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Monday, January 16, 2012

Step by Step

I survived my appointment!  I got to meet with the registered dietitian (RD),  and the Licensed Clinical Social Worker (LCSW) as well as talk with the lady who is in charge of the insurance side of things.  Below is a LOT of information that you probably don't care to know. I need to blog it so I can make sure I remember what I was told and to help me process it all.  Feel free to read or skim or just keep praying!  :)

The RD was really sweet.  That's a plus since I'll see her more than anyone throughout this process.  She gave me the overview of what the after-surgery eating schedule will be as well as talked with me about making small-sustainable changes starting now.  Keyword for me was "sustainable".  She noted (as I already knew) that I do great at losing weight.  I've had a lot of success...over and over and over.  So small "sustainable" changes, ones that are permanent, are going to be key for me.  Between now and the time I have surgery, they would like me to lose about 17 pounds - through small sustainable changes.  That's no magical number, necessarily, but a percentage of my current weight. (Nope, not yet comfortable listing that here.)  And if I'm being perfectly honest, I know that I could lose that in the next couple of weeks if I wanted to do what I've done in past.  So I'm really having to concentrate on the word "sustainable".  I don't just want to get "thin" - I truly want to be healthy in all aspects of the word!  To help with that, I'll begin keeping a food journal and watching habits over the next several weeks to figure out what I need to change.  I've also got a "checklist" of things to do:

  • Do not skip meals. Skipping meals leads to overeating later in the day.  If you do not eat a meal, try to eat a healthy snack or meal replacement.
  • Make healthful food choices.  Read food labels.  Choose whole fruits, vegetables, low fat protein sources, whole grain breads and cereals and low fat diary products.
  • Make small substitutions. Limit high sugar foods.  Try sugar free and low fat alternatives when available.  Beverages should be water or sugar free drinks.
  • Servings count.  Be aware of high calorie, high sugar, or high fat foods in your daily meals.  Be conscious of portions when you are eating these foods and use lower calorie versions when available.  Pre-portion your foods to control the amount.  When eating out, share an entree or take half home for lunch the next day.
  • Plan Ahead.  If you know you will be out for long periods, plan your day ahead.  Unhealthy and unplanned snacking at visits at vending machines or fast food, plus added calories can be the result.
  • Avoid situations and places that trigger eating.  Change daily activities.  Do not eat in front of the TV, while driving, surfing on the computer, etc.
  • Sip fluids.  Begin to drink 64 ounces of fluids per day.
  • Keep food records.  Keep records of activity.  Keeping records allows you to pay attention to what and how much you are eating.  Bring your journal to all visits to the center.
  • Exercise. (Discuss with physician).  Even fifteen minutes three times a day will improve your health. Walking will help to improve the circulation in your legs and pulmonary status, both of which can be major complications during potential surgery.  If you cannot tolerate more than five minutes of activity at a time, do it several times a day.
  • Begin taking a multiple vitamin and mineral supplement daily.  Note:  I'll be taking at least 2x the recommended vitamin dosages after surgery. That's new for me!
  • Do not pursue pregnancy until 18 months post-op.  Note: This is the easiest one on this list!!  w00t!  I can cross this one off!
  • Don't smoke.  Note:  This is as easy as not getting pregnant!  Cross two off the list!  w00t! w00t!
  • Attend 2 hours of nutrition classes prior to surgery.  
I was also given some information on "Healthy Eating Balance" of carbs/protein/fats.  And she gave me some good links to online sites to help calculate these things for me as well as an app for my phone!  (fitday.com or sparkspeople.com or "daily burn" app - if you were curious) Cool!  

All-in-all that part was a refresher of things I've heard before.  Now to apply it...for good!

The LCSW had a young intern with her.  Both were very nice and very supportive.  I couldn't help but notice the intern's walk.  I wanted to ask her if she had CP or if it were something else.  I didn't want to embarrass her myself though.  Anyway... this was definitely the longest part of the appointment.  We spent almost an hour just chatting and going over some of the answers on my preliminary paperwork (remember, Hand Cramp 101??).

Interestingly enough we spent a LOT of time on my first marriage.  The circumstances leading up to it.  The verbal, emotional, physical abuse.  The alcoholism.  The numerous things that led up to it's demise.  How I handled that...or didn't handle it.  I admitted that there are still signs of the effects it had on me.  The conversation turned to my girls and how they have responded to all they saw back in the day.  Sometimes the guilt of not leaving the situation sooner hits me.  I wonder how life would be different for them if I had...-shrug-

We talked about my current marriage and I kind of chuckled when she said, "Does he (CME) deserve you?  You're such a sweet person.  He darn sure better deserve you!"  And I said, "Yes.  I think we deserve each other."  :)

We discussed other family history and my definition of a "good childhood."  I think I summarized it something like, "We had everything we ever needed and most of what we wanted.  We traveled a lot, we had game nights, had involved parents and were a close family."  Yes, I had a good childhood, so nope that's not why I'm obese.  LoL  (My take-away, not her comment.)  I got to talk a little about Grandmama and the closeness I had with her and that I still miss her.

Then it was on to a wonderful 150 question psych evaluation.  Most of them were no-brainer true or false questions for me.  I had to think about a couple of them and really wished there was a "sometimes" answer, but it was only T or F.  There were a couple of questions that made me laugh, like, "Some of my answers today are because of being in a bad mood." T or F  or "I travel across the Atlantic more than 30 times a year."  T or F  or "I like to flirt with the opposite sex."  T or F.  I think some questions were in there to see if I was paying attention and not just randomly answering them.  They were funny, nonetheless.  I did like the fact that the questionnaire also included questions about faith and God in my life.  It made me wonder how people get through this without God.  Seriously.

LCSW also left me with some homework to complete over the next couple of weeks.  I've got to complete a GENOGRAM which is basically like a family tree of sorts - but adds the things like health issues, addictions, etc.  Then I've got complete worksheet after I've been keeping a food journal for 7 days.  Next, I have to complete a 4-page self-evaluation of how my weight has affected various aspects of my life; relationships, daily activities, education, religion, etc.  Finally, I have to list the 10 Reasons Why I am Committed to Reach my Goal Weight.  All this to be done by my next appointment on 1/31/12!!

This Saturday, I have to go the lab at the hospital to have the following labs run: (for all my medical friends - you'll know what these mean more than I ever would!) TSH, CBC, B-12, 25 OH VITAMIN D, THIAMINE (B1) CMP, AMALYSE, MAGNESIUM, PHOSPHORUS, HIGH SENSITIVE CARDIAC CRP, TYPE AND RH (plus antibody screen), PT, PTT, TOTAL IRON BINDING CAPACITY, IRON, URIC ACID, INSULIN, HGB AIC, RBC FOLATE, SERUM FERRITIN LEVEL, INTACT PTH, LIPID PANEL. How much blood is that going to take???  Plus urinalysis, chest x-ray and EKG.  The nice thing about it is that I can do this on Saturday and not have to take miss work for this part.  They were very sensitive to the fact that I'm missing work for the appointments so they did everything they could do to schedule appointments to take as little time away as possible.  Another positive.

My future appointments look like this:

  • Jan 31 - 1 hr appt with  LCSW to go over my homework/.5 hr appt with RD/1 hr appt with  MD (not surgeon)
  • Feb 8 - 1/2 hr appt with MD & RD/1 hr Behavioral Modification Class
  • Feb 23 - 1/2 hr appt with MD & RD
  • Mar 14 -  1/2 hr appt with MD & RD/1 hr Behavioral Modification Class
What I know is missing is the exercise evaluation as well as meeting the surgeon - which I told is usually 2x prior to the actual surgery itself.  Right now I'm just going to focus on the 1/31 appointment and then take each one thereafter as they come.

Anyway, after the almost 3 hours, I have a little more information; I know when my next appointments will be and what they consist of; I have homework.  My insurance allows 2 visits/month and the way things are going it looks like my surgery could be as soon as mid-April!  I still don't have a set date, but each day is another step closer.

"I praise you [God] because I am fearfully and wonderfully made; your works are wonderful, I know that full well." ~Psalm 139:14

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