Placido Flamingo's Apologia

Back to Work Tomorrow

Going back to work tomorrow morning. Or, more accurately, back to the office. I've been working a bit from home. But this'll be my first time to wake up and get dressed and commute to the office in the nearly three weeks. I feel like the timing is right.

I went to the doctor last Thursday for my second follow up visit. Everything looks good. Also on Thursday I advanced my diet from liquids to pureees and blended foods. Basically the consistency of applesauce or baby food. I can have pureed chicken or turkey, or pureed vegetables, or mashed sweet potato, or sugar free yogurt, pudding, or applesauce. I still need to have one protein shake each day to supplement my protein intake, which should be at least 70g/day. It's hard to get to that number. I don't make it about as often as I do.

Things that feel better: the pain from the surgery itself is much better. One spot in my stomach gives me some pain if I'm particularly active, if I sneeze, or while I'm trying to sleep. But it's a huge improvement over the last week or two. I've gone from narcotic pain pills, to round-the-clock Tylenol, to nearly nothing.

Things that feel worse: My back. My neck and shoulders. Very, very uncomfortable. Worst after I've been active and at night when I'm trying to sleep. I think I must be using my back muscles in strange and unusual ways to compensate for not using my abdominal muscles. I'm trying a heating pad for the first time as I type this. Not sure it's helping. We'll see. At this point my back is fast becoming my #1 complaint.

The other ongoing issue is my right thigh, still suffering from the pinched nerve that I somehow got during the surgery. Still some numbness, still some sensitivity to touch. Doctor says it should go away on its own but may take a while.

Biggest issue right now is eating the semi-solid food and monitoring how that affects me. I have to eat tiny amounts, quite often. A typical meal is 1.5 ounces of pureed chicken and 1 tablespoon of pureed vegetable. And after that I'm stuffed. Stuffed! Which is very, very strange. But two hours later, once I start becoming hungry again, I go back to craving all the things I used to crave. And when visiting friends order take-out (which I want them to be able to do), I miss food a lot.

No vomitting yet, almost three weeks out. Probably not a record I'll be maintaining for too long, but nice. I did have a low blood sugar reaction a few nights ago to some yogurt that, while fat free and less than 100 calories, had some added fructose that I reacted to. Apparently the fructose overwhelmed my system, which released a bunch of insulin, which caused the low blood sugar. I was dizzy and a bit disoriented. I've actually been lightheaded several nights in the last few days. My friend Mike thinks it's a reaction to how low my calorie intake is, and that that's why it hits at night. My mood also seems to start out strong and fall off a cliff late at night, and last night I had a full blown anxiety attack. Missing food. Uncomfortable in bed or sitting up. Worried that I'd made a terrible mistake in having this surgery. Did I mention missing food? Gold stars to Mike and to my brother Brian for helping me though that one. So far so good tonight.

Two Weeks Later

Well... two weeks ago I was in the ICU, recovering from surgery earlier that morning. In just about four hours I would meet Wandering Chris... but more on that later.

Some updates on how I'm doing:

• The pain is mostly downgraded to mild soreness. Still can't find a good position to sleep in. Sneezed earlier and that turned out to be a bad idea. But entirely manageable by Tylenol. (Now the only over the counter pain medicine I'm allowed -- no Aspirin, ibuprofen or Alleve.)
• The overall trajectory of the last week has been positive, but it hasn't been a smooth curve. Last Thursday and Friday I had a terrible new stabbing pain in my stomach that made it hard to walk -- I was worried something was wrong -- that turned out to be the worst gas pain ever. I'm still not entirely convinced that's what it was, since it felt nothing like gas has ever felt to me for the last 32 years, but I've been assured that's what it was. If that's true, I feel like there needs to be a different word to describe this so-called "gas." For now, I'll capitalize it. Gas. Right. Then on Sunday night I developed a fever (about 101) and chills and several bouts of diarrhea (sorry, this blog won't be for the squeamish.) Worried, again, I called the doctor, got his service, who connected me to the doctor on call, who called my doctor, who told the doctor on call to tell me to take some Tylenol and call him (my doctor) in the morning. And the fever was gone by morning.
• My father, who was here for about 13 days, beginning with the day before the surgery, left on Sunday morning. And then Sunday afternoon I had sort of an anxiety attack. Actually there wasn't much sort of about it. I had a full blown anxiety attack about being alone in the apartment. Which wasn't rational, since I'm ok by myself, but these things usually aren't. So take my normal anxious tendencies, raise by a factor of 10, and add my new post-surgery penchant for crying at the drop of a hat, and you'll have a pretty accurate picture of Sunday. Before the fever kicked in, that is. Special thanks to Keith and Marisol who came by and helped me through both aspects of the day.
• I weighed myself this morning. It's been three weeks since I started the pre-op diet, and two weeks since the surgery itself. And according to my home scale, I've lost about 30 pounds in the last three weeks. And the strangest thing about that is how off-topic that seems to me. At any other time in my life, losing 30 pounds would be a huge story; it would be the lead story. Now it seems like an afterthought. The last two weeks have given me this sort of tunnel vision, in which I seem to have lost sight of what the point of this whole thing was... It just feels like this thing (major abdominal surgery) happened to me two weeks ago, and each day since has been about recovering from that. The fact that I'm still on liquids seems entirely a function of recovering from that surgery than from any "diet" or the like. And so the weight loss just seems like a side effect like soreness or tiredness. More than one person congratulated me on the weight loss earlier today and I had trouble accepting the compliment.
• People have asked whether I get hungry. The answer, somewhat surprising and somewhat disappointing, is yes. I thought that I would wake up from the surgery never hungry and indifferent to food. In fact, I woke up fixated on water (more on that later as well), and began to get hungry within the last week or so. Now the good news (the great news, really) is that I can satisfy that hunger quickly, even on the liquids I'm still stuck on. And when I lose sight of that, I remind myself that I'm living on protein shakes, thinned soups, sugar free pudding, and Crystal Light without having a psychotic break, so obviously my hunger threshold has changed pretty dramatically. But the fact is that between those things, I do get hungry, and when I do, my brain still wants what it always wanted. A pizza. A cheeseburger. Even just chicken. I haven't had brain surgery, after all. I haven't yet developed new habits. I just have a new reality and new rules. But the old cravings and triggers and preferences are all still there. And some of those things I'll be able to have in a couple of months. And hopefully I'll now be satisfied with a tiny fraction of the amount of those things as I was before. For now, I've begun fantasizing about the pureed and blended food I should be able to start in a couple of days. It still won't be chewing, per se, but I'm hoping it will feel more substantial than the liquids.

I hope this satisfies those of you calling for an update. More to come.

Open for Visitors

I'm open for visitors and gawkers. $5 to see my surgical drain.

Ouch

I came home yesterday at about 4:15pm.

Happy to be home.

Lots of discomfort. Some pain. Absolutely no strength in my abdomen. Can't bend. Standing, sitting, all hurt. Dad and Mom helping me do most everything. Sipping liquids. Feel full, often uncomfortable and sometimes nauseated almost immediately. I'm also super emotional, crying at the drop of a hat. Over good and bad things. Kinda like a pregnant lady.

Have lots of stories. Committed to blogging about them. Plan to alternate longer posts telling stories of my stay in the hospital with shorter real time posts about being at home. Think of them as Lost-style flashbacks. No flashfowards planned just yet.

Visitors welcome.

More to follow.

Distractions

Well I didn't think I could be distracted tonight.

But here are two developments in the last 30 minutes:

• My brother has asked me to consider becoming a justice of the peace and performing his wedding ceremony next year.
• There's no water flowing into my apartment. No sinks. No showers. No toilets. My father, aka my recently arrived house guest, is super excited.

Luckily, I don't have much going on tomorrow. Because this is a lot to think about.

Tomorrow

Well... in 12 hours I'll be at the hospital. Surgery should start at 10:30. Then recovery, then ICU.

Thanks for all of the encouragement during the last week.

Two slip-ups aside, I've lost 10 pounds in the last 6 days. Which accounts for the headache and the lightheadedness.

My next post will be after it's all done, probably late Thursday after I'm discharged.

Here I go.

36 Hours to Go

First, the good news. I've kicked the 32 hour itch. It's been almost 48 hours of pure rule following liquid dieting goodness. About 36 hours to go.

The bad news. Here comes the anxiety. Major surgery. 36 hours. Yikes.

And Then There Were Two

The 32 Hour Itch

When I first started this week of liquids, several friends and family members assured me, "It's just a week. You can do anything for a week."

An analysis of the last 5 days reveals a different finding. It seems I can do anything for about 32 hours.

For those of you keeping score, I've had three days of following all the rules, and two days that have included rule breakery. Today was a rule following day.

This is hard stuff. I'm not proud of my 3-2 record. Obviously I'm hoping that that they don't open me up on Tuesday, shout "this guy cheated TWICE -- shut it down!" and send me home.

In 60 hours, I should be in surgery. And I should be able to do anything for 60 hours, right? Right?

Previously, on Lost

A quick timeline of events leading up to this past week:

2002 -- My father has gastric bypass surgery, after struggling with his weight for decades. Between the ages of 25 and 55, my father lost 75+ pounds, through various methods, at least three separate times. Each time, the weight returned. After his surgery, he lost 150 pounds and went from a 56" waist to a 36" waist.

2002-2004 -- As happy as I was for my father, I was skeptical that the surgery was the right approach (even after it worked so well for him), and refused to consider the notion that I would ever need to have it. I wouldn't even discuss it.

2004 -- I lost 45 pounds doing the South Beach Diet. Later that year, I gained it back.

2006 -- I began to research bariatric surgery options, and came to believe that it might not be such a bad idea for me after all. Spoke to my HR person at my then job, who made some calls and was told that my insurance at the time, Blue Cross Blue Shield, covered the surgery. Spoke to my (now former) primary care doctor, who agreed it was a good idea, and he sent me to see a surgeon at George Washington University Hospital. Had an initial consultation with that surgeon. Was told that not only would this work for me, it would be the only thing that would work in the long term and allow me to not only lose the weight but keep it off. Went for a pulmonology screening. Was checking off steps in the process. Then learned from my insurance that in fact this would not be covered -- because my employer had fewer than 50 employees. And while Blue Cross did normally cover this procedure, they did not cover it in their "small group plans." And that was that. A few months later I left that job for another opportunity, unsure of the coverage situation at the new job.

2007 -- Learned that at this job, my new employers themselves excluded coverage of the surgery from their insurance coverage. To be clear -- the insurance provider itself (first Great West, later Aetna) would normally cover the surgery, but my employers included it on a list of exclusions that lowered their costs. Other things on that list include Lasik surgery and non-reconstructive breast implants. This at a company specializing in health issues.

2008 -- Leave THAT job for my third job in three years. Learn after three months that their insurance (Aetna) DOES cover the surgery. And there's no employer-authored exclusions. And no small group exceptions. We're a go. I decide for various reasons not to return to the surgeon I saw in 2006 and instead visit the Sibley Center for Weight Loss Surgery for a consultation. I spend a couple of months deciding between the gastric bypass procedure and the Lap-Band.

2009 -- With an initial OK from the insurance company, I complete a three month process where I meet once a month with a nutritionist, psychologist, and personal trainer, all to prepare me for what will come after the surgery and to assess whether I'm a good candidate. I also see my primary care doctor for his approval, and a gastroenterologist for an upper endoscopy. The endoscopy, in February, reveals some minor ulcers that caused no symptoms but that needed to be cleared up. I start on an acid blocker. Around this time my new job continues to self-destruct, as the things they hired me to do disappear along with the global economy. I'm laid off. I can COBRA my insurance and still have the surgery, but I need a job. I can go back to the last job I had, thankfully, but that's the place that excludes coverage of the surgery. Several freakouts later I negotiate a deal to return to the old job on an hourly basis without benefits, continue to COBRA the current insurance, and proceed with the prep for surgery. Six weeks after the initial endoscopy and three weeks after starting the old/new job, I have a second endoscopy that reveals that the ulcers have healed. Thanks, acid blocker. We now wait for final insurance approval, which comes about two weeks later. Which was four days ago.

My Suggestion Box

So as I trudge through this week of liquids, several friends have offered advice on how to get through it.

They've told me to keep busy, and sleep a lot, and talk on the phone. (Although one friend who called me to distract me then fell asleep on the phone while I was talking. He does that.)

But here's my favorite suggestion so far, from a friend we'll call O.

O told me to look at pictures of the Holocaust.

I asked him why.

Because, he said, no one wants to eat while they're looking at pictures of the Holocaust.

Um... right.

Any other suggestions out there? Keep 'em coming.

Gastic Bypass, explained

Here's a nice explanation, complete with video.

Still have questions? Leave them in the comments and I'll answer them in future posts.

5 Days to Go

Last night I fell off the liquid wagon. Hard. I blame hypoglycemic delirium, and broccoli as a gateway drug.

In better and not unrelated news, my headache went away.

I'm not going to beat myself up over this. It shouldn't have happened. But I have 5 full days to make up for it. And I'm going to use my new yogurt dispensation and my temporary vegetable allowance and I'm going to follow the rules.

As I type this I'm drinking a Worldwide Protein Shake from Trader Joe's. It's not bad tasting. More importantly for the next 5 days, it's not bad smelling. Because in the last 2 days I've been using protein powders from Unjury, which taste ok (weird, but ok), but smell like infection and despair.

Informed Consent, now with extra information

I was there for three hours. There was a meeting with the nutritionist (I can add some vegetables for the next 3 days, and some yogurt through the weekend) and a meeting with the surgeon and a meeting with the nurse practitioner and I learned all sorts of things about how I’m going to have some drain thing that looks like a hand grenade attached to me for a week collecting fluid from inside my abdomen that I have to empty and take notes about, and about the catheter I'll wake up with that will be removed the second day, and about how I’ll be in the ICU for the first night, and about the tube I have to blow into to get the ball to jump, and about something called the swallow test. Filled out lots of paperwork. Had blood drawn. Bought special vitamins. Good times.