Check Your Head

It's been a few days since I've posted. Today, I went to the psychologist. I was nervous about this one. Mainly, just because I did not really know what to expect. My surgeon had recommended a couple places for this pre-surgery requirement, and I confirmed with this selected doctor that they took my insurance. Luckily, they were able to get me in with only about a week and a half notice.

I think it's important to understand that you don't have to be nervous about this appointment. First off, it's no mystery to the doctor why you're there. There's no weird, awkward silences. Secondly, they're not there to judge you, or to determine if your reasons for wanting the surgeon are virtuous enough. What I learned quickly, is that it was simply an insurance requirement for the psychologist to gain information from me about my lifestyle and motivation for the surgery, to just deem whether I am mentally stable or not. They are trying to rule out any major mental health concerns that could have someone seeking such a surgery for unhealthy reasons.

After talking to the doctor for about fifteen minutes in a relaxed atmosphere, he sat me privately in a small room where I took approximately thirty minutes and answered ~160 True/False questions that were part of a personality test, of sorts. Again, it sounds worse than it was. The test actually went quite quickly, and the questions were along the lines of - "True or False: I often think I am not worthwhile of my family's affections," or: "True or False: I have one or more friends I can turn to in times of need." Now, those aren't verbatim, but they give a general idea. As you can see, it's easy to discern how they are likely trying to disseminate whether someone is suffering from major mental health concern or not.

Doctor said he'd write up my results over the weekend and send them over Monday! Easy-peasy!

Next up is my Nutritionist visit on Monday. I am super excited for this appointment, as I know it's going to be the best insight so far into what I will be expecting after the surgery, and as I move forward with my weight loss.

Start the Tests!

After my first consult, I went ahead and scheduled all of the tests and consultations the doctor required. My first ones were bloodwork, an EKG to ensure my heart is healthy and an ultrasound to check out my liver, gallbladder and the like to ensure those are good also.

For those who have never had to have an EKG or ultrasound, let me comfort you in knowing that both are painless procedures. An EKG involves a medical professional placing several stickers connected to wires around different spots on your body. Now, for females, you may have to lift a breast as two stickers do have have to go near the upper left rib cage area. Then they scan you and a fancy machine prints out your heart results. They remove the stickers and you can leave. Start to finish, it took me all of five minutes.

The ultrasound requires you to lie on your back while wearing a hospital gown. The doctor let me keep all undergarments and my pants on. They did not make me remove the hospital gown, just leave it open them back. After you lay down, the technician puts a warm jelly-like substance on you and presses around with a smooth handheld device. It does not hurt at all. Sometimes they may have to add a little bit more of the warm jelly. This did take a while. I believe this part of the procedure took about 15 minutes, and then she had me lay on my left side where she did about five more minutes of scanning. After that, I sit up, she left, and I was able to put my shirt on and be done.

Honestly, the hardest part of everything was getting my blood drawn. I'm not a huge fan of needles. I don't have a phobia, per se, but I'm very hard to poke. Luckily, my hospital was awesome and had a very skilled phlebotomist who was able to get me on my first try. All in all, I spent about three hours at the hospital. Most of that time was in waiting rooms. I did not experience any major pain and was able to drive, and did not need anybody with me. If you want somebody there for moral support, though, just make sure they have a good book!

When Diets and Exercise Aren't Enough

The closer I get, the more confident I am becoming that I have chosen the right path. A publication given to me from my doctor stated the following, and it is such a summary of my fight against weight loss and many of my family members who I've seen battle with it their entire lives:

"WHY DIETING AND EXERCISE MAY NOT BE ENOUGH TO FIGHT OBESITY
 
Because your body works to defend it's set point, dieting and exercising are rarely effective in helping people with obesity achieve and maintain a healthy weight long-term. When you go on a diet, your body thinks its being starved and its survival instincts kick in. As a result, your body stores energy-rich body fat, and you can't lose weight easily. A landmark Swedish study found that, on average, a 200-pouind patient fighting obesity with diet and exercise alone would only be able to achieve a sustained weight loss of 4 pounds over 20 years.
 
UNFORUTUNATELY, YOUR BODY'S HORMONES ARE WORKING AGAINST YOU
 
When weight is lost, lower body fat levels trigger hormones that encourage the body to get back to it's previous weight set point. A New England Journal of Medicine study showed that while dieters may initially lose weight, their bodies change levels of hormones that encourage weight regain in response to the weight loss. These hormones increase appetite, decrease feelings of fullness, and slow down metabolism. The study also found that these hormones had not returned to pre-diet levels even 12 months after the initial weight loss, meaning their bodies were still encouraging weight regain a year after they stopped dieting. This is a powerful defense mechanism and may explain why the majority of weight loss attempts fail.
 
BARIATRIC AND METABOLIC SURGERY CAN RESET YOUR SET POINT
In order for a person with obesity disease to achieve significant long-term weight loss, the body's weight regulation system must be reset so that the body will stop storing excess fat. By altering the complex relationship your body has with food and its metabolism, bariatric surgery helps reset your body's ability to effectively manage weight. New research indicates that some types of bariatric surgery (gastric bypass, sleeve gastrectomy, and billiopancreatic diversion) have metabolic impacts that enable a new, lower set point, allowing the body to return to a lower body fat level. By altering the anatomy of the stomach and/or intestine, these surgeries affect hormonal signals, resulting in decreased appetite, increased feelings of fullness, increased metabolism, and healthier food preferences. These positive changes allow your body to lose weight without the internal fight to return to the higher set point.
 
Bariatric and metabolic surgery is the most effective treatment to date, resulting in sustainable and significant weight loss along with resolution of weight-related health conditions in up to 80% of people. Bariatric surgery has been also shown to resolve diabetes, sleep apnea, joint pain, high blood pressure and high cholesterol."

Initial One-on-One with the Doctor

So, today, I met with my doctor and we had a major change come up. He indicated that due to my age, he did not know if Roux-En-Y would be the best choice for me because of how drastic it changes your digestive track, as well as the fact that you have to be on a strict vitamin regimen for the rest of your life. He suggested I have the Gastric Sleeve done, and after having explained the differences to me, he sold me. It will take more self-regulation of not eating sweets or other high calorie food, but overall, I think it's going to be a far better choice for me. It involves the Restriction without the Malabsorption. The valve and small intestine are completely kept in tact, and there is a far shorter recovery time.

They had me meet briefly with the insurance consultant who gave all the orders for the supplemental testing and meeting I needed to have to qualify. I scheduled appointments to meet with the nutritionist, psychologist, and get my blood work, EKG and ultrasound completed. These are all standard and need to be done by all candidates for the surgery. They check to make sure you're of healthy mind and body before going into bariatric. So, I have several appointments over the next week and a half or so, but I'm excited to get the ball rolling!

Here is a great side-by-side comparison I got from http://www.gastricsleeve.us/gastric-sleeve-vs-gastric-bypass.html about the difference between the Sleeve and the RNY. You have to choose what's best for you after discussing with your own doctor.

Weight Loss Procedure	Gastric Sleeve	Roux-en-Y Gastric Bypass
Approach to Weight Loss	Restriction Limits food ingestion Controls hunger sensations	Restriction & Malabsorption     Limits food ingestion Reduces food absorption
Changes to Stomach	Stomach size reduced 75-80% of the stomach is cut away along the greater curvature and removed from the body	Stomach size reduced and new stomach outlet (stoma) created     Stomach is separated into two and stoma is created in the smaller upper pouch; lower remaining portion of the stomach is bypassed
Changes to Small Intestine	Kept intact	Cut and rerouted     Small intestine is cut in the middle; upper section is bypassed and lower section is attached to the stoma
Changes to Pyloric Valve	Kept intact	Bypassed
Average Operating Time	1 to 3 hours	2 hours
Average Hospital Stay	2 to 3 days	2 to 3 days
Average Time off Work	2 weeks	2 to 3 weeks
Average Recovery Time	3 weeks	3 months
Causes Dumping Syndrome	No	Yes
Dietary Guidelines	600-800 calories per day, during weight loss period 1000-1200 calories per day for weight maintenance Meals should consist of high-protein, low-carbohydrate and low-fat foods Drink 6-8 cups of water or other low-calorie liquids per day	800 calories per day during weight loss period 1000-1200 calories per day for weight maintenance Meals should focus on protein-rich foods and nutrient-rich fruits and vegetables Drink 6-8 cups of water or other low-calorie liquids per day Chew foods thoroughly into a pureed consistency
Eating Habits	Eat five small healthy meals each day Do not eat and drink at same time Do not overeat, skip meals, or snack between meals	Eat three small protein-rich meals each day Do not eat and drink at same time Chew foods into a pureed consistency Do not overeat, skip meals, or snack between meals
Problematic foods	Not many problematic food as the stomach continues to function normally, but high-calorie and high-fat foods and drinks must be avoided and daily calories limited for weight loss to occur	Foods that are dry, sticky, or fibrous can cause discomfort or blockage, including tough meat, bread, pasta, rice, raw vegetables, nuts, popcorn, and skins of fruits and vegetables, and chewing gum Sweets can cause Dumping syndrome Carbonated beverages can cause bloating High-calorie, high-sugar, high-fat foods and beverages will ruin weight loss efforts
Nutritional Supplements	Multivitamin Calcium Vitamin B12	Multivitamin Calcium Vitamin B12 Iron
Average Weight Loss	Studies show greater than 60% excess weight loss at 12 months after surgery and a maintained excess weight loss of 53-69% at 5 year follow-up.(1)	Rapid weight loss during first 6 months Weight loss settles 18 to 24 months after surgery 70% excess weight loss at 1 year 60% excess weight loss at 5 years

REFERENCES

1. ASMBS Clinical Issues Committee, "Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure," Surg Obes Relat Dis. 2012 May-Jun;8(3):e21-6. doi: 10.1016/j.soard.2012.02.001. Epub 2012 Feb 10.
2. Bethany J. Slater, Nina Bellatorre, and Dan Eisenberg, "Early Postoperative Outcomes and Medication Cost Savings after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Type 2 Diabetes," Journal of Obesity, vol. 2011, Article ID 350523, 5 pages, 2011. doi:10.1155/2011/350523.