I had my last bariatric doctor visit before the surgery. It was two weeks before the surgery.

First was the weigh in. I am back down to 394! Bye-bye Easter candy!
They discussed with me what to expect the day of the surgery and what to do the day before and morning of the surgery. I was given two items. The first item was a clear plastic package with two individually wrapped bottles and hand “towels” (a terry-cloth mitten). A two minute timer (an hourglass with sand) and instructions were also included. Inside the bottles were an antiseptic/antibacterial soap called Dyna-Hex CHG (chlorhexidine gluconate) solution. One bottle and towel was marked “Morning” and one was marked “Evening”. As expected, the “Evening” package is for use the night before the surgery. The “Morning” package is for the morning of the surgery. Both are to be used in the shower. After washing my hair, I need to use the solution to wash my entire body from the neck down and leave it on for 2 minutes (hence the timer). After the timer is up, rinse off. Same for the morning of the surgery. These are to help prevent any infections after the surgery. The antibacterial solution is going to kill most of the bacteria on your body including the staph bacteria which 1 in 3 people carry on their body at all times. This bacteria is normally harmless unless it gets infected in an open wound. This is why they made the CHG solution – to kill most if not all of the bacteria on the skin before surgery to greatly lessen the possibility of getting a infection.

The other item that was handed to me was a plain white cardboard box. Inside were two leg cuffs to be placed on the calves after surgery. They are used to help prevent blood clots in the lower legs. I was told that I could wear these for up to 10 days after the surgery, depending on how often I walk. Apparently, if I walk daily, then only a few days. I will ask the nurse after the surgery how long for sure. The leg cuffs have velcro to wrap around the leg and have an air tube leading out from them. There was also an air pump/battery pack that came with a cord to plug into the wall. The cuffs provide alternating pressure on the legs to keep the blood flowing.

After my appointment, they had to do some bloodwork and get a urine sample for some final tests to check for any infections and check my vitamin levels. As usual, I tell the lady that will be drawing the blood that she will need the smallest possible butterfly needle made. Even with the butterfly needle, the lady trying to draw the blood could not find a vein after poking around for awhile and gave up. Using a cotton swab and tape, she covered the spot where she stuck me with the needle. I was sent upstairs to the lab to have a professional phlebotomist draw the blood and have me “pee in a cup”.

I went upstairs and waited to be called back. Well this lady phlebotomist knew her stuff. She got it with one stick and I was done in only a few minutes. She was a large lady like me. After drawing the blood, she turned around to enter all my information into the computer. She knew I was there for my last doctor visit before weight-loss surgery and we were discussing how much my life will change. I told her, “You know, it’s amazing all of the things that skinny people take for granted.” She stopped typing and turned around, eyes wide. She spoke slowly and told me, “Say that again…” and looked into my eyes. I repeated myself and she said, “Girl don’t you know it!!!” We then mentioned different things that skinny people might take for granted: like being able to sit in a movie theater or an airplane, sitting in a booth in a restaraunt, being able to use a seatbelt in a car without a seatbelt extension, being able to use a regular bathroom stall, buying clothing in a store instead of having to buy all your clothes online at one or two special “Plus Sized” stores and being able to fit in an office chair at work (I know this one very well – most work places don’t have large enough computer chairs so either I have to sit in a tiny chair that is crushing my legs or buy one and bring it in).

My bloodwork results did come back showing that my white blood cell count was a bit high. I told them that it was because I have psoriasis and it often creates a high white blood cell count as it is an autoimmune disease (over-active immune system). I also told them that another doctor back in mid-March (less than 2 months ago) also found my white blood cell count a bit high and ordered chest X-Rays to make sure I didn’t have pneumonia or some infection in my lungs. Those X-Rays came back clear. My bariatric doctor wanted to see those blood test results and X-Ray so I had my other doctor send them over. I got a call a couple of days later from my bariatric doctor’s office telling me that they got the tests from the other doctor but still needed an updated X-Ray as “normal procedure”. I was mad at this as I am already getting about one medical bill a day in the mail and doing yet another chest X-Ray just seemed so redundant and stupid. But my hands were tied. If I didn’t get the second X-Ray, then they wouldn’t perform the surgery. Plus I had to do it the day that I was going out of town – so I left straight from the imaging place to my destination. The next week I called my bariatric doctor and asked if they got the new X-Rays back yet. She said they did and that they were clear. Imagine that. So I asked if I was still cleared for surgery, and she said that I was. Onward!

So in addition to seeing a nutritionist and doing a sleep study, I also had to see several other doctors to make sure that I was mentally and physically prepared for gastric bypass surgery.

Let me say this about weight-loss surgery. When I originally decided to have weight-loss surgery, I only saw the cost of the surgery. My insurance will cover a great amount of it, so I could afford it. But I didn’t know about all the other costs that would be added to that cost of the surgery such as the high co-pay every time I had to visit the bariatric doctor (which was many times in the six months leading up to the surgery) and of course the anesthesiologist will be a separate bill. There is also the cost of all of the specialists you have to see. Plus, if they find anything wrong (such as me having sleep apnea), there are additional visits and possible new equipment to purchase. It isn’t a scam, it is just something I was unaware of. I just want everyone who chooses to have weight-loss surgery to be aware of all the extra costs involved. Thankfully, everyone is willing to take payments and my insurance covers about three fourths of the bills. Just be prepared for the extra costs.

One specialist I had to see was a psychologist. They wanted to make sure that I was in the right frame of mind for going through surgery and wasn’t “crazy” or had depression problems. I had to fill out a 10 page questionnaire at the office before seeing the psychologist. Questions like “do you hear voices”, “how often do you find yourself depressed”, “do you eat when you are depressed”, “do you binge eat”, and “do you ever feel fearful”. After filling out the paperwork, the psychologist reviewed my answers and asked questions relating to my answers. At the end of the session, the psychologist smiled at me and said, “Well, you can tell everyone you are not crazy,” then said that I am clear for surgery. Before parting, the psychologist told me, “you are a really fun and upbeat gal!”. lol that was probably because I do laugh a lot and am a very positive person.

Another specialist on the list was a cardiologist. My bariatric doctor wanted to make sure that my heart was strong enough for surgery and for the exercise that I will need to be doing after the surgery to aid in weight-loss. If you don’t exercise after surgery, the quick weight-loss will make your skin flabby and depending on how much weight you have to lose, the excess skin will have to be surgically removed as it can be a health hazard. The more you exercise, the tighter your skin will be. Since I am around 400 pounds, the cardiologist didn’t have me run on the treadmill like most people. They gave me a heart monitor with a total of 4 wires attached to my chest and side. I had to wear it for 24-hours and bring it back the next day. Every time I did any strenuous activity, I was to push a button on the monitor and it made a time stamp. I then had to write the time and activity into a log. The next day I gave the monitor back to the cardiologist. While they were reviewing the results, they ran an EKG* on my heart. After waiting in the patient room for a bit, I was told everything came out good and I was cleared for surgery. One more hurdle leaped.

The most dreaded thing that I had to do before the surgery was an upper endoscopy. I had to be admitted into the hospital and have an I.V. put in. The I.V. was the worst part. I have very tiny itty-bitty microscopic veins. I had one person on each arm and hand feeling for a good vein and poking and probing as they went. After many pokes, one girl was probing around with a needle in the back of my hand and it hurt so bad that tears started streaming down my face. I begged her to please stop. She then said she would get the numbing spray to use on my hand. I thought, “NOW you want to use the numbing spray????” She did find a vein eventually. In a half hour or so, I was wheeled into the “operating” room. They then put me under and snaked a camera down into my stomach to have a look around. They had to check for any lesions, ulcers, tumors, etc. With a gastric bypass, they don’t remove the stomach – they keep it to help aid in digestion. I woke up in my room and they told me that everything looked fine other than my stomach lining looked a little irritated. Once again, I was approved for surgery. Whew! Glad that one was over with! However…I think I now fear getting the I.V. for the surgery more than the actual surgery.

*“Electrocardiography (ECG or EKG*) is the process of recording the electrical activity of the heart over a period of time using electrodes placed on the skin. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle depolarizing during each heartbeat. It is a very commonly performed cardiology test.” ~Wikipedia

If you eat healthy, you make your body healthier and feel better. When you eat trash, you trash your body and feel sluggish.

One thing my insurance required me to do to qualify for the surgery was to visit a nutritionist once a month for six months. This is to get you into the mindset of eating healthier and get on the path to eating right. The nutritionist also prepares you for your dietary needs after the gastric bypass. I learned so much from just those six visits. I also got a handbook from the nutritionist breaking down what food is allowed after the surgery and during which time period (right after the surgery, two weeks after, six weeks after, etc.).

Just from what I learned during those nutritionist visits, I went from my starting weight of 419 pounds to 394 pounds in six months. This showed my insurance company and my bariatric doctor that I am motivated to lose weight and a great candidate for the surgery as I will be more likely to stick with the program and diet even after the surgery. One thing they mention when you join the program: “If you gain weight while in the program prior to the surgery, there is a chance you will be kicked from the program”. I wasn’t perfect….I fell off the wagon a few times and gained weight. The important thing is, I got back on the wagon and was able to lose the weight again. I know I won’t be able to do that forever. In the past, I eventually stayed off the wagon after every diet. That is why it is important that I still get the surgery – even after showing that I can lose weight by sticking to the program. In the end, I weigh less than when I first joined the program and that is what they look at.

I weighed myself every month at the nutritionist’s office so I used the same scale every time. Here is how my weight loss went:
419 – Starting weight in November when I had my first nutritionist visit.
412 – Early December visit.
412 – January visit ~ this is what happens when you spend Christmas with your family and eat all the family meals over the holidays. But at least I maintained my weight.
402 – February visit ~ back on track!
394 – March visit ~ under 400 pounds! Yay!
399 – Early April visit and last nutritionist visit ~ Easter happened….I admit I am a chocoholic. My parents came to visit and brought some Easter chocolate with them. I thought I could handle it and just eat a little at a time. Nope….
394 – April 28th ~ Had an appointment with my bariatric doctor – yes it was a different scale, but should only be off by a pound or two. Either way, it shows I am back on track again!

The biggest improvement to my diet and the very first thing that I did was cut out soda completely. That was so hard to do. I was a soda hound. I used to drink 4 of the 16oz bottles of Dr. Pepper every day. For me, quitting soda felt like what it must be to quit smoking. If I smelled it, I wanted it. Certain foods that I always ate with soda made me crave it so bad. In fact, all meals tasted a bit different without soda. I craved it all the time! Even now, 7 months after my last soda, I still crave them to some extent. I can still remember what they taste like and I miss it. I used to drink diet soda, but still gained weight. After I heard about how bad Aspartame is, I switched to regular soda. I still gained weight. But either way – soda is very bad for your body. All the sugar, chemicals, carbonation, acid and caffeine are destructive to your good health. I am very glad I don’t drink soda anymore. With all of that caffeine, my moods were always up and down all day. Now I am “steady as she goes” as the nautical term says. It was so hard to quit soda that it made it easier for me to not go back and drink one. I remember how hard it was to quit and don’t want to have to go through it again.

Another thing that I cut out that I admit I occasionally fall off the wagon with is fast food. Did you know that you can make a taco or hamburger at home and have it be only a fraction of the calories that it would be at a fast food restaurant? I asked my nutritionist why this was, and she said it was the quality of ingredients. By using the leanest beef you can get, light versions of sauces, etc. – you can eat similar food to what a fast food chain would carry but at only a meager portion of the calories. Well, at least I eat fast food a LOT less than I used to – and it shows in my weight. I used to stop by a fast food restaurant for a meal at least 3 times a week. Now, I only do it once every two to three weeks. After the surgery, I know I will have to stop eating fast food all together as the grease and fat will make me very ill. Sure I could still get a salad at many fast food joints, but I make a far better salad at home.

The third item that is cut out of the diet is fried food. Nothing that is cooked in oil or deep fat fried. That cut out my favorite fast food restaurant – Long John Silver’s. I adore their shrimp. I used to get a very large portion of their shrimp every Friday as part of my weekly routine. They got to know me by the sound of my voice at the drive-through speaker and we would chat for a while at the window. Good sign that you might be eating unhealthy if you are on a first name basis with the staff at a fast food restaurant. I even said goodbye to them at my last visit there. It was the week before my first nutritionist visit. I told them I would miss them and they said to just stop by anytime and say hi – don’t even have to order – just say hi and catch up. I guess part of this is also because I live in the South and people tend to be more friendly here. I never have gone back – I don’t want to tempt fate…or challenge my will-power.

In going to the nutritionist, I learned to eat healthier. Not just less, but healthy and balanced meals. I was instructed to keep a log of what I ate, when I ate it, how much I ate, how many calories it was and how much protein a day I consumed. Protein is very important for someone having weight-loss surgery – it is needed to help with the healing after the surgery. They stress the need for protein constantly. Whether it be lean meat, low-fat cheese, nuts, eggs, or protein drinks – the requirement is 60-80 grams of protein per day. I was told not to go over 80 if possible because too much protein per day every day will make your kidneys over-work and possibly fail. After the surgery they stress liquids first (so no dehydration), protein second, produce third (fruits and vegetables) and all else is last (grains, etc.) – depending on how much room you have in your stomach.

I was trained to eat small portions of every food group. My nutritionist suggested something like a bento box for meals (a segmented box with a lid). I got 5 and on Sunday would make all my lunches for the week. I took a photo of my bento boxes after I filled them and showed it to my nutritionist. She said it was perfect! Lots of variation in food (something she had been drilling into me) and each of the food groups. Here is the photo:

Looks pretty good, huh? That is tuna fish, by the way, in the bottom right section. I liked putting it on the Ritz crackers. Of course, as my nutritionist told me, Ritz crackers were not the best choice in crackers as they are buttery and have more calories than other options such as Wheat Thins. I got Wheat Thins as well – I like both crackers. I am not a big vegetable person, but I like cauliflower and carrots, so I stuck with them for lunches. I love tomatoes, so grape tomatoes were easy for me to eat. Blueberries are also a favorite of mine – and something my nutritionist encouraged me to eat as they have very few calories. Yet, sometimes I had strawberries or raspberries instead of blueberries. I would also often switch out the vegetable and meat choices for variety. For dinners, I would have a chef salad which would have all my veggies and protein in one meal. Sometimes I would cook some chicken wings (baked not fried) or have some artichokes that I would dip into fat-free calorie-free Parkay Spray butter. Guilt-free butter – gotta love it! I have even made homemade hamburgers with lean meat or tacos which provide lots of protein and veggies.

I also learned that there are four stages of diet after the surgery.
Stage 1
First two to three days after surgery – nothing but clear liquids. This includes hot broth, ice if you want to chew on something, flavored water (I hate those), caffeine-free herbal tea (no milk and no sugar – bleck), sugar-free sports drinks, clear protein drinks (GNC has become my best friend for protein drinks!), sugar-free popsicles (yay!) and sugar-free Jello (yes not a liquid but if you dissolve it in your mouth until it is a liquid, not a problem). I can still take my medicine and vitamins, but must crush them with a pill crusher and dissolve into water.

Stage 2
For two weeks after stage 1 – everything in stage 1 including any opaque liquids. Still nothing with lumps or anything that could get stuck in the stitches of your stomach which would cause complications. So this includes skim milk, decaffeinated tea and coffee with skim milk, low-fat yogurt with no fruit included and cream soups such as tomato soup (again nothing with any solid chunks in them). I am sure there are other things as well that are opaque liquids, but these are some of the items listed in the handbook.

Stage 3
For two to six weeks after stage 2 – everything in the previous stages but also soft foods. Sugar free pudding, soft low-fat cheese, low-fat cottage cheese, all soup, eggs, canned chicken or canned tuna (soft and moist – they say to avoid dry meat or poultry at this point), 90% or more lean ground beef (boy will I be looking forward to this one – I adore beef!), canned fruit in unsweetened liquid, unsweetened applesauce, bananas, hot cereal such as oatmeal and Cream of Wheat and mashed potatoes (with only with light butter or margarine on top). I am pretty sure watermelon would be included in this list – one of my favorites! Again, there are more than listed, just soft and moist foods.

Stage 4
Last stage – this will be the regular bariatric diet. Everything from the previous stages including all fruit, any lean beef/chicken/fish, all vegetables, whole grain bread/pasta/rice/cereal/crackers, potatoes (no this doesn’t include french fries lol), low-fat dressing and just eating healthy and sensibly. NO fried foods, NO sweets and everything has to be low-fat.

All stages require 60-80 grams of protein per day and you must sip every liquid – no gulping. Also food must be chewed thoroughly before swallowing. You must drink your liquids 30 mins before and 30 minutes after each meal so that your tiny stomach doesn’t get filled with water when it should be meal time and getting protein, vegetables, fruit, etc.