This is an excerpt of a manuscript I'm working on, feedback appreciated!-Tom
©2006- Tom Stormcrowe
All rights reserved
Introduction
Where do I start? I suppose I should describe the problem. I developed a rare metabolic disorder called Empty Sella Syndrome which caused me to gain a tremendous amount of weight. I peaked at 581 pounds (That's 264 kilos, for those of you who use the metric system.). Needless to say, my general health was beginning to suffer. Matter of fact, I had gotten to the point that I was basically unable to have a normal life!
I had gotten so heavy, I was unable to stand for more than a couple of minutes or walk more than 50 feet without crushing chest pain. You can imagine the difficulties this caused me. I was unable to work, and was stuck in an over-sized wheelchair. This weight problem was slowly killing me.
The symptoms of gaining all this weight, other than the chest pain were quite oppressive, to say the least! I was put on supplemental oxygen because my arterial blood O2 saturation was at 68%. This low a blood oxygen level is unhealthy to say the least! The strain on my heart was incredible. I developed an enlarged heart, along with congestive heart failure due to my morbid obesity. The poor oxygenation was contributing to poor kidney function, which was contributing to my congestive heart failure. In addition, I developed severe edema in both legs, to the point that I was developing ulcerations from the ischaema caused by a combination of the swelling and poor oxygenation. The poor healing and immune system depression was contributed to by the development of Type II Diabetes as well. Essentially, I was falling apart. I had come to the point where I had to make a decision. I had to decide whether I wanted to live or not!
I had spent years dieting, unsuccessfully. I actually continued to gain weight for
years, regardless of the diet I was on. I finally saw a doctor named Kenneth Power, a Canadian doctor who had come to the USA to practice medicine. Dr. Power recommended I look into Bariatric Surgery because he felt I was down to it. I would be dead inside of two years if I didn't get my weight under control. The prospect of this surgery scared the living crap out of me, I must admit!
Chapter 1
The Search and the Fight For Surgery
I started my search for a surgeon on the Internet, looking for information about the procedures offered. I also was looking into various factors, such as sites like the site located at http://www.weightlosssurgeryinfo.com/dtcf/. This is a site that specializes in information and support for patients either looking into or having gone through Bariatric Surgery. It was a godsend! I was able to find information of the surgeons in my area as well as information from patients who had undergone the surgery and their experiences at the various programs in the region. I eventually chose Saint Vincent Hospital in Carmel, Indiana and Dr. Rosemarie Jones.
As I had mentioned in the introduction, I had blown up into a tremendously obese man! Dr. Jones treated me with the utmost of respect, her manner with patients is incredible! For the first time in a long time, I didn't feel like a freak! On my first appointment, I went through a class on what I could expect. After the class I had my consultation with Dr Jones. At this appointment, I was able to feel my first bit of hope! It looked like I might have a chance after all.
I should interject an observation at this point. Bariatric Surgery isn't the easy way to lose weight! Far from it! There are risks! First, 1 in about 200 dies in the surgery, even done as a laporoscopic procedure. After the surgery, there is a risk initially of a postoperative infection. Long term effects include poor absorption of various vitamins, calcium, protein, and the potential of physical side effects.
The potential physical side effects include formation of scar tissue, paralysis of the stomach, adhesions, both bowel and pleural, blockages, hernias, and the list goes on. The person considering this surgery needs to take all this into consideration when they are considering the surgery!
Along with everything else, you have to understand that insurance carriers do NOT like to pay for this surgery! My insurance carrier was Blue Cross/ Blue Shield through my employer, Marten Transport. Marten had disallowed Weight Loss Surgery, except for medical necessity. BC/BS had taken the stance that even though I was diabetic, with a heart condition, and on supplemental oxygen as well as being wheelchair-bound, it wasn't medically necessary for me to have this surgery. I was required to more or less jump through hoops to get my surgery approved. I was required first to go through a psychological examination to prove I understood the ramifications of the surgery. I cleared this hurdle........denied!
I filed an appeal through the mechanism BC/BS provided, and they “lost” my records! They had no record of my medical necessity records, so they were resubmitted. Another several months went by, and I was denied again! At this point, I was put into contact with a lawyer, Judy O.! She agreed to represent me in my efforts to get this surgery.
In the meantime, BC/BS was requiring me to undergo a physician supervised diet. This was not successful, and I was still denied! Judy contacted the lead counsel of BC/Bs with my information, and was finally able to break through the bureaucratic nightmare I was in! My surgery was approved thanks to this contact, and was scheduled for March 11, 2005. I was so shell shocked though, from the fight to get it approved that I was not holding my breath! I didn't actually believe I was going to get my surgery till I arrived at Saint Vincent on the morning of March 11 and was being prepped for surgery. I kept expecting the phone to ring and have my insurance deny the procedure right at the last minute!
Chapter 2
The Surgery
My family had gathered for the surgery, from all over the country, literally! My mother and Stepfather was in From Florida, My Uncle John,and Aunt Debbie (Who are the ones who hooked me up with Judy Overturf, incidentally!), as well as my Aunt Julie! I hadn't seen Aunt Julie in nearly thirty years! I actually thought the drugs were kicking in and was hallucinating her! Dr Jones came in and I suppose I should mention at this point in my narrative that she is a stone fox! I had a big old shot of Demerol, I think it was, or possibly Dilaudid in me and apparently told my mother “See Mom, what did I tell you, Dr Jones is a fox”! Narcotics will do that to you. Things are a bit hazy at this point, kind of a blur. Appropriate though, because I went through a bit of a rebirth after my surgery! There should be a bit of a gap between the old life and new one! One person I should also mention, last but definitely not the least, would be my wife Earlena. Her support and help got me through this mess on a day to day basis! Without her, I don't believe I would have had the will to make it.
to be expanded
Chapter 3
Recovery
I woke up in the recovery room in severe pain! At this point, I have to admit, I wondered if it had been worth it! The pain was intense and I couldn't have any pain killers because I was experiencing respiratory problems and narcotics depress the ability to breath. There was a significant risk that the pain killers would have killed me! I just tried to crawl into my head and close out the pain! Every so often, I'd have the nurse in recovery rather loudly tell me to breath! She is a nice lady, and I'm afraid I can't for the life of me remember her name. During the period I couldn't have pain killers, though, I thought of her as Nurse De Sade`!
One of the first things they do after a surgery, just as soon as you are able to, they get you up walking! This actually helps the pain! It seems when a laporoscopic Roux-N-Y procedure is done, they inflate your abdominal cavity with a neutral gas to give the surgeon room to work. If you lie around, the gas forms a bubble that compresses a nerve and puts pressure on a nerve plexus in your shoulder. This causes excruciating pain! Morphine does absolutely nothing for this pain, and the only way to get rid of it is to dissipate the bubble, by walking and moving around!
So we come to my first walk! I can tell you, it wasn't exactly the most athletic power walk in history! It was more a hobble and a wobble, as JRR Tolkien once put it! I was as weak as a new born kitten! I had my wife steering the IV pole, a nurse behind with my wheelchair, and a nurse on both my right and left side. I was trying to keep my sense of humpor, and joke around that I hadn't had that much feminine attention in years! I can tell you, a sense of humor is an important part of your recovery process. It allows you to get through the pain, as well as the embarrassment involved. After the surgery, I was so debilitated, I couldn't even wipe my own butt! This is a part of the embarrassment I am talking about! Another is the fact that I couldn't bathe myself! I have always been self reliant and here I am, totally dependent on others for basic needs like an infant! This is a part of why I refer to this period as my rebirth! All I could do at this point was pray that I would recover quickly!
In the process of recovery, you face a terrifying prospect, eating! This is when you discover that you do or don't have major complications to the surgery initially. I was given breakfast the next morning, not that I was hungry, but you do have to eat! I had one oz of scrambled eggs. No, you didn't read it wrong, that was one ounce volume! I promptly got violently ill. I couldn't believe how painful it was just to eat! One fluid ounce of egg and I threw up in less than 30 seconds! When you have your first breakfast after the surgery, you will have a choice of various breakfasts, all in the one oz. size, custard, Cream of wheat, or scrambled eggs. I recommend you avoid the eggs, at least for the first few days!
Another aspect of life after Bariatric Surgery is no coffee, at least for the next six months! You have to be sipping fluid almost continuously, to get enough fluid in you to avoid dehydration! You need to get at least 60 oz of fluid a day into you! How do you do this when you have a stomach the size of an egg and is initially so fragile you can rupture it by taking too big of a sip of water? You drink out of a 1 oz portion cup! That's right, those little portion cups that a restaurant might use to portion out salad dressing on the side, yup, you got it.........them! You also use a sports bottle, or a child's sippy cup! Anything to control the amount of fluid you take in in a sip! You don't use a straw, though, for two reasons. First, to much fluid volume can be sipped too easily. Second, too much air can get into your stomach! I addition to water, you drink protein shakes. Mine were a combination of Carbo-Lite, 1% milk, and powdered milk. As a substitute for the Carbo-Lite, Carnation Sugar free Instant Breakfast can be used. Both of these can be purchased at Walmart, by the way! You need to drink 4 portions a day, at 8 oz each. Guess what, there's 32 oz of your required 60 oz minimum of fluid! I tried to drink a lot of milk, because of the calcium and additional protein, by the way, so most of my fluid intake was either water, protein shake or milk! It's a good thing I like milk, true? The other thing I like is both Cream of Wheat, and Cocoa Wheats! This is a good thing, by the way, because those are about the only type of semi-liquid food my stomach could initially tolerate, other than sugar free pudding, or sugar free custard, or Jello! The rest of my diet, my chef was Gerber! I rediscovered why babies hate strained peas! I did find out I like pureed squash! This was a surprise, because I hated it before! It's amazing how your tastes change when it's one of the few foods you can keep down! My favorite meats were Gerber Veal, Beef, and believe it or not, they make Pureed Chicken and Noodles! Strained Bananas are cloyingly sweet, but easy to keep down.
One thing I seriously missed was coffee! You have to understand, as coffee goes, I drink rocket fuel! This is defined as a cup of Sumatran Coffee fortified with 4 or more shots of espresso! Like I said, rocket fuel! If it didn't make my eyes pop out and switch sockets and my head pop off, why bother? The problem with coffee is that it's a diuretic! That is to say it makes you go.....and go......and go! Coffee isn't purchased, it's rented! Another way to look at it is that coffee is a Shylock, it loans you the cup of fluid, but is charges three in interest!
Another drink that's out the door is soda. Several good reasons for this, by the way! First, the carbonation can blow out the stomach early on, and literally kill you. Second, too much sodium! The only real exception to that rule is Diet Rite! They are caffeine and sodium free. The only problem is that pesky carbonation! As I mentioned before, it can cause serious problems!
Now we come to the problems of taking medication. You can't swallow anything bigger than an aspirin tablet, anything larger must be broken up. This is something you need to be aware of when dealing with time release medications especially. Always remember to check with your pharmacist as to whether the med can be broken up. If it can't, you will need to have your doctor consider other medication options. Other medication options include liquid medication. Keflex Liquid , an antibiotic you will likely be on immediately after the surgery as a prophylactic against infection is one that deserves mention. Have you ever wondered why babies cry when they have to take Keflex liquid? I can tell you! It tastes absolutely horrible! The best description I can come up with is that it tastes like a combination of dog crap smell and asphalt! Absolutely disgusting! Chances are you will be learning to give yourself shots of Lovenex as well. This is a blood thinner/anticoagulant and it's necessary to prevent formation of clots where clots aren't supposed to be......like your legs, lungs or heart. In addition, you will be taking large doses of vitamins, in form of children's chewables as well as B12 liquid under the tongue and B1. Calcium supplementation will be necessary as well. This is because you have a reduced ability to absorb vitamins. You will be taking these the rest of your life. The Bariatric procedure is a lifelong commitment, this is something you need to accept now. If you don't, you can face serious problems down the road. Your surgeon should cover all of this with you. If they don't, you are selecting the wrong surgeon!
The elimination of the receptors that occurs also changes your dietary habits dramatically. Sugar and starches can cause a problem called Dumping Syndrome. This is where you get tremendous diarrhea from a massive peristaltic wave. Essentially, your bowel floods with fluid to flush out the sugars and starches you can no longer process very well. Along with the diarrhea, you can get cramps, chills and nausea. The wrong foods aren't the only thing that can cause you discomfort either. If you eat a little too much, you will learn the true meaning of pain! It literally makes you throw up! You also need to chew your food up very thoroughly. A piece of meat, improperly chewed can block the outlet of your stomach pouch. This causes pain and nausea. The treatment for this ranges from drinking meat tenderizer dissolved in water to, in more extreme situations, having an endoscope run down and push it through. Remember, and I can't stress this enough! Chew your food, and eat SLOWLY! Your stomach will thank you! It is definitely possible to eat past your pouch capacity, and wind up quite sick before you even realize it. Like I said, this is a lifelong change.
Another interesting little occurrence is green poop! This can occur because of the antibiotics you are taking, as well as magnesium uptake problems. Magnesium is contained in green leafy vegetables like spinach. If it smells really weird, it's probably from the antibiotics. We have various bacteria that live in our intestines and large doses of antibiotics can damage that population. These bacteria live in symbiosis with us and among other things, synthesize vitamins for us that we cannot make. If this population is damaged, other bacteria move in and the result is smelly green diarrhea. It will normalize, but it is disturbing.
More to come, this is a sample of the commitment required for surviving and recovering from Bariatric Procedures. It's not the easy way out at all! It should be considered as a last resort, after all other options fail! If you need it, go for it! It will be difficult, but it's worth it!
