MelissaJane

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Somebody started a "what did you wish you'd done to get ready for surgery" thread the other day, and a lot of people said they wished they'd gotten their vitamin levels up.  The thing about nutrient levels is that once they crash, it's hella hard to get them back up again; it can really take a long time and megadoses, or prescription doses, IVs, etc, to get you where you need to be.  So starting out in a good place is a huge help.

Do you have any idea what your levels of vitamin A, vitamin D, calcium, or iron are?  Those seem to be the ones that DSers have the most problems with post-op.  But I am willing to be that for at least half the people reading this, one or more of those nutrients is already low. 

So use this time to your advantage.  If you think you might have surgery - GET TESTED NOW.  Ask your PCP to run the standard list of wls pre-op labs. See what the whole picture is, and start getting your levels up now.  Whether you wind up having surgery next month, next year, or never, this can only help your health.

I am a very healthy (well, you know, except for that pesky SMO thing) 42-year-old pre-op with no signs of nutrient deficiencies. But my A, D, and calcium were ALL in the toilet.  I'm lucky, in a way, that I've had to wait for surgery, because after a couple of months of aggressive supplementing, all three are in high-normal range now.  I'm confident that in that way, at least, I am more than ready for surgery.  Give yourself a big leg up on wls success.  Find out where you are with nutrient levels and start improving them now.

I've been reading a lot of Fat Acceptance stuff recently, and it’s made me think about what obesity is and is not. 

Part of me wants to love the FA movement, of course.  Who doesn’t love being told that you are just fine as you are, and that the most difficult, intractable, painful issue of your life is really no big deal?  Who doesn’t like hearing that the rest of the world needs to grow up and get its shit together, but you’re fine?

When I read FA blogs, the thing that seems to me like the REALLY BIG elephant in the living room is the fact that obesity can kill you, and long before it does that, it makes you really fucking miserable.  The FA people promote a concept called Health At Every Size, and they reject the conclusions of the (freaking zillions of) studies that show links between obesity and ill health; as far as I can tell, they draw the conclusion that a sedentary lifestyle and crappy food choices make you sick, but obesity in and of itself does not  - the idea is that you can be obese and perfectly healthy, if you exercise and eat well and take care of your health.  Well, OK.  I don't read the studies that way, but I do think the FA folks have at least one good point, which is that the medical community is so biased against obese people that that prejudice influences the science about obesity.  I still think that when people lose weight and see their BP go down, their diabetes vanish, their sleep apnea resolve, etc., it might be a little more than a sudden attack of healthy living.  But OK.  

The thing the FA people don't acknowledge is that it sucks to be fat, not just because we get called names by cretins or looked at funny when we order ice cream or have to shop in the Fat Ghetto for clothes.  It sucks to be fat because it hurts. It's hard to carry an extra hundred or two hundred pounds - or more - around on joints made to carry half or less of what they're asked to support.  It isn't just that the nasty bad oppressive Thin Hegemony insists that airline seats be too small and makes us embarrassed to go to our senior proms.  There are real, unpleasant, life-diminishing consequences of obesity.  These may start fairly innocuously with joint pain, but you can pretty much count on acquiring some exciting co-morbidities down the road that will gradually immobilize you, shrink your life bit by bit until finally they kill you. It sucks to experience those things in a very real way that is not an expression of self-loathing or an internalization of anti-fat oppression.  Even if - and boy, is this ever a big if - even if you read the studies in the FA way, and it's not really obesity that's gonna kill you, well, it sure as hell feels like it's killing you.  

I'm looking forward to buying some cute clothes, and I'd love to run into my ex-husband once I’m all cute and little, and I can't wait to go to the theater and actually be comfortable in my seat.  But that's all just a wee bit of icing on a cake that is all about how I feel in this body.  I have structured my life so that I can do as much as I can even though it's hard to walk without pain, hard to take care of my kids without exhaustion, hard to do much of anything requiring physical exertion any more.  I hate that.  I hate it even more now that my kids suffer for it.  I don't want them growing up with a mom who's always just sitting and watching them play because it's too hard to get down on the floor, and too exhausting to run around with them.  I want to have energy; I want to be able to rely on my body as I live my life at full-tilt. 

I would like to stop defining myself through the lens of my body.  I never wanted to call myself a BBW, or see myself in that way, because I never wanted my size to be part of the label I used for myself.  And to be honest, I don't find myself beautiful at this weight.  I can't just accept myself as fat and dare the world to do the same and hold my head high through the humiliations that come with obesity and think of myself as a self-affirming activist; I'd be bullshitting myself.  Who has feet that hurt so much they can't sleep and says Yay, I love my body just as it is!?  Who snores so much they keep their husband awake and are constantly exhausted and says, great, I'm perfect just the way I am!?  Hell, not me.  I'm done with constructing a constrained and diminished life around a body too big to function well.  That is very far from beautiful to me. 

 

I've plagiarized other peoples' lists, especially JoTeddie and moore972003's, and added some questions of my own to come up with this list of questions to ask at my consultation with Dr. Roslin.  Just FYI if you're compiling a list of your questions, this list leaves out some basic questions about the procedure, my surgeon's background, etc., because I already know the answers.

General:
How many of your DS surgeries that started out lap were converted to open?
How many of your DS patients have died? From what?
How many of your DS patients have had serious complications? What were they?
How many of your DS patients have had serious nutritional complications?  Are there specific deficiencies you see most often?  How are these patients followed? Have you had to do any revisions?
How often do you see leaks?

Will my being from out of town affect my follow-up?
How do you determine what size common channel, alimentary limb, and gastric sleeve?
What do you think my goal weight should be?

Pre-op:
Do I need to lose a certain amount of weight or get to a certain BMI before surgery?
What is the pre-op diet?
What are the preparations for the surgery? Testing? Timeline?

Surgery:
Will my surgery be open or laparoscopic?
How will the incision be closed? Stitches, steri-strips, glue or staples?
How long would the open incision be?
How long should the surgery take, barring complications?
Will I have an epidural?
Will you remove my appendix during surgery?

In the hospital:
Will I/should I wear a binder after surgery? Does the hospital provide one, or should I bring one with me?
What level of pain/nausea should I expect?
Will I be taking an acid reducer after surgery? For how long?
Will I go home with a feeding tube?
Will I have a drainage tube? For how long? Will I go home with it?
How long should I expect to be in the hospital? What’s required for me to be dischargeable?
Can my husband stay with me in the hospital?

Post-op:
Typical discharge instructions?
Will I need to stay in the area following discharge?
When will the staples/stitches be removed?
When will I need to return for follow-up? How frequently?
What type of follow-up do you prefer for DS post-ops? Can a local doctor provide this? What sort of doctor? How can he/she communicate with you about my particular long-term needs?
How often will labs be checked in year one? Thereafter?
Can labs be ordered by my PCP and faxed to your office for analysis?

Activity level
After surgery, when can I resume my normal activities?
How long should I expect to be out of work?
How soon will I be able to drive?
Do I have a limit on how much I can carry or lift? For how long?
How soon can I begin an exercise regimen, besides walking?
What types of exercise do you recommend and at what stage post-op?

Diet and nutrition
Are practice nutritionists experienced in DS follow-up?
What is the post-op diet?
What’s the vitamin regimen following surgery? Does it change over time? What percentage of calories and fat will my body absorb post-op?
How many calories and fat grams should I eat post-op?
How many grams of protein should I consume each day?
Do you recommend protein supplements?
Are there any specific foods I should not consume post-op?
What supplements and medications will I be taking post-op?

Longer term medical issues
Will there be medications that I can no longer take post-op, or medications I won't absorb normally?
What are my odds of getting a hernia? Does the risk vary whether the surgery is open or lap? Can I cause a hernia? What should I do to avoid a hernia?
What are my odds of adhesions?
How might this surgery affect health problems I may develop later? (cancer treatment, need for stronger meds for arthritis, osteoporosis, etc.)

I love to travel.  I love to throw myself into a new place and figure it out, whatever that entails, whether it’s dirt roads in the Rockies or back alleys in Edinburgh.  I even like the dead spaces, which is how I think of the days spent on airplanes or trains, on platforms and in waiting rooms, sitting and waiting, sitting and moving, sitting and waiting.  I find time in such places surreal, as though you’ve stepped out of normal life and are simply existing in a series of way stations until you step back into the stream of life again.  

Yesterday, I made a very small journey, the wee beginning of this much larger journey.  It wasn’t difficult or terribly challenging, just wearying, a little tedious.  But it had that surreal time-out-of-life quality, and when I returned, I realized that I was changed from it.  I’m on this path for real now. 

I went to New York city yesterday.  I got up at five when the babies woke up for their still-asleep milk, and took a shower and left before they woke again.  The weather was yucky and I was afraid the rush hour drive to the station, 30 miles away, would take forever.  It wasn’t bad, and I was there early – great, since the train was 2 hours late.  So I sat, and I read, and every once in a while I swam up out of my book a little panicky, hoping I hadn’t read right through a boarding announcement.  It’s nearly a four hour train ride with nothing much to look at, so I read, and I read myself universes away from my train hoping I wouldn’t read myself right past Penn Station.  When I got to New York it was raining buckets, so I took a long subway ride making nearly a complete circle around the park just so I wouldn’t have to walk a few blocks in the rain.   I’d planned my trip so that I’d have about three hours to kill in Manhattan before the informational seminar with Dr. Roslin.  I got to Lenox Hill Hospital fifteen minutes before it started.

It wasn’t very impressive.  Canned, rather flat PowerPoint presentation that left out all kinds of key information on all three surgeries discussed.   Nutritionist who only addressed lap band/RnY dietary issues.  Tired hospital facilities (I kept thinking about all those LHH patients who said, bring a fan, the air conditioning never works).  And then Dr. Roslin, nothing like I expected.  Such a Brooklyn kid!  He is clearly a confident surgeon, but has none of the aloof surgeon’s reserve.  He’s got a brash bad-boy quality; I suspect he likes fighting conventional wisdom, challenging the status quo, being on the wrong side of the establishment.  

I didn’t take one look at him and think, this is the guy for me.  After he spoke, I didn’t feel like, yup, he’s the one.  But I think he is.

And on the way home, I realized that my boring little journey down to New York had been important.  It didn’t seem like it should be.  It wasn’t very interesting, I wasn’t there for very long, the seminar was about as uneventful as such things can be.  But I was not the same.  I was, literally, not in the same place.  I’d stepped out of my normal life and when I stepped back in, it was with my feet on a new path.  

I’m going to have this surgery.  

That's the first time I've said that. 

I’m going to go down to New York again, with Owen, on the 27^th, and see Dr. Roslin, as well as the nutritionist and psychologist.  I’m going to make an appointment with my PCP and get her ready to work with me on this – or maybe find a new PCP, depending on her reaction.  I’m thinking about how to tell my parents, and a few key friends.  I’m excited, still a bit frightened, but less so.  

Here we go!