Baby(less) steps...

Went to my OB/GYN to have an IUD placed today. I had tried the copper one, Paragard, last year. I didn't think it was possible for my periods to get worse due to my PCOS and endometriosis, but ta dah- they did! They're actually had me in the emergency room a few times for 7+ hours while they tried to get my pain and hemorrhaging under control. My OB/GYN swears that Mirena and the progesterone in it will make them better. I'm focusing on getting things in order before surgery. Birth control is one of them.

According to Dr. Northup, women with PCOS become fertile myrtles after surgery due to the dramatic weight loss. It's not advisable to become pregnant within the first year after surgery. For me, someone who has no desire to have children, it's not advisable AT ALL. So, fingers crossed that the Mirena works out.

Part of my insurance approving me for the surgery is that my doctors advise/clear me for it. Because PCOS is considered a comorbidity, I asked my OB/GYN is she would be willing to write one recommending that I have the surgery. She did...ON THE SPOT (Dr. Magner is awesome if anyone in the Cincinnati area needs an OB/GYN). So that's one letter. I have an appointment with my primary care doc tomorrow (which I will now refer to as my PCP- it's healthcare lingo). My blood pressure the last few times I've had it taken was in the 140's/90's. Today at the OB/GYN- 158/110(!!!) So I'm meeting my PCP tomorrow to talk to her about my blood pressure and see if she'll write my letter of recommendation for the surgery. Wednesday, after a training class for work, I'm gonna swing by the weight loss doc I went to for copies of my charts.

At this rate, I'm gonna have every single thing they need from me before my appointment next month.

Also, I've been researching other issues that arise after surgery; depression and divorce.

There's a phenomenon known as "Bariatric divorce". Divorce rates are already high; for those who have had bariatric surgery, however, they're even higher (like 50% higher).
As one of many articles on the subject points out, it's likely that the marriages that crumble after surgery were ones that had a weak foundation to begin with- http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/relationship-challenges-before-and-after-weight-loss-surgery.
David and I have been together since time began (ok, fifteen years...feels like forever when you're thirty).

Us in our 30's....seriously

Are we perfect? No. Do we have our issues? Yes- we're normal like that. We're also best friends and have been through a lot. I don't know that I can definitely say no hard times will come from me losing all of this weight. That's why, just to be proactive, I'm gonna start seeing a counselor. One that can see both of us. Another possible side effect of bariatric surgery is, oddly enough, depression! I know- it's hard to imagine being depressed when you're shedding all of this weight that has been physically AND mentally weighing me down all of my life. According to the research I've done though, sometimes the changes the weight loss brings in your life are so sudden, people don't know how to cope. I figure our insurance pays for it so, again, be proactive and stay ahead of the game. 

Update- I just came back from seeing my PCP (I love Dr. Drake, you have no idea). We talked it out and decided that, for now, a low-dose blood pressure medication would be beneficial- my blood pressure was still a bit high today. Plus, another comorbidity doesn't hurt in my favor to have weight-loss surgery. I asked her to write a letter clearing me for surgery and recommending it and she did- right on the spot. She had time while I was blubbering to her about how embarrassed I am about gaining weight back and feeling embarrassed and having a hard time even leaving the house. I never cry- I'm not a crier! I just think I've been holding this in for a while (plus, I did have the Mirena put in yesterday- maybe it's from the progesterone in it? Yeah, I'll blame it on that). 

Now I have two letters of approval from my two docs that I see regularly, I have a couple of comorbidities, a more than qualifying BMI, and the tenacity to see it through:
is it February 26th yet?!?






 

First contact...finally!

After several months of trying to get something started, it's happening!

Happy dance!

Mercy called with my insurance requirements for surgery: 3 months of a nutritionist supervised diet and a letter of clearance from my family doctor. That's it. 

Mercy, on the other hand, does a ton of testing before you can have the surgery- a sleep study to test for sleep apnea, EKG's for any heart problems you may not be aware of, labs to check my thyroid, iron levels, vitamin levels, and cholesterol levels, a psychological evaluation (do I tell them about the voices?), and possibly a GI evaluation to check for ulcers or a hernia. 

My first appointment is February 26th (it would have been March 17th if I'd waited until the doc was at Anderson, where I'd much rather go). Hey, to get in sooner, I'll drive all the way to Fairfield. 

When I count it up, if there are no complications with Cigna, that means I'll hopefully be getting surgery in May or early June!

Is it February 26th yet?

Waiting and learning

I research everything to death....TO DEATH.
When I do my grocery shopping, I comb over every ad for every local store and cross-reference the sale items we would actually use for any coupons available. 

When my car was totaled, I spent hours researching cars, auction sites, car listings, repair websites...anything I could get my hands on.

When I've made a decision about something important, I didn't make it lightly; I've spent hours weighing all of the facts, opinions, and evidence. 
Since making my decision to pursue gastric sleeve surgery, I've kicked my research into high-gear. From medical websites to chat rooms to blogs to groups on Facebook, the resources are endless.

Don't know what the gastric sleeve surgery is? Allow me to school you:

• In this procedure, a thin vertical sleeve of stomach is created using a stapling device. The remaining 2/3 of the stomach is removed. This limits the amount of food that can be eaten at one time.
• Most popular surgical weight loss procedure in the nation.
• Surgery lasts one hour and requires a hospital stay of one day.
• Dietitians will provide on-going education on dietary regimen before and after surgery.
• Typically results in a significant amount of weight loss.
• Dramatic impact on weight-related health problems.
• Excellent long-term results.
• Allows for normal digestion/absorption.

What mostly drew me to the sleeve instead of the full by-pass was the fact that it just restricts how much food my stomach can hold. What happens with the gastric by-pass is malabsorption; meaning, you don't absorb all the nutrients. Also, with the sleeve, the part of the stomach that's removed is the part that secretes Ghrelin, a hormone that's responsible for making you feel hungry. 

I'm hungry ALL THE TIME. Especially since losing over 100lbs. It's almost like my body doesn't like that I've lost the weight and it just wants me to gain it all back. I try to trick it by drinking a glass of water 5 minutes before every meal; doesn't work...I'm just as hungry 5 minutes later. I eat a lot of protein at every meal. I even put protein in my morning coffee with this stuff-

It has protein, amino acids, and leaves no taste in my coffee. It does in my green tea (the green tea has a delicate flavor, after all) and, well, it tastes the way you'd expect ground-up bones to taste. But it leaves my hair and nails looking great, so I can deal.

Are you one of the individuals that thinks people who opt for surgery are "lazy" and "looking for the easy way out"?
Nothing could be further from the truth.

Many insurance companies have rigorous tests and requirements before they consider you for a candidate. Often, you have to do 3, 6, even 12 months of a supervised diet. You're forced to make lifestyle changes to prove to the insurance company that you're committed to this new lifestyle. Getting the surgery is just the beginning: most of the time, you're scheduled off of work for six weeks. Not because you need to heal from the surgery, but because you have to adjust to your new lifestyle and it takes 100% of your focus. 

Getting surgery isn't a "magical fix"; I've learned a lot from joining a wonderful group on Facebook of individuals who are in the process or have had surgery. It's still a lot of hard work and ups and downs. In one blog I read, the woman openly admitted she didn't change what she ate. She still ate chips, ice cream, cookies, etc. She just didn't eat big servings in one sitting, but rather snacked all day long. She's not gaining any weight, but she's not losing either. So no, the surgery is not a magical fix that will automatically make you a size two overnight.

I know what I should eat. I know how to eat and exercise and live a healthy lifestyle. I just need a powerful tool that can last me a lifetime. 

I'm tired of my back hurting. I'm tired of my knees hurting. I'm tired of being self-conscious and embarrassed every time I leave the house. I'm tired of being hungry all the time. Something is wrong with me, and I need help. I'm taking control and getting the help I need. So far, the only family support I have is David; he's been wonderful. I feel like my weight not only holds me back, but it holds him back as well. If I were a healthier size, we could get out more and exercise, have fun, and do more together. 

I'm ready to start living. Let's do this.

Communication in healthcare(lack of)

I've spent a decade working in the healthcare industry; I've mostly been a provider but, occasionally, I've been a receiver. Have you ever played the game Telephone? Yeah, we get to play it every day, but with your medical information. Luckily, most of us are pretty good at it.

And then sometimes shit happens that makes the receiver want to choke someone.

I initially started this process back in August. I work for St. Elizabeth; I know people who have gone through the bariatric program with St. Elizabeth and had nothing but wonderful things to say. I know the surgeons, therefore, I wanted to utilize the same program. Our insurance is through Cigna. I got on their website to look up anything and everything about bariatric surgery coverage. Wonderful news, they cover 80% of it and St. Elizabeth is in-network! Even after the proceeding experience, I still would recommend St. Elizabeth's program- http://www.stelizabeth.com/weightmanagementcenter/.
Dr. Moon really is wonderful.

The first step of going through this process is sitting in on an hour-long information session. I called St. Elizabeth (end of August, keep in mind) and the earliest opening they had was early December; ok, fine...I'm determined, so I'll do what I gotta do and wait however long it takes. They take my information and ask me if I have insurance and, if so, who with? I give them my info, tell them Cigna, and they said "we'll see you in December!"
I get a call in October saying that they added another session in mid-November; would I be interested in coming sooner? Well duh...sign me up!

I get there and there's maybe 20 people attending. I sit down in one of the bariatric chairs. I'm sorry- I get horrible and judgmental here...but two people brought FAST FOOD to a weight loss seminar! 
That's like bringing a beer to an Alcoholics Anonymous meeting!
But ok, I get it....we all have our problems and that's why we're here.

I listened to Dr. Moon lecture for an hour about how damaging it is to your body to be obese, the dark outlook on our future if we remain obese, the qualifications for gastric surgery (I'll educate you fine folks on that in a bit), as well as what to expect before, during, and after the surgery. 

Now, here's some knowledge for you smokers; smoking effects how your body heals. I won't get detailed but, nicotine and carbon monoxide slow the healing process and put you at a higher risk for post-op complications (here's a link that gets into the details if you want: http://www.ncbi.nlm.nih.gov/pubmed/1323208
Dr. Moon told us that 90 days prior to and after surgery, due to all of the staples that go into the stomach/intestines, NO SMOKING.

No smoking?

The world is ending!!!

OMG!

You would have thought he told people they had to kill their firstborn child.

Hands shot up in the air all over the room- "Can we still vape?!?", one woman asked, clutching her chest. "Does it have nicotine in it?" was the followup question from Dr. Moon, a nod yes from her, followed by "well, then no". 

I wanted to stand up and say, "Look people, surely you're all here because you want to improve your health, quality of life, and extend your life expectancy, right? The surgery isn't a magical thing that fixes you- you're still responsible for dieting and exercising. There still has to be life changes; what's one more?!?"

Srsly, people?

In my head, I'm chanting "I'm not here to judge, I'm not here to judge...focus on your own journey..."

So before leaving, I schedule my initial consult with Dr. Smith (Dr. Moon's partner) and it's December 16th...ugh. More waiting. The MA's there make a copy of my insurance card and take the forms I've filled out. 

I show up a month later for my appointment only to be told "Uh...Cigna won't pay us therefore, we won't take Cigna."

*explosion in 3...2...1* "What are you talking about? Cigna has you on their website as an in-network provider, my plan pays for 80% of the surgery....what the fuck (yes, I dropped the f-bomb) do you mean?!?"

They get me the gal from the insurance department. She proceeds to tell me that yes, St. Elizabeth is in-network for any other surgery...except the one I want. "I've been here for three years and the entire time we've been fighting with Cigna to get them to cover us. We've had patients spend months going through the process only to get up to the point of scheduling the surgery, and we can't get an approval from Cigna because they say we charge too much."

"So why didn't someone tell me this back in AUGUST when I told you who my insurance provider was?!"
*crickets*......
"You've wasted four months of my life". Turn and walk out....followed by 5 minutes of sobbing in my car. Then a pissed off drive home, full of more determination than ever.
Do you see what I mean about the lack of communication in healthcare? Do you think that since my experience, they've told their staff to tell Cigna members to look elsewhere when they call about the seminar? I'm gonna bet no...

I called Cigna when I got home and told them all about my experience and asked them just who in the hell they will pay for; in the entire state of Ohio, they'll only pay OSU in Columbus (website here for more info: http://wexnermedical.osu.edu/patient-care/healthcare-services/weight-management/bariatric-surgery
 ...or they'll pay for the program through Jewish/Mercy here in Cincinnati: http://www.e-mercy.com/weight-management-solutions.aspx 
Or, in Kentucky, they'll cover St. Luke in Lexington or St. Mary's in Louisville.  

Gee...even as much as I hate Mercy, I'd hate to drive all over the country.
I've never had a positive Mercy experience; neither has anyone in my family, now that I think about it.

Last night, I sat through Mercy's version of the same seminar. No fast food and the doc didn't even mention the no-smoking, so it wasn't as entertaining (bummer). But I did learn that the Mercy programs has more benefits that St. Elizabeth didn't- they offer a free 6 month membership to all of their gyms, free lifetime cooking and nutrition classes, and right now, they're waiving their program fee that insurance doesn't pay for...it's a $750 fee. Thank you, thank you very much!

Now I'm just sitting and waiting for the insurance gals at Mercy to do their thing and call me.
 

Appropriate, since it's 6 degrees outside

 

A new adventure!

I. am. fat.
This isn't ground-breaking news to anyone; I've been obese since I can remember.
And to those who read "I. am. fat" and think of this:

To me, it's wrong. When you're morbidly obese, your fat consumes you. It does define you because it becomes an every day obstacle and it defines your actions. Which define you.
You have to pay outrageous prices for clothes and, to be honest, the selection is pretty limited (read crappy). You have to squeeze to fit into...well, everything- a car, a seat at a restaurant, rides at an amusement park, seats at the movie theater, or a waiting room chair. You feel constantly scrutinized, not only by strangers, but by well meaning family members...and yourself. Constantly.
Plus there's the health issues (just a bit of medical terminology- a health issue that you have because of another health issue is called a "comorbidity". For example, many morbidly obese people have high blood pressure or diabetes as a result of their weight. Therefore, their hypertension and diabetes are considered comorbidities). Comorbidities related to obesity include:

• High cholesterol
• Diabetes
• Hypertension
• Arthritis and other bone/joint diseases 
• Sleep apnea 
• Asthma and many other respiratory diseases
• PCOS and various other reproductive diseases
• Metabolic syndrome (learn more about metabolic syndrome here: http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/basics/definition/con-20027243
• Gallbladder disease
• Endocrine diseases

....the list of comorbidities related to obesity is endless. What it all boils down to is, people who are obese, or have a BMI of over 30, are not going to live a long or full life. Every time we get a morbidly obese patient in their 50's in hospice, they're in there at such a young age because of their weight. And I look at them and I see myself in 20 years...
So, I am pursuing bariatric surgery.
I know I've had some weight loss success in recent years. I'm gonna come clean- it wasn't 100% me- more like 80%. It wasn't all because I lived a low-carb lifestyle and exercised. I also took a weight loss medicine for a year called Phentermine(also known as Adipex). Would I have lost weight if I took it and ate whatever I wanted? No...I lost someone I had considered my best friend because we started taking it together and I had amazing success while she had none. The difference? I was disciplined while she wasn't. But I won't tell her story for her...
But the Phentermine did help greatly. I felt little to no hunger. I had tons of energy. It made me a bit manic, to be honest. But it also made me experience some depression too. It wasn't horrible; I could tolerate/cope with it. But after time, the effectiveness of the Phentermine began to decrease, which is normal. I was even able to maintain my weight. But, as with the majority of obese people, the frustration of working hard and getting nowhere began to take its toll. Life happened. Sometimes, due to work and school, I didn't have time to make a completely low-carb meal, so we had sandwiches. I'd go into work where there's always cake, cookies, and candies laying around and, during a stressful shift where I didn't get time to sit down and eat my healthy lunch, I sat down with a few cookies to eat while I charted. Life happens. Unfortunately, because of my PCOS and insulin resistance, a few cookies that wouldn't be enough to effect most people, makes me gain a couple of pounds. Then comes the shame. And the frustration. And then more food.
It's a vicious cycle. 
So why didn't I tell anyone about the Phentermine? Because of the stigma and shame that's associated with having help losing weight. The same stigma that's attached to having surgery. "You need to learn how to put down the fork. Eat more salads. You're looking for the easy way." You're damned if you do, and you're damned if you don't. Look, if all it took to be a healthy weight was to eat salads and go for walks, I'd be a size 2. I've eaten enough salads in the last 3 years(not drowned in croutons and dressing) and I've not only walked- I've RAN. My fat ass ran so much over the last summer, I developed wicked achilles tendonitis in my right heel. You know how much weight I lost over the summer? None- I only maintained. I starved myself sometimes and got nowhere. Nothing worked.
In fact, I've gained 35 pounds back since August. My highest weight was 380lbs- I had thought my highest weight was 370, but I revisited my PCOS blog from 2009 and I had stated my weight then at 380. Also, looking back at old pics from then, I can believe it.

Holy crap, my face! I had chins on my chins and I never realized it. Then there was the rest of me-

A svelte size 28 circa 2006/2007. I've been very lucky that PCOS and mild hypertension have been my only comorbidities. When I was sick last week and took the pic of myself saying "Thank god for makeup", I was shocked;

especially when compared to this face from when I was in the 230's.

I'm beginning to see that old, fatter face reappear and it's depressing.
In fact, I've been completely depressed the last few months because of the shame in gaining weight back. I've been letting it effect my life and my relationships. To anyone who's felt ignored by me for the last few months, I'm sorry. Quite frankly, it's been hard to leave my bed, much less my home. I'm embarrassed to be out in public.
I got down to 235 at my lowest last year and that was with STARVING myself. For a month, I only had one 12 oz hemp protein shake a day along with the phentermine and I couldn't get my body to cooperate and lose any more than that. I know a good handful of people who have had bariatric surgery and had amazing results with it. But I noticed one common factor with all of them; not a single one of them told anyone they were doing it until after they had the surgery. 
Why? I don't know; I can only speculate that it may have been because they didn't want to be judged as a failure for needing such a drastic measure. Initially, I had the same plan when I started thinking of this back in August. I wasn't even going to tell my parents because I didn't want anyone to look down on me for needing help. It's especially hard and embarrassing for me because of my past success.
Look, I can build a house by using a rock to bang boards and nails together;
But it works a hell of a lot better if I have a hammer.
My weight has been a lifelong issue- I NEED a lifelong tool I can use. 

So, I've decided to do something hard- I'm sharing my journey with anyone who needs it.
Or for anyone who wants to judge me- I'm over giving a damn. 
I need to do this for ME so I can be here longer for the people I love and have a better quality of life.