The boring but good to know stuff

Section 2


Frequently Asked Questions
I like that there is an FAQ section in the manual.  There are 46 questions and answers about the whole process.  I'm not going to list all those out, but it is a very extensive list.  Ones that stood out to me are:

• Why do you get an EGD (that scope thingy I had done last month)?  Many morbidly obese patients have reflux and ulcer disease which is not diagnosed and may need treatment prior to surgery.  Furthermore, once the stomach is divided, evaluating the stomach will be difficult and if abnormalities are found at the time of the EGD, treatment can take place before the gastric pouch is divided.  This does not prevent things from happening in the future.  Note that stomach cancer is not associated with gastric bypass.
• How is the stomach divided? A stapler is used to divide the stomach. The two parts of the stomach will be separated completely.  (Why does the scene from the movie Office Space come to my mind?  You know, the one where Milton is explaining why he kept his Swingline stapler after the company switched to the Boston staplers?)
• How much intestine is bypassed?  The "roux" (or bypass) limb will vary from 75-150 cm, but most likely it will be closer to the 150 cm length.
• What size is the stomach pouch?  Approximately 30ml or 1 ounce; the size of an egg.  (That's pretty small - see diagram below.)
• Do you cut the acid producing nerves to the stomach?  No.  Some surgeons prefer to cut these vagus nerves to minimize ulcers but this is not the standard of care.  You will still have acid in your digestive tract to break down the food.
• When can I drink water and other liquids?  After your UGI (upper GI x-ray) on postoperative day 1 is cleared you can drink.  Your bariatric diet will begin at this time.  Your nurse will let you know when to start drinking and help you keep records of how much was consumed.
• How do people die from gastric bypass surgery?  Most patients die from either leaks resulting in peritonitis or from clots in their legs traveling to the lungs (pulmonary embolism).  The risks will be discussed with you in detail prior to your surgery.  (This is actually a concern that my youngest son had about me having surgery.  Keep him in your prayers as he's not really sure about the whole thing.)
• Why do you not remove the other part of the stomach that is divided?  It continues to secrete important juices for digestion and removal of this organ has been associated with more postoperative complications.
• What about the extra skin after I have lost all that weight?  After 18-24 months, most patients will plateau with respect to their weight loss/gain and referral to a plastic surgeon will be an option for excision of extra skin.
• What are some common side effects after surgery?  Nausea, vomiting, hernia at incision site, infection at incision site, general fatigue and constipation are often seen after surgery, but all resolve or can be fixed without much trouble.
• Is rapid weight loss dangerous?  Yes.  Usually this danger is because the patients don't consume the essential nutrients during this time period.  The bariatric center will be working with you on a regular basis to prevent this from happening.  Essentially this danger is eliminated if you follow the recommendations of the nutritionist/dietitians. 
• Can I drink coffee and soft drinks after surgery?  Caffeinated drinks dehydrate your body and should not replace other fluid supplement such as juice or water.  Carbonated beverages can cause painful gas and potentially unwanted pressure on the staple lines.  Leaks could happen from this.  Soft drinks that are "flat" are more acceptable once you are eating your lifetime diet. (Forget that!  Flat soft drinks are icky!)
• What is dumping syndrome?  When you eat pure or refined sugars (high caloric foods), these immediately enter the small bowel causing fluid to rush in to the intestine as part of digestion.  This action is associated with flushing, sweating, rapid heart beats, abdominal pain, and diarrhea. The degree of dumping depends on the amount and type of food.  It usually subsides in 30 minutes.  Try to learn what food causes these symptoms such that they are avoided in the future.

Discharge Instructions

The postoperative phase of gastric bypass can be very demanding of your mental and physical endurance.  What details do I need to remember after surgery?

Surgery performed / wound care - standard post-op wound care instructions.  Keep it dry; don't take the steri-strips off until advised by the doctor; notify the doctor if there is bleeding from the suture line, the skin starts to separate, pus or cloudy fluid is seeping from the incision, the incision or abdomen become increasingly painful and medication is not controlling the discomfort, fever >101, inability to urinate or pass stool/gas.

Activity - laparoscopic surgery: May resume any and all activities when comfortable; may return to work in 1-3 weeks if no problems arise; WALK as much as tolerated; expect your endurance to be low initially, but will improve; no driving until cleared by surgeon.

Medication - do not take aspirin, or aspirin containing medicine (ugh! Excedrin  is usually the only thing that works for my headaches!); Immodium AD to help with post-op diarrhea as needed; Gas-X can be beneficial; Fiber supplements with Metamucil or Fibercon are recommended once you are are on the pureed diet; some pills will be rather large and difficult to digest.  Crush if possible. Some medications dosages may even need to be altered to accommodate for the altered digestive tract.  You will need to take an antacid medication (chewable Pepcid or stronger) for approximately 6 months after surgery to lesson the chance of marginal ulcer formation.

Diet - At time of discharge, you have been advanced to Phase III or full liquids.  You'll maintain this regimen until your first postoperative visit by the dietitian and then should advance to a pureed diet. (More on the phases in a different post.)  Remember to drink 48-64 oz of fluid per day - sipping but not with a straw.  Straws can lead to swallowing of excess air.

General Concerns - any of these should prompt you to call your doctor: sudden shortness of breath or tightness in our chest not relieved by resting; uncontrolled nausea with vomiting; increased abdominal pain or new chest pain; persistent hiccups; leg pain or swelling.

Again, this is just a little of the information in this section.  For me it's the "boring" but good to know" stuff.  It also helps me to feel even more informed about the procedure.  It's good not to enter into a major event being ignorant of the details.  

My next appointment is tomorrow and I feel like I'm right on target where they want me to be.  If so, that means MD should give the thumbs-up to the insurance company and we'll work on getting a concrete date set!  It's hard to believe how quickly this process is going.  I first stepped foot into bariatric center in September 2011.  The time has flown by!  I'm anxious to see where I am in another 6 months!

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

So much information...How do I remember it all?

I've read through my "education manual" now.  There. is. so. much. information. SOOOOO much!  I'm feeling a little overwhelmed by it all, and to be perfectly honest a little bit intimidated by it.


That may seem silly to some of you, but there is just so much to take in and so much to remember.  I know the manual is there for my reference, but I want to "know" it.  I want to be able to not really have to think about it - because when I stop to think about it, I realize that the surgery is really only a tool.  Another tool to help me lose weight.  Tools have failed me in past.  Tools have broken.  Tools have gotten lost in the shuffle of life.  So yes, it's a bit scary and a bit intimidating.  That being said, I'm still excited.  I'm still encouraged by how God is giving me the strength and courage to face the surgery.  I'm looking forward to my appointment on Wednesday to see if MD is ready to recommend the surgery to the insurance company!!


Thoughts on all I've read...


I want to be careful not to post too much information here.  I don't want anyone to think that they can (or should) try to follow certain "eating" plans without being under supervision of a physician.  Our bodies are intricate machines...designed by God to function as He planned.  We should really be very careful in how we treat it.  Years of abusing our bodies really takes its toll.  So make sure before you start repairing the damage you've done to consult a physician or health professional.


So... what's in the manual?  Glad you asked!  I'm going to highlight things that stuck out to me as I went through the manual.  To keep this entry from getting WAY too long (it's long enough as it is!), I'm going to tackle one section of the manual per post.


Section 1
Two Weeks Prior to Surgery

• Begin walking.  (Common theme throughout this section.)
• Reduce caffeine by 1/2 - it stimulates the appetite.
• Drink six 8-ounce glasses of water per day.
• Take chewable multivitamins.  (started this already)
• Take calcium twice per day.  (going to ask about this one)
• Start eating 3 meals per day.  Do not worry about the calories, just work on the habit for now.  (I do okay with this...most days.)
• Avoid binge eating or having the "Last Supper"  (hahahaha!  I've had a lot of "lasts suppers" over the course of my weight loss journeys... the "what is the one thing that I want to eat before I can never eat again" meal!)

Ten Days Before Surgery

• Choose protein-rich foods.
• Start eliminating sweets and carbs.
• Reduce by another half or eliminate completely the caffeine I drink.

One Week Before Surgery

• Stock the pantry with foods for the first few weeks after surgery.  Be sure to have a variety of "Free Foods", the foods allowed on Phase II, Phase III, and Phase IV.  Remember I will only be eating small quantities...don't buy these in bulk!
• Read the nutrition information in the manual again.
• Make sure to take all vitamins daily.

Day Before Surgery

• Relax!!!  (great advice...you try relaxing before surgery!)
• Ask your doctor for medication to help you sleep the night before surgery.
• Read your education manual.  (again?!)
• Write in your weight-loss journal.
• Call a friend who is supportive of your decision.
• Reread your commitment statement and the reasons you chose to have surgery.
• Starting at 6am the day prior to surgery, begin clear liquids only - NO CAFFEINE (caps added for my benefit!): Beef or chicken broth; jell-o; Sprite or 7-up, crystal light, clear juices.
• Walk as much as possible.
• No nail polish.  (No problem)
• Medications - list of what not to take and what's ok to take
• Shower with CHG soap (night before and morning of surgery) - given specific instructions on how to shower, how long to shower, how long to rinse, etc.  (What?!  I hope CVS has it!) 
• DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT - INCLUDING ICE CHIPS.

Day of Surgery

• Arrive two hours before scheduled surgery.
• Meet with the anesthesiologist.  (I'm sure CME will make reference to him/her about how I breathe funny when trying to come out from under anesthesia.)
• The operation time can vary - but in some case it can be up to 2-3 hours  (Glad I'll be out of it during that time!) and approximately an hour in recovery.
• I'll be given Heparin or Lovenox right before surgery to lesson my chance of forming blood clots.

Hospital Stay

• Length of stay is 2-4 days (including day of surgery)
• Must take comfortable slippers because I'll be up and out of bed walking quickly.  I'm not sure if my sock-monkey slippers will be "safe" to walk in right after surgery.  I may need new slippers.
• Walking after surgery is EXPECTED.  If you do not agree to walk, then you will not have the surgery. 
• Why is walking after surgery important?  It helps prevent blood clots, improves healing, relives post-op indigestion and gas, promotes deep breathing, decreases the chance of developing pneumonia, helps control pain and improves emotional outlook.
• Bring my education manual with me to the hospital!

Incision

• The size of the incision(s) varies and depends on whether surgery is open or laparoscopic.  (I'm hoping for the 5-6 smaller [1cm] incisions over the incision from the bottom of my breastbone to my above my navel!)

Pain

• Each person's pain tolerance is different (my words), expect some level of pain in the first couple of days after surgery.  Usually mild to moderate abdominal soreness but not severe abdominal pain.
• IV pain meds will be given and I'll be taught how to use it effectively to control the pain.
• I may experience nausea and indigestion but I can let the nurse know so she can give me the appropriate medications.
• I'll have pain meds to take when I am released.  (I hope to not have to take those - I really dislike taking medication...for anything.)

Diet

• I will begin with clear liquids for 24 hours before surgery and resume with clear liquids for three meals after surgery.
• I will progress to "full liquids" on day four.
• I will be monitored closely while in the hospital to make sure I am getting adequate nutrition.
• My RD will visit me.  :)
• I may struggle to get in all the liquids required the first few days after surgery.  IT'S NORMAL.
• I will not be able to drink and eat at the same time.  My stomach will not have enough room and it will make me vomit.  (Ewww!  I hate vomiting!)

Drains, Catheters, Tubes and Other Devices
I'll save you the graphic details - you can thank me later.


How to Prepare

• Walking is the single most important activity you can do to improve your health and prevent blood clots after surgery!  (this is really a good thing to remember even if you're not having surgery!  W.A.L.K.)
• Start walking now.
• Walking improves circulation and lung function and develops a habit of exercise.  (Note to self - tackle the exercise topic soon!)

Range of Emotions

• The first few days/weeks may be very difficult emotionally.
• My hormones may be disrupted after surgery (watch out world!)
• Sadness - because I have lost a "friend" (food)
• Anger - that I can't change my mind and go back to my old life.
• Hurt - life and people do not magically change once I lose weight.
• Resentment - of others who can eat like I would like to...but can't.
• Fear - of others noticing me more...or of regaining weight.
• Vulnerable - having to face old hurts that have been hidden beneath the layers of fat and are now exposed.  (I put an * next to this one.)
• Happiness - with myself, life, others
• Joy - at experiencing what I have wanted so badly
• Pride - in myself and what I've accomplished (side note - please pray that I never become prideful, but continue to focus on God's work in my that allowed me to accomplish these goals!)
• Relief - from the medical conditions I lived with.  
• Freedom - to move, to breath, to live life to the fullest!!

Facts to Remember About My Digestive System

Again, I'll save you a lot of the details...here are the most important in my mind:

• Nausea may be frequent int he first few weeks after surgery.  There are medications to help!
• My new stomach pouch will only hold a maximum of 2-3 ounces at one time right after surgery.
• STOP EATING WHEN YOU FEEL FULL.  If you over eat, you will vomit.
• You must eat three meals per day in order for my pouch to stretch normally.  
• I will be taking Vitamin B12 for the rest of my life.  (Much better than taking medications for heart disease, diabetes, etc!)
• I should carry some form of identification on me that will inform healthcare workers of my altered digestive system - in case of emergency.  (I'll ask my paramedic hubby what he thinks would be good for this part!)

So there is a glimpse of the first section of my manual.  I'll end this post with one other sentence that caught my attention and a word of good advice regardless of where you are in your own journey:


Your weight won't defeat you, but your negative thoughts will.
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"I praise you [God] because I am fearfully and wonderfully made; your works are wonderful, I know that full well." ~Psalm 139:14

The family that eats together...

CME and I have discussed what we each think will happen (as far as our family goes) after I have surgery.  I personally think that the eating habits of our entire family will change.  MD made the comment at my last appointment that, "when Mom eats better, the whole family tends to follow suite." (that's my paraphrasing - but you get the point).


CME, on the other hand, has mentioned the other possibility.  That while I lose weight, he may gain.  He has a co-worker who's also had the surgery and while she's losing weight, her husband is gaining.  She attributes it to the fact that she'll take a bite of something and he'll finish it.  I really don't see that happening for us.  And I really do think the boys will eat better.  They're already starting to be more conscious about the labels - honing in on the fat and sugar contents.  (Side note - grocery shopping is going to take a lot longer when I start really analyzing the labels!)  


CME found this NPR story that pretty much supports my theory and is about gastric bypass.  I guess only time will tell.


Click here for the NPR Story 
(be sure to actually listen to the article as well.  Also...is it weird that the subject of this story has a last name that is my family last name???)
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"I praise you [God] because I am fearfully and wonderfully made; your works are wonderful, I know that full well." ~Psalm 139:14

Change

change/CHānj/

Verb:	Make or become different: "a proposal to change the law"; "beginning to change from green to gold".
Noun:	The act or instance of making or becoming different.

That's a word that defines my life right now.  Everything around me is changing.  Constant change is probably some sort of oxymoron, but that's my life at the moment - a state of constant change.  Some of the change is bad...the work situation with the majority of my friends losing their jobs.  Some of the change is good...the work God is doing in me.  Regardless, change sometimes takes a while to get use to.  


The adjustment period for the change I made tonight may me longer than I expect, but I'm "ok" with the results.  At least I think I am...


I had about 4 inches cut off my hair...and it's now DARK brown.  I've highlighted my hair for so long, I can't even remember the last time it wasn't! 

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

Sticks and Stones

I've been surfing tonight.  Not on water, of course, but on the web.  I'm a bit discouraged at something I'm noticing.  I've seen it before - many times.  But it seems to be bothering more tonight.  "I lost weight on my own...without surgery."  


On my own.  Without surgery.  Why are those words needed?  I mean, congratulation for losing weight!  That's fantastic!  Really it is!!  I'm happy for you.  What an accomplishment!  Do I care if you had surgery or not?  No.  I'm just genuinely happy that you've been able to take control of your eating habits - however worked for you.  So should I be any less excited for the person who lost weight through gastric bypass surgery?  Am I less of a "success" if I use gastric bypass surgery as my tool to a healthy life?  I don't understand why surgery has such a negative stigma clinging to it.  I don't understand the people who say, "Well, I'd lose weight too if I took the easy way out."  or "Surgery is cheating." or any of the bazillion other comments like that on the web.


Maybe I'm hypersensitive to words.  But words can cause a lot of pain.  As kids we're taught the rhyme: "sticks and stones may break my bones, but words will never hurt me."  Lie!  Hurtful words are often much more painful and take longer to heal.  I can guarantee you that most (if not all) obese people have fallen victim to words that have caused some deep wounds - even if they weren't obese at the time the words were used against them.  Some still carry scars from childhood way into their adult lives.  Sure, we're not kids any more and we should have "thick skin" about some subjects.  But can't we, as a society, really just be more selective in what we say?  I'm not talking about being politically correct.  I'm talking about being nice.  It's as simple as that.  Be nice to people.  Is it necessary to put down, belittle, or demean others?  Are we (as adults) above bullying?  Not always.  And it's never ok to use words as arsenal against children.  Unfortunately, I've done that...and have had to go back and apologize to my kids.  It's an awful feeling when I know that I've let words spew from my mouth that truly hurt my children's feelings or make them feel less than the fearfully and wonderfully made person that God created.  I can't take back the words once they've left my mouth, but I can apologize and admit the fact that I did not respond appropriately.  I'm not too "grown-up" to admit that I was wrong.


When the boys start arguing, more specifically name calling, I can almost guarantee you that you would hear this:


Me:  "Hey!  Words are suppose to..."
Boys:  "Lift up"
Me:  "Not..."
Boys:  "Tear Down"


I wish people understood the impact that their words had on others - no matter what the subject.  Words are powerful weapons.  They can lift up or they can tear down. 


This is hanging on our wall as a reminder of a lot of good advice for our family.  

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

Behind the Blog

I added a "Behind the Blog" page which is more of an "about Deedra" page.  You can check it out, if you're so inclined, by clicking the link at the top of this page.
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"I praise you [God] because I am fearfully and wonderfully made; your works are wonderful, I know that full well." ~Psalm 139:14

Guilty as Charged

Oh what a week it's been!


I have read about half my education manual - though I really thought I'd have it finished by now.  I'll be posting about some of that later.  But first I need to get this out there... I am guilty of letting life's distractions take my focus off where it needed to be on this journey.  I've had a lot of conversations with God this week, but I don't think there was one time that I asked Him to help keep me on track and focused on this life change.  For the record - I can tell!!


After that great exercise evaluation - I've not been to the gym yet.  I've thought about it.  But it's not been anything more than that.  I did start journaling my food intake again - which is good, but what I'm consuming is not.  Oh, I could use the excuses that it's my birthday week or the fact more changes are happening at work - or should I say I did use those excuses - but truth of the matter is that they are just that...excuses.  I have let food control me once again.  I've found excuses to fall off the wagon.  I truly understand how difficult it is for alcoholics to stay sober.  I do.


One of the things I've discussed with the LCSW (as part of the individual and group counseling) is how to respond to "events".  Example, how do I respond to a birthday celebration...or two...or three?  Snacks at the Boy Scout Events?    Events are hard for me.  At least on my own.  I did split my piece of birthday cake and ice cream (yes both!) with CME.  That sounds really good until I tell you that the piece of cake was enough to be at least 2 servings anyway.  I thought I did "ok" with my choice of a slice of thin-crust cheese pizza and salad when I went out for lunch with friends, but birthday dinner (with a couple of my kiddos) of shepherd's pie, complete with mashed potatoes and beef gravy, nixed any "good" I had done at lunch time.  I did use one of the tips from LCSW when at the Boy Scout induction ceremony for my son.  I took a small bite of a cookie bar/brownie type thing and gave CME the rest.  (That's not the tip.)  I waited for a bit then looked at CME and said, "I have to walk away or I will go get one all for myself."  (tip)  Walking away / leaving the room when others are snacking or eating is an okay thing to do.  I know it's not always going to be that way, but for the immediate time being, it's how I'm going to HAVE to respond.  (Read that as saying:  "If I walk out of the room - don't take it personally!")


My old logic would go something like this:  You've blown this week already...might as well start fresh again on Monday.  What is it about Mondays?  What makes them the magical start over day?  Really.  It's just Thursday...I can will start fresh tomorrow!  There's no waiting until Monday.  Tomorrow is a new day.  A new start.  But now my new start needs a makeover.  I need to be focused in my prayers about this.  I cannot let another day slip by without asking God to be in control of my life and this journey.  Fully in control - not just of what I want Him to control.  I can do all things, through Christ who gives me strength! ~Philippians 4:13
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"I praise you [God] because I am fearfully and wonderfully made; your works are wonderful, I know that full well." ~Psalm 139:14