Okay, in this post I'm in the talk about the surgery itself. It's going to cover the time from the pre-surgery assessment on the Tuesday before surgery until the release from the hospital on Wednesday two days after the surgery: a period of eight days.
I'm using Dragon Nuance software where I'm dictating this into my MacBook Pro. It's great software, especially for someone like me who's a very lousy typist. Unfortunately there can be some problems with spelling, capitalization, punctuation, and just wrong words. I've tried to correct as I've gone along but I would appreciate any feedback on where additional corrections should be made. Some of this material is kind of hard for me to read over again and especially hard for me to read over and catch mistakes in. Dragon, for some reason, thinks I say "in" when I mean to say "and" and you will see that more than I would like and those are hard to catch. So bear with me.
When I had talked to the surgeon back in October, it was one of those brief doctor meetings. Everything seemed kind of rushed. It didn't seem like he wanted to really get to know me or anything. Now, for a surgeon, he seemed actually very nice. Most surgeons I have met are arrogant pricks, and this guy was clearly not that. He was very handsome, very much in-shape. Most of his clients were very obese women. I imagined they were thrilled to get any kind of attention from him. Here I was, an obese gay man. He didn't seem at all homophobic but you never know.
He immediately suggested the gastric sleeve. He suggested this because first of all, I was not that overweight. And secondly, if I did gain weight following the gastric sleeve, there was something else we could do, namely the Roux-en-Y. If we did the Roux-en-Y first, we were stuck. There was nothing beyond that. Since almost everything I have done has failed it seemed silly to do something that didn't have a failsafe option so I immediately agreed that the gastric sleeve was the way to go. And I certainly liked the idea he thought that there was something I wasn't fat enough for.
Getting back to the day of the preop assessment. On Tuesday morning at about 8 o'clock I got a call from Brittany, "that I did know that my appointment for the fourth class was at 9 AM didn't I?" Well, no I didn't! I had gotten Robo-called by the hospital on Sunday night that I had a 1 o'clock appointment at the pre-op clinic on Tuesday afternoon, but I had no appointment for any kind of class on Tuesday morning. In fact, all my other classes had been at 3 o'clock on Tuesday afternoon. I had a patient scheduled for 9 AM on Tuesday morning but I wasn't going to let this get in my way. In the seconds before my 8:15 patient showed up, I texted my 9 AM patient saying an emergency had come up and I could not see him at nine. After my 8:15 patient, I bolted to the hospital and got there about 10 minutes late and had my fourth class. It's all kind of whirlwind, but they gave a lot of paper and it was a lot about the diet the first week after surgery -- I didn't know it, but there was a diet to follow the 10 days before surgery. Since we were now two days out from Thanksgiving this meant that I wasn't going to have the Thanksgiving I'd planned on it and I knew that my husband was going to be very disappointed as he had been planning this Thanksgiving for quite a long time.
In the class people were excited–nervous about their upcoming surgeries. I was right along with them. We met a woman who's going to visit us in the hospital, another dietitian type. I now learned that most of the bariatric surgeries go to the same place, the same floor after their surgeries so we patients might run into each other. I began wondering, but never asked, how many people were going to be in each hospital room. When I was done with the class, I still had time until the pre-op assessment and thought I might do some work for a psychopharmacology class I'm taking online. I checked the syllabus to see what was due, and it turned out there was a midterm exam due the next day that was already posted online. So for the next couple of hours I sat in the hospital atrium and used the hospital's Internet to take my pathophysiology midterm exam. Guess what? I made an A!
After I finished the exam, I went to the Apple Store around the corner from the hospital for some one-on-one training I had previusly scheduled and then it was time for my pre-op assessment. They've really got everything mechanized now. The last time I had surgery of any kind was to get my tonsils removed when I was six years old more than 45 years ago. Technology and medicine has changed since then. Today, Pre-op assessment is its own building with its own doctors and nurses. I spent the better part of three hours getting assessed. I had a cold about 10 days ago and still had a lingering cough and wheeze. I was really afraid this was going to hold up the surgery but I also did not want to go in for surgery and die from respiratory problems so I was torn. I ended up being pretty honest and straightforward about all the medications I take my medical history etc. etc. The doctor was really nice and answered all my questions, even my questions that had more to do with my pathophysiology class than with my upcoming operation. After the exam, he sent me to the lab for blood work and then I was off to see my own clients.
The next day, I got a call that my blood levels were abnormally low in vitamin D in that they would be sending a prescription to my local pharmacy that I should begin taking but not to worry, that many people in these northerly climes have low vitamin D and it's not life-threatening and won't stand in the way the operation. The next thing I should hear will be a phone call on Friday between 2 o'clock and 5 o'clock in the afternoon telling me when to show up at the hospital for the surgery itself.
The next day was Thanksgiving, and I tried as much as I could to stick to a high protein low carb diet. The ideas this I was told was to shrink my liver so that it would stay out of the way and they could better operate on my stomach. This makes sense to me. But damn, I like my dressing. I like my pumpkin pie. I did not have a single bit of pumpkin pie And just a tiny bit of cranberry sauce and just a little bit of dressing. I only really lost my willpower on the dressing. but Jesus, it was Thanksgiving.
The next day I got the call from the hospital just as they said I would. Of course when the call came I was in the only spot in the hospital where I work on Fridays which is a dead zone for cell phone calls, but I didn't know it, so I had trouble getting the call. I ran outside to call the hospital back iand after just a little bit of confusion found out that I was to report to the hospital at 7:45. Of this couldn't be better! This must mean that my surgeries was at eight! I must be the first surgery of the day! of the week! Nothing could possibly delay this! I was really excited.
My parents had practically begged me to let them come up to "help out" during the surgery. I have never found my parents to be particularly helpful. Whenever they've tried to help me out, I end up taking care of them. At first I resented it when my mother, for example, insisted on helping my sister every time she moved from one apartment to the other during college but never helped me. One time finally I was talking to my mother just so happened a few days before move and she blithely said, "well if you want any help just let me know" I replied, "any help your willing to give I would love to have." Well, I have feeling that wasn't exactly what she meant. She meantt for her offer to be graciously dismissed. and when she showed up to "help" she ended up being sick and spent the day mostly lying down and in the way all the while complaining about the way the rest of us were packing and moving. So no, I didn't think I would ask them to help but I did want to keep them informed as what was going on I explained to them my excitement of the early morning appointment and being the first surgery the day. "well you're not the first surgery the day honey. They've asked me to be there as early as 530 in the morning before." Just a word of advice, when someone tells you they're excited about something, whatever it is it's okay to say, "that's great I'm happy for you. I'm happy you're excited." They're not asking you to validate their excitement. They are not looking to debate with you. They are sharing a feeling. and if they want any validation, it's that it's okay to be excited and in my world it's almost always okay to be excited even if that excitement is based on something unrealistic. In fact, I think that's what people call hope. At any rate, I wasn't looking for counterfactual evidence of whether or not I was the first appointment in the morning I was looking for something to carry me through that weekend to give me more and more confidence. The idea ofsomebody poking around in my body with a knife after artificially putting me into a coma with chemicals is a scary thought and for some reason clinging to that idea that I was the first appointment in the morning comforted me. My mother saw fit to take that away for me. Idiot.
Of course she was right. and that weekend I thought about last directives powers of attorney I wanted to make clear them it was my husband and who would make all medical decisions for me if I was incapacitated as my next of kin but that I wanted the termination of all care to be a joint decision between the three my husband my father my mother in that any one of them had veto power. That they would be like the United Nations Security Council and that the do not resuscitate order would come only when all three of them could agree on it. Otherwise I would be resuscitated.
For some reason, my sister Donna has become an amazing human being in the last 20 years. She's just an incredible person. She is especially been a godsend during the surgery process. She had some difficult abdominal surgery of her own and so she knows about the pain and the other stuff more than almost anybody. she's been amazingly helpful.
Sunday night I went to bed and it seemed like Monday morning would never come. every hour I'd wake-up, "Was it time yet?" finally at about six I got out of bed got into the shower and scrubbed myself clean and started getting my things together for the hospital. My husband and I drove down to the hospital parked and checked in at the desk of the fifth floors as we'd been instructed. for our privacy, they gave us a number: 58. This was what they would call instead of a name anytime they needed us for anything. we had all our computer equipment with us we saw a corner with a plug and empty chairs we quickly to get over I tried to read a book on my iPad not sure what my husband was doing, and almost immediately I got a text message from my sister and started texting back and forth with her. I noticed there was a board kind of like you would see at an airport with arriving and departing flights it had a list of numbers and beside each number it said something like preop, operating room, recovery room as where we were waiting was also the place where families would wait during surgeries and here they could keep track of where their loved one was in the surgical process. Beside my number 58 it was blank. I hadn't even started the process yet.
After we'd been there about 45 minutes a guy came to the front desk and called two numbers including mine and took us back into the pre-op room. We walked through several long, twisting hallways. I remember lots of people in medical equipment. I remember a large desk that looked like a reception type desk and behind it was a whiteboard with people's names which I assumed were the surgical patients. just beyond this desk to the left it looked a lot like an emergency room with lots of little curtained off areas with like examining tables. My husband to wait here with me I was instructed to take off all my clothes including my underwear and to put on this gown which opened in the back. The next thing I knew the anesthesiologist poked her head in and suddenly I didn't want to hide the fact that I felt a little wheezy.
I think the nervousness I was feeling was exacerbating my asthma. They found me a nebulizer and the anesthesiologist listened closely to my lungs. I was hoping and afraid at the same time that she would say that I couldn't have surgery. I loved the fact that she was a woman. For a woman to do anything like be an anesthesiologist means he has to be at least twice as good as a man. Another guy came in in said he needed to mark on my skin where the incision was good to take place. There was a marker in a sterile seal which he opened and promptly dropped on the floor. He picked it up from the floor I guess it was no longer sterile and marked an X on my belly and left. I was hoping the sterility standards were higher in the operating room. I get judgmental when I'm nervous. The nurse put an IV in my arm and I remember a shot of heparin in my stomach and I remember one of the surgeons popping his head in to see if I'd had the shot of heparin already, I got the idea that they were getting impatient with the operating room and that the anesthesiologist held the reins at this point because she got to decide if I was good to have the surgery or not.
Soon it was time to go. They wheeled me a short way from the pre-op to the operating room I remember looking kind of old-fashioned with big round lights people bustling around all over me the anesthesiologist giving me a shot in my arm and I asked him what it was he said it was Versed. I smiled and said I like Versed.
The next thing I remember there bunch of people over me I'm in a it seems like a large room with several beds each of them have curtains drawn around them does a nurse's desk right in front of me I can tell I ask if I'm all right, They say everything's fine. I asked what time it was. I think they said it was about 11:30. In addition to the gastric sleeve, they found that I needed a hiatal hernia corrected. I feel like I've been punched in the stomach, I somehow knew that I have a catheter in me and that lots of wires connected to me.
After maybe half-hour so 45 minutes they wheeled me up to a room and I think my husband was there when I got there. I had a Dilaudid drip that I could squeeze every 15 minutes for pain and that made me feel pretty good. I certainly didn't feel at all hungry and with all the IVs that I was getting I did not have to drink water. The big deal that first day was getting up and walking. That evening at about six a push by Caldwell the nurse came in and unplugged everything so that I could take a walk and my husband and I took a walk around the hallway. They have a nice little set up in the building with distances marked in the little map in your room of if you take different routes how far you go so you can keep track of your progress and lots of little sitting areas along the way.
After that walk I felt exhausted my stomach hurt. I felt a little nauseated. I collapsed back into my hospital bed. I could see the incisions were the surgery taken place. They were just tiny cuts covered over with tape larger cut above my navel couple of inches long was covered up by three pieces of tape there were some bruises in my stomach normally I harry area had been shaved. I had been meaning to do some manscaping.
There was a whiteboard in my room. Where they would write today's date, the name of my nurse, in the name of my CMA. I don't remember any names from that first day, but they were also very nice to me. When my husband and I took a walk, everyone was so encouraging. And it felt so safe, that people have their eye on us in case I were to stumble or anything. But back to the whiteboard, it also had a goal on it, and the goal was to manage pain. I like that goal. It seemed that my job was to rest and to push the Dilaudid button every 15 minutes.
The Dilaudid seemed to control the pain, but I also noticed that I had a hard time thinking. It was very hard to focus on anything. And I would kind of drift in and out of consciousness. My husband and I watch a show on TV called Revolution and it was on that night and we watched it together but I could not pay attention to the plot and when I would hit the button for my Dilaudid I would get a wave of nausea that was like nothing I'd felt before. well, it felt kind of like the nausea I felt one time that I later figured out must have been gallstones. When I told the nurse this she said maybe I shouldn't use that the Dilauded as much. I started getting nervous and while previously I told my husband he should go home, I meekly asked if he wouldn't mind spending the night with me and of course he said he would.
That first night was kind of rocky. I was actually in a lot of pain, but I didn't want to use that the pain button because of the nausea. At about 1 o'clock I decided to go ahead and use the button and I got one of those emesis trays that fit under your chin and you can vomit into just in case. In the meantime my saline IV was running out and that machine started beeping. For some reason my heart rate would get very slow and another machine would start beeping. There were things wrapped around my legs which would inflate and deflate all night long. It felt like everything was conspiring to keep me from getting any sleep. At about 4 AM, a resident physician came in she put a shot of something into the IV it was a different kind of painkiller and she said I could get this every 12 hours i and it would not make me nauseated. She was right!
I forget the name of the painkiller, but it seemed to kill the pain and allowed me to get some sleep. I decided that for the whole day, I would punch the Dilaudid button every 15 minutes, using my iPhone as a 15-minute timer. Today, I was going to get my catheter out!! I was a little spooked about the process, about having someone diddling with my privates and how much it was going to hurt. The nurse bent over me. pulled the covers down, put a pad under me to catch god-knows-what coming out of me (blood?pee?). She used a syringe to deflate the bulb up in my bladder and slid the tube out. The sensation was definitely weird, like peeing seaweed for two seconds, but not all that unpleasant and not painful.
This second day I like to think of as the day of piss and pain. it was all about producing pee on my own and Michael and
Sunday, December 2, 2012
Saturday, December 1, 2012
Pre-bariatric surgery
The whole reason I got into these blogs to begin with was that I was looking for other people's experiences of bariatric surgery. Either I wasn't looking for proper way or whatever, but he didn't seem like that many people had recorded their personal experiences of going through the surgery. So I promised myself that as I went through the process I would blog my experiences so that other people when it came time for them to make a decision about maybe getting the surgery themselves when police have my experience to use as a yardstick. You know, I don't have any idea if my experience is typical or atypical or normal or abnormal, but this is the real live experience of somebody who made the decision to get bariatric surgery and then have the surgery.
I had the surgery exactly 5 days ago. And I thought for this first blog post about it I would summarize what the experience was like leading up to it. I think I mentioned in previous blog post that I have a really strong family history of heart disease. My grandfather was 42 years old when he died of a heart attack in the middle of the day when he was working as a clothing store as a shoe salesman. My grandmother on the other side of the family was 49 years old when she died of a heart attack on the way home from visiting my mother pregnant with my little brother. I was five months old. I believe that her husband, my grandfather (who may or may not actually my grandfather, but that's a whole another story believe me) had a heart attack at around 50 years old that was nonfatal. My own father had a nonfatal heart attack at 55 years old and a triple bypass. Since then he's had at least two more heart attacks and a stroke.
Six years ago my husband and I weighed about 300 pounds apiece. We each lost about 60 or 70 pounds. And we've kept that weight off for about four or five years but in the last two or three years I've started gaining it back. I've been diagnosed with sleep apnea, high cholesterol, I've 60% blockage in one coronary artery, and I still weigh about 240 pounds. I've been exercising pretty rigorously four or five times a week and trying to watch what I eat. But it hasn't worked.
I weigh myself every time I go to the gym and that weight is almost always the same. it's about 238 pounds, but it's been creeping up. I find that I play games with myself. I give myself little food reward when I do something good. It so easy to grab a sample at Starbucks of the gingerbread cake or to have a piece of burrito as I shop the aisles at Costco. "That doesn't count" I tell myself. It does count.
My cardiologist recommended I go to this informational meeting about bariatric surgery at the hospital. He said one of the most useful aspects of the meeting was that I would meet people who'd actually had the surgery and I would see the kinds of people who consider the surgery and I would see if I felt like I was one of those people or not. Maybe I'd feel like I just wasn't one of these people at all. That sounded reasonable to me. I wrote a blog post about my partner and I going to the informational meeting about six months ago. These people did seem like me.
The next step was filling out an application that was included in the packet of paper that we were given at the informational meeting. Also included in the packet of paper was a list of four or five psychologists that would be willing to do a psychological assessment. A few days after I turned in the application I got a phone call scheduling the first nutrition meeting or class.
For the class we checked in on the 17th floor as if we had a doctors appointment and then were directed to sit in some chairs and couches near one particular door where the nutritionist would stick her head out and announced when the class was beginning. I noticed that hardly any of the chairs in the area had arms on them -- a nod to the special needs of the super overweight. And as we fatsos gathered together trying simultaneously not to be embarrassed but also not to look at each other in the face we were finally called back for first our weighing, politely giving each other privacy, and then we were seated in the class. I didn't know it at the time, but if we gained 15 pounds or more over the course of the classes we would be ineligible for the surgery. These monthly classes are partly a test to see if we can put some of these lessons into action.
And this first class is pretty basic. One woman in the class seemed particularly nervous and asked particularly stupid questions but I suppose there's one in every group and it only made me feel better that as nervous and as stupid as I felt, there was somebody even worse off. The class went a little long which I didn't appreciate, because I had clients of my own and I so had to get back to my office to see them.
What I did learn that the class is that some of the students, that is some of the pre-bariatric patients were far more organized than I was and were further along in the requirements. The requirements include the psychological assessment, and assessment by your primary care physician and making an appointment to see the surgeon himself. I realized I had to get on it. When I got back to my office and started calling psychologists trying to set up an assessment appointment. I spoke to one answering machine after another.
The first psychologists called me back, her earliest appointment was one month away. Since I didn't know how that would compare to the others, I took it. The next psychologist who called me, had an appointment just 10 days away. I would have to rearrange my schedule a little bit and he wanted me to bring $200 in cash. (I expect that that it was the result of some bad experience.) He turned out to be a very nice man and a colleague of the woman I share an office with. He swore a lot and made me realize that it didn't make me take him any less seriously as a psychologist when he swore. Maybe I don't swear enough in my practice.
Next, I called up my primary care physician and made an appointment to see him. He suggested all kinds of tests including a liver ultrasound and a cardiac nuclear stress test. One of the things I like about my primary care physician is that he's super cautious and he was going to be super cautious before surgeryand I gladly went along with it.
They kept telling me that the surgeon's office had a dedicated person-- I'll call her Britney-- who was going to make all the arrangements with my insurance and this was going to be tricky because I was on a COBRA and my insurance expired at the end of the year so I was on the deadline to get the surgery done.
A COBRA refers to insurance from a former employer that you're able to keep paying for all by yourself after you stop working for them. You're only allowed to keep this for 18 months total. I quit my job on June 3, 2011 to go into private practice. My cobra would run out in December I assumed the policy would give me the entire month of December iand it would run out at the end of the year. Later, I learned that it would run out on December 3.
At any rate, I showed up to my second class which was all about proteins. It turned out I hadn't gained any weight from the first class, but I hadn't lost any either. The dietitian seem to be disappointed. I learned that I was going to have to get a protein shake at a nutrition store and I would have to be taking in 60 g of protein every day. This didn't seem to be such a big deal but the dietitian made a big deal out of it. We were told that our homework was to go and try different kinds of protein shakes and find one that we liked. During the class I had asked another student, that is another preop patient, if he knew how to get in touch with Brittany. He gave me her phone number and email address. I was nervous that I hadn't heard from her. However, at the end of the second class, the dietitian said "Britney said she still needs to see..." and then she said my name. I was a little amused that with only at handful of students, the dietitian had not bothered to learn any of our names. I was a little anxious to see what Brittany had to say to me.
It turned out that, sure enough, Britney was being told that my insurance had expired. I assured her that it had not expired and that if she could have the three-way call with both me and the insurance person it would straighten everything out. We had This conversation on the phone one day in October, mid-to-late October. She said that she would get back to me in five minutes or so but that she had to do something for the surgeon first. I waited about an hour, and then called the insurance myself. They explained it all to me, the whole deal with the COBRA and how the policy was set to terminate each month pending a new payment. They explained that every time Brittany had opened an authorization it had closed mistakenly when the policy automatically terminated and then she had opened a new one. Because I wasn't fat enough to get this surgery outright, my doctor had to plead my case to the insurance and the insurance had to approve of it. the time between when Brittany would open the case and when the policy would automatically close was not enough time. They explained all this to me, but I wasn't sure how I was going to explain it to Britney.
after talking to my insurance for about an hour, I was driving in my car on my way to work, Brittany called and I spoke to her on the speakerphone in my car. I was really aggravated that she hadn't called me back like she said she would. I had a half hour drive to my office she got the insurance guy on the phone we had a three-way conversation and somehow she got it resolved. I'm not sure how. Day
with that out of the way, I would get periodic phone calls from Brittany telling me where the approval was in process. I would call the approval department at the insurance company. One day the nurse or does the approvals was out sick, another day was a company wide meeting, there were all kinds of reasons why my approval was not moving forward. I was despairing that this couldn't happen before my insurance ran out on December 3.
. And then, the Thursday before Thanksgiving I got a call. the only things lacking from my insurance file were an approval from a primary care physician and proof that I attended one of the classes. I desperately called my physicians office not really knowing what they wanted but knowing that he wanted me to get the surgery. I emailed him promising to messenger any note from his office to my doctor's office or whatever needed to be done I was so desperate.
The next morning, I got an email from my doctor saying he had no idea what I was talking about. In all his years he'd never had to give any kind of approval like that before. What to they possibly want? And then on my way to work at a hospital way out of the Western suburbs I get a call from Brittany as seem if there's anything I can find or anything I can think of where the physician might have given approval, and something clicked. He was a physician in the same group as the hospital I was having the surgery in. He used the same electronic charting system. on our last visit, just a couple of weeks ago, he must've made some notations that I was okayed for surgery. Could she access that? Britney said that she could! And when she did, she found that notation and she said that would be fine and that was all that they needed and that this would satisfy the insurance company and all I needed to do was wait. it was about 1030 in the morning. At about 3 o'clock that afternoon, I received word from the insurance company that I had been approved for surgery.
Bittany called later to say that my fourth bariatric class and my pre-op physical were scheduled for Tuesday. I was on my way.
I had the surgery exactly 5 days ago. And I thought for this first blog post about it I would summarize what the experience was like leading up to it. I think I mentioned in previous blog post that I have a really strong family history of heart disease. My grandfather was 42 years old when he died of a heart attack in the middle of the day when he was working as a clothing store as a shoe salesman. My grandmother on the other side of the family was 49 years old when she died of a heart attack on the way home from visiting my mother pregnant with my little brother. I was five months old. I believe that her husband, my grandfather (who may or may not actually my grandfather, but that's a whole another story believe me) had a heart attack at around 50 years old that was nonfatal. My own father had a nonfatal heart attack at 55 years old and a triple bypass. Since then he's had at least two more heart attacks and a stroke.
Six years ago my husband and I weighed about 300 pounds apiece. We each lost about 60 or 70 pounds. And we've kept that weight off for about four or five years but in the last two or three years I've started gaining it back. I've been diagnosed with sleep apnea, high cholesterol, I've 60% blockage in one coronary artery, and I still weigh about 240 pounds. I've been exercising pretty rigorously four or five times a week and trying to watch what I eat. But it hasn't worked.
I weigh myself every time I go to the gym and that weight is almost always the same. it's about 238 pounds, but it's been creeping up. I find that I play games with myself. I give myself little food reward when I do something good. It so easy to grab a sample at Starbucks of the gingerbread cake or to have a piece of burrito as I shop the aisles at Costco. "That doesn't count" I tell myself. It does count.
My cardiologist recommended I go to this informational meeting about bariatric surgery at the hospital. He said one of the most useful aspects of the meeting was that I would meet people who'd actually had the surgery and I would see the kinds of people who consider the surgery and I would see if I felt like I was one of those people or not. Maybe I'd feel like I just wasn't one of these people at all. That sounded reasonable to me. I wrote a blog post about my partner and I going to the informational meeting about six months ago. These people did seem like me.
The next step was filling out an application that was included in the packet of paper that we were given at the informational meeting. Also included in the packet of paper was a list of four or five psychologists that would be willing to do a psychological assessment. A few days after I turned in the application I got a phone call scheduling the first nutrition meeting or class.
For the class we checked in on the 17th floor as if we had a doctors appointment and then were directed to sit in some chairs and couches near one particular door where the nutritionist would stick her head out and announced when the class was beginning. I noticed that hardly any of the chairs in the area had arms on them -- a nod to the special needs of the super overweight. And as we fatsos gathered together trying simultaneously not to be embarrassed but also not to look at each other in the face we were finally called back for first our weighing, politely giving each other privacy, and then we were seated in the class. I didn't know it at the time, but if we gained 15 pounds or more over the course of the classes we would be ineligible for the surgery. These monthly classes are partly a test to see if we can put some of these lessons into action.
And this first class is pretty basic. One woman in the class seemed particularly nervous and asked particularly stupid questions but I suppose there's one in every group and it only made me feel better that as nervous and as stupid as I felt, there was somebody even worse off. The class went a little long which I didn't appreciate, because I had clients of my own and I so had to get back to my office to see them.
What I did learn that the class is that some of the students, that is some of the pre-bariatric patients were far more organized than I was and were further along in the requirements. The requirements include the psychological assessment, and assessment by your primary care physician and making an appointment to see the surgeon himself. I realized I had to get on it. When I got back to my office and started calling psychologists trying to set up an assessment appointment. I spoke to one answering machine after another.
The first psychologists called me back, her earliest appointment was one month away. Since I didn't know how that would compare to the others, I took it. The next psychologist who called me, had an appointment just 10 days away. I would have to rearrange my schedule a little bit and he wanted me to bring $200 in cash. (I expect that that it was the result of some bad experience.) He turned out to be a very nice man and a colleague of the woman I share an office with. He swore a lot and made me realize that it didn't make me take him any less seriously as a psychologist when he swore. Maybe I don't swear enough in my practice.
Next, I called up my primary care physician and made an appointment to see him. He suggested all kinds of tests including a liver ultrasound and a cardiac nuclear stress test. One of the things I like about my primary care physician is that he's super cautious and he was going to be super cautious before surgeryand I gladly went along with it.
They kept telling me that the surgeon's office had a dedicated person-- I'll call her Britney-- who was going to make all the arrangements with my insurance and this was going to be tricky because I was on a COBRA and my insurance expired at the end of the year so I was on the deadline to get the surgery done.
A COBRA refers to insurance from a former employer that you're able to keep paying for all by yourself after you stop working for them. You're only allowed to keep this for 18 months total. I quit my job on June 3, 2011 to go into private practice. My cobra would run out in December I assumed the policy would give me the entire month of December iand it would run out at the end of the year. Later, I learned that it would run out on December 3.
At any rate, I showed up to my second class which was all about proteins. It turned out I hadn't gained any weight from the first class, but I hadn't lost any either. The dietitian seem to be disappointed. I learned that I was going to have to get a protein shake at a nutrition store and I would have to be taking in 60 g of protein every day. This didn't seem to be such a big deal but the dietitian made a big deal out of it. We were told that our homework was to go and try different kinds of protein shakes and find one that we liked. During the class I had asked another student, that is another preop patient, if he knew how to get in touch with Brittany. He gave me her phone number and email address. I was nervous that I hadn't heard from her. However, at the end of the second class, the dietitian said "Britney said she still needs to see..." and then she said my name. I was a little amused that with only at handful of students, the dietitian had not bothered to learn any of our names. I was a little anxious to see what Brittany had to say to me.
It turned out that, sure enough, Britney was being told that my insurance had expired. I assured her that it had not expired and that if she could have the three-way call with both me and the insurance person it would straighten everything out. We had This conversation on the phone one day in October, mid-to-late October. She said that she would get back to me in five minutes or so but that she had to do something for the surgeon first. I waited about an hour, and then called the insurance myself. They explained it all to me, the whole deal with the COBRA and how the policy was set to terminate each month pending a new payment. They explained that every time Brittany had opened an authorization it had closed mistakenly when the policy automatically terminated and then she had opened a new one. Because I wasn't fat enough to get this surgery outright, my doctor had to plead my case to the insurance and the insurance had to approve of it. the time between when Brittany would open the case and when the policy would automatically close was not enough time. They explained all this to me, but I wasn't sure how I was going to explain it to Britney.
after talking to my insurance for about an hour, I was driving in my car on my way to work, Brittany called and I spoke to her on the speakerphone in my car. I was really aggravated that she hadn't called me back like she said she would. I had a half hour drive to my office she got the insurance guy on the phone we had a three-way conversation and somehow she got it resolved. I'm not sure how. Day
with that out of the way, I would get periodic phone calls from Brittany telling me where the approval was in process. I would call the approval department at the insurance company. One day the nurse or does the approvals was out sick, another day was a company wide meeting, there were all kinds of reasons why my approval was not moving forward. I was despairing that this couldn't happen before my insurance ran out on December 3.
. And then, the Thursday before Thanksgiving I got a call. the only things lacking from my insurance file were an approval from a primary care physician and proof that I attended one of the classes. I desperately called my physicians office not really knowing what they wanted but knowing that he wanted me to get the surgery. I emailed him promising to messenger any note from his office to my doctor's office or whatever needed to be done I was so desperate.
The next morning, I got an email from my doctor saying he had no idea what I was talking about. In all his years he'd never had to give any kind of approval like that before. What to they possibly want? And then on my way to work at a hospital way out of the Western suburbs I get a call from Brittany as seem if there's anything I can find or anything I can think of where the physician might have given approval, and something clicked. He was a physician in the same group as the hospital I was having the surgery in. He used the same electronic charting system. on our last visit, just a couple of weeks ago, he must've made some notations that I was okayed for surgery. Could she access that? Britney said that she could! And when she did, she found that notation and she said that would be fine and that was all that they needed and that this would satisfy the insurance company and all I needed to do was wait. it was about 1030 in the morning. At about 3 o'clock that afternoon, I received word from the insurance company that I had been approved for surgery.
Bittany called later to say that my fourth bariatric class and my pre-op physical were scheduled for Tuesday. I was on my way.
Monday, November 12, 2012
I can't stand it when people don't like me. I can't stand it so much, that it gets in the way of anybody actually liking me. Seriously. It's as if I have these antennae that are fine-tuned to the slightest disapproval. I pick up on disapproval or just dislike in someone else and I'm off to the races. It's why my relationships are so, well, troubled.
Because I (thankfully) live in a dark blue state, I thought Dumbledore and I would travel to an adjacent yellow state to GOTV for the President. D couldn't go at the last minute, so I went on my own. When I got to the assigned location, I realized I was the last to arrive and the crew had bonded. And, horror of horrors, I was at least 20 years older than the next youngest person. This is my nightmare scenario. I try to fit in, but I can just feel their thoughts ("creepy old guy"..."why is this old guy here?"...."didn't he get that this was a thing for young people?").
It's only now, in looking back, that I realize this was all me, in my head. I kept thinking of them as "kids," first of all, which is completely on me. They went out of their way to be nice. But these guys were also in a strange environment with strangers trying to fit in, probably some of them nervous like me. Many of them political dweebs, like me, not necessarily socially graceful. I was fucking panicking.
The next day, when it came time to split up into two-person teams, I got teamed with someone not in my group. I was kind of relieved because I thought my group hated me. My group was all going to a big political rally that afternoon. They even called me to see if I was coming. I imagined the young woman rolling her eyes as she forced herself to call the old guy to invite him so he wouldn't feel his feelings had been hurt. Since I had made fr ends with my canvassing partner from outside my group, I said I wanted to keep canvassing (Dork!) and lost another chance to bond with these incredible young people.
I could go on, but it's painful. So many opportunities I lose because I'm so sure people don't like me. When they don't like me, I feel like I'm setting myself up for some kind of humiliation. Some kind of thinking that I am someone's friend and finding out that the feelings aren't reciprocated. Betrayal, I suppose. Why is betrayal such an issue for people?
Is it because we come into the world so dependent and full of love for those that take care of us and are so angry when they can't follow through, when they humiliate us? My parents took such good care of me physically, but I felt so humiliated all my life.
For example, when I was 4 years old, I realized I couldn't tell what color things were. Every one in my class could name colors, but I kept getting mixed up, calling things the wrong name, coloring things the wrong color. After another brown apple and an admonishment by the teacher that apples were red, I noticed that the big crayon with the flattened side had markings on the side. I recognized the letter r, which kind of sounded like red, and thought maybe I could remember that way. It didn't take me long to realize that every color had markings on the side that told you what color it was, but shhhhh! Don't tell! That's cheating! That's only for the teacher to see! Kids are supposed to learn the names of colors from looking at them. that's what everyone else did.
So for a couple of years, beginning at age 4, I was a secret reader. I also had trouble with left and right. (Still do!) I couldn't learn them. I had trouble learning to tie shoes. I couldn't snap my fingers. I had "tongue thrust" where instead of swallowing normally, my tongue would thrust forward, eventually knocking my teeth out of whack. I had to go to speech therapists.
When I was eight, I learned I had been in a car accident. In the days before seat belts and child seats, I was probably sitting in some rinky-dink unsafe seat or maybe on the car seat itself when a sudden stop hurled me forward into the dashboard. An EEG confirmed brain damage. I have very little coordination in the tips of my fingers, the tip of my tongue. Weird, I know. At rest, my mouth would hang open and my tongue would hang out. Boy did I catch hell for that! My father would erupt at the dinner table when I was chewing and swallowing improperly. I was TRYING. Do you know how it feels to be a kid and to try and try and not be able to succeed? It's positively humiliating.
No wonder I had no friends growing up. I retreated into fantasy worlds of movies and books. I still do. I love the computer because I don't have to see the tell-tale signs of disapproval that make me want to flee a relationship. I can imagine people like me, they really like me. More later.
Does anybody relate to this?
Because I (thankfully) live in a dark blue state, I thought Dumbledore and I would travel to an adjacent yellow state to GOTV for the President. D couldn't go at the last minute, so I went on my own. When I got to the assigned location, I realized I was the last to arrive and the crew had bonded. And, horror of horrors, I was at least 20 years older than the next youngest person. This is my nightmare scenario. I try to fit in, but I can just feel their thoughts ("creepy old guy"..."why is this old guy here?"...."didn't he get that this was a thing for young people?").
It's only now, in looking back, that I realize this was all me, in my head. I kept thinking of them as "kids," first of all, which is completely on me. They went out of their way to be nice. But these guys were also in a strange environment with strangers trying to fit in, probably some of them nervous like me. Many of them political dweebs, like me, not necessarily socially graceful. I was fucking panicking.
The next day, when it came time to split up into two-person teams, I got teamed with someone not in my group. I was kind of relieved because I thought my group hated me. My group was all going to a big political rally that afternoon. They even called me to see if I was coming. I imagined the young woman rolling her eyes as she forced herself to call the old guy to invite him so he wouldn't feel his feelings had been hurt. Since I had made fr ends with my canvassing partner from outside my group, I said I wanted to keep canvassing (Dork!) and lost another chance to bond with these incredible young people.
I could go on, but it's painful. So many opportunities I lose because I'm so sure people don't like me. When they don't like me, I feel like I'm setting myself up for some kind of humiliation. Some kind of thinking that I am someone's friend and finding out that the feelings aren't reciprocated. Betrayal, I suppose. Why is betrayal such an issue for people?
Is it because we come into the world so dependent and full of love for those that take care of us and are so angry when they can't follow through, when they humiliate us? My parents took such good care of me physically, but I felt so humiliated all my life.
For example, when I was 4 years old, I realized I couldn't tell what color things were. Every one in my class could name colors, but I kept getting mixed up, calling things the wrong name, coloring things the wrong color. After another brown apple and an admonishment by the teacher that apples were red, I noticed that the big crayon with the flattened side had markings on the side. I recognized the letter r, which kind of sounded like red, and thought maybe I could remember that way. It didn't take me long to realize that every color had markings on the side that told you what color it was, but shhhhh! Don't tell! That's cheating! That's only for the teacher to see! Kids are supposed to learn the names of colors from looking at them. that's what everyone else did.
So for a couple of years, beginning at age 4, I was a secret reader. I also had trouble with left and right. (Still do!) I couldn't learn them. I had trouble learning to tie shoes. I couldn't snap my fingers. I had "tongue thrust" where instead of swallowing normally, my tongue would thrust forward, eventually knocking my teeth out of whack. I had to go to speech therapists.
When I was eight, I learned I had been in a car accident. In the days before seat belts and child seats, I was probably sitting in some rinky-dink unsafe seat or maybe on the car seat itself when a sudden stop hurled me forward into the dashboard. An EEG confirmed brain damage. I have very little coordination in the tips of my fingers, the tip of my tongue. Weird, I know. At rest, my mouth would hang open and my tongue would hang out. Boy did I catch hell for that! My father would erupt at the dinner table when I was chewing and swallowing improperly. I was TRYING. Do you know how it feels to be a kid and to try and try and not be able to succeed? It's positively humiliating.
No wonder I had no friends growing up. I retreated into fantasy worlds of movies and books. I still do. I love the computer because I don't have to see the tell-tale signs of disapproval that make me want to flee a relationship. I can imagine people like me, they really like me. More later.
Does anybody relate to this?
Friday, July 6, 2012
Wednesday, June 27, 2012
Anybody there?
OK. Nobody's even bothered to comment on my narcissistic ramblings. That sucks. Is that even normal? Or are my narcissistic ramblings even worse than most of the drek here on the Interwebs. Everybody seems to love Lena Dunham's angst, but it's not pretty when you're more grown up (and less pretty).
For the past year I've been trying to read Infinite Jest on my Kindle. I feel like I'm supposed to like it, and it's kind of interesting in spurts, but very hard to follow. What I hate most of all about the Kindle is I can't count ahead to the end of a chapter and see how many more pages I have to read before coming to a satisfying stopping place before putting te book aside again. And since I can't wade through it, I'm not really reading anything else I could be reading in the meantime as I read chapter after chapter, sometimes again and again, not really getting all that much out of it or seeing what one chapter has to do with the other knowing the author eventually hanged himself in suburban Claremont, CA, a place I know all too well.
I've lived all over. Washington, Philadelphia, NYC, Boston, LA, SF, Miami, you name it, chances are I've sojourned there. I'm ready t pick up and move again, but it gets harder and harder as you get older and older, you know?
For the past year I've been trying to read Infinite Jest on my Kindle. I feel like I'm supposed to like it, and it's kind of interesting in spurts, but very hard to follow. What I hate most of all about the Kindle is I can't count ahead to the end of a chapter and see how many more pages I have to read before coming to a satisfying stopping place before putting te book aside again. And since I can't wade through it, I'm not really reading anything else I could be reading in the meantime as I read chapter after chapter, sometimes again and again, not really getting all that much out of it or seeing what one chapter has to do with the other knowing the author eventually hanged himself in suburban Claremont, CA, a place I know all too well.
I've lived all over. Washington, Philadelphia, NYC, Boston, LA, SF, Miami, you name it, chances are I've sojourned there. I'm ready t pick up and move again, but it gets harder and harder as you get older and older, you know?
Tuesday, June 26, 2012
Cutting Out the Fat
This is weird. My blog has only been up for an hour and 12 people have seen it. I forgot something: I'm considering getting bariatric surgery. I've tried to lose weight every which way and nothing has worked. Dumbledore & I went to a bariatric surgery seminar last week. It was in a classroom type room at the hospital. Lots of fat people. The chairs (wisely) didn't have arms. No snacks, shich was probably a god thing.
The (skinny) surgeon made it all sound clean and medical. Not too scary. I wonder if he secretly laughs at al the fat people in the audience? He says: "obesity is a disease. A disease we don't really understand. Very few people are permanently helped through diet and weight loss alone. Most people eventually need some medical intervention to lose weight." I was really skeptical until the four women who had just had the surgery in the last several weeks spoke. They were all really happy with it. One woman was almost exactly my weight, 237 # (I can only say that because of the anonymity!) and lost about 75# in a few weeks post-surgery. She was wearing a halter top which she couldn't pull off, but it was exciting to see that she thought she could. You just know she was the type of women who, before the surgery, would never have considered a halter top.
When my parents were here, my mother snidely confided that my cousin Elaine got a gastric bypass. She said it in just about he same tone she'd use if Elaine had got an abortion or had a condom full of heroin removed from her gut. I know it's dumb, but the thought of my family members saying, "the Faygelah is getting bariatric surgery because he couldn't control his appetite" just grates on my last nerve.
The (skinny) surgeon made it all sound clean and medical. Not too scary. I wonder if he secretly laughs at al the fat people in the audience? He says: "obesity is a disease. A disease we don't really understand. Very few people are permanently helped through diet and weight loss alone. Most people eventually need some medical intervention to lose weight." I was really skeptical until the four women who had just had the surgery in the last several weeks spoke. They were all really happy with it. One woman was almost exactly my weight, 237 # (I can only say that because of the anonymity!) and lost about 75# in a few weeks post-surgery. She was wearing a halter top which she couldn't pull off, but it was exciting to see that she thought she could. You just know she was the type of women who, before the surgery, would never have considered a halter top.
When my parents were here, my mother snidely confided that my cousin Elaine got a gastric bypass. She said it in just about he same tone she'd use if Elaine had got an abortion or had a condom full of heroin removed from her gut. I know it's dumb, but the thought of my family members saying, "the Faygelah is getting bariatric surgery because he couldn't control his appetite" just grates on my last nerve.
Naval Contemplation
My parents just left. I'm exhausted. They came all the way from Large Southwest City, their hometown and mine, to visit me in my husband- Dumbledore- in Large Midwest City. although, I think the real mission was to complain… About everything. Like I said, I'm exhausted. All I can feel is the “not good enough's” going through their heads. And the thing is, I don't know why I care. I came here to be thousands of miles away from them. I got what I wanted, didn't I?
But I can't help but see my life through their eyes, and it's pretty miserable. I mean, by their standards. We don't have any money. We have no kids. Our lives are more than half over and we really don't have that much show for them. I'm left feeling so depressed I can barely stand it.
And wouldn't you know, they chose Gay pride weekend, the biggest Gay pride weekend ever to come visit. And Dumbledore and I missed it all chauffeuring them around from one disappointment to the next.
And you know, that's another reason I'm depressed today. Am I the only middle-aged gay man who resents the entitlement young gay kids have? I mean it's really silly. All I ever wanted was for gay kids to feel entitled to the things their straight peers took for granted. Now they do take it for granted, and I resent their lack of appreciation for their older brothers and sisters who paved the way for them to have an easier life. Just looking at that in black and white makes me feel silly. But today just feels like such a burden.
I'm tired of feeling depressed. I've got to do something to make myself feel better. I've really isolated myself lately which is one reason I thought posting a blog might make me feel, I don't know, part of a community. Or much is to watch the clicker stay at zero and feel more depressed than ever. Actually, I'm already feeling a little bit better. Just getting this out there. I know what I have to do. I need to get my butt down to the gym, and get those endorphins going. I need to do a bunch of paperwork that's been sitting there. And I need to get over myself and do something that makes the world better place i
But I can't help but see my life through their eyes, and it's pretty miserable. I mean, by their standards. We don't have any money. We have no kids. Our lives are more than half over and we really don't have that much show for them. I'm left feeling so depressed I can barely stand it.
And wouldn't you know, they chose Gay pride weekend, the biggest Gay pride weekend ever to come visit. And Dumbledore and I missed it all chauffeuring them around from one disappointment to the next.
And you know, that's another reason I'm depressed today. Am I the only middle-aged gay man who resents the entitlement young gay kids have? I mean it's really silly. All I ever wanted was for gay kids to feel entitled to the things their straight peers took for granted. Now they do take it for granted, and I resent their lack of appreciation for their older brothers and sisters who paved the way for them to have an easier life. Just looking at that in black and white makes me feel silly. But today just feels like such a burden.
I'm tired of feeling depressed. I've got to do something to make myself feel better. I've really isolated myself lately which is one reason I thought posting a blog might make me feel, I don't know, part of a community. Or much is to watch the clicker stay at zero and feel more depressed than ever. Actually, I'm already feeling a little bit better. Just getting this out there. I know what I have to do. I need to get my butt down to the gym, and get those endorphins going. I need to do a bunch of paperwork that's been sitting there. And I need to get over myself and do something that makes the world better place i
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