet another thing to find out!

I called Dr. Provost’s office today to see about scheduling a consultation. Because of my current insurance (Cigna), I will have to attend an information session before I can meet with the medical staff. Luckily the Bariatrics Department at UT Southwestern holds a session twice each month. I’ll be going to one next Thursday.

The person I spoke with on the phone warned me that to get insurance to cover the surgery, I might have to go through six months of “medically-monitored weight loss,” whatever that entails! My mom (who’s also a Physician Assistant) said that she thinks I’ve already done that with some of the things that I’ve tried before, but we’ll have to see. But, that will work with the two times I can potentially have the surgery—either this summer or over winter break. Six months would put me in November, and then I could hopefully get a surgery date in December. Who knows! Well, hopefully I’ll know more after next Thursday.