Last Post for December

OK. So if you look at the post for December, up to this one, I had 13. Not cool and that would have been the number going into surgery tomorrow.

Decided that I would go with one last post for tonight.

This is the official last post before I head to surgery. I will have to be there at 5am and will probably not be posting again until the gastric bypass is done.

Wish me luck and see you on the other side.

Gastric Bypass is Tomorrow

I did go out last night to Logan's and got an 18 oz Ribeye steak. It was excellent, cooked perfectly.

Today I am starving. Dr Clements mentioned that I could have clear liquids today and broth but I really didn't see the point of that. So, I decided not to eat anything today. I have had a 20 oz sprite and a lot of water. The hunger is overwhelming and I am wondering what I am doing here. Hunger makes you depressed and I am doubting everything.

I had to go out and buy Magnesium Citrate, which is a laxative, from my local CVS and drink a 10 oz bottle. I expect that I will be in the bathroom all night.

At this point, I am starting to dread the whole thing and wish that I didn't have to do this. But, I do not see any other options and am going to do it. I am really starting to get scared and worried.
My step mom had gastric bypass and mentioned to me last night that she was having to take B12 injections for the rest of her life. That was worrisome for me.

But, I am on a glide path now and there is no back out plan.

I did go and get an MRI today on my knee. Just to rule out any problems with the joint. I continue to have a significant amount of pain in that joint and it appears that it is just the gout. That is good, in a way. But, that means that it is the gout and that it is worse than ever. With an injury then they can do surgery and fix it. With the gout, it means that it is more of a chronic disease issue. In other words, not fixable and to just deal with it. I hope that the gastric bypass will help me with the gout.

36 Hours Away

I am now 36 hours away from the surgery and am starting to get scared of the whole thing. I ordered my vitamins and protein shake from bariatricadvantage.com today and should get those by the end of the week. Those are not cheap but I think that it will be worth the money.

I ordered:

-Calcium Citrate
-Multivitamin
-Protein Mix

With the shipping, it was $96 dollars.

Dr. Clements recommended this site in one of his support group meetings.

The gout attack that I was dealing with a couple of weeks ago continues to plague me in some minor joint knee pain. I am now wearing a knee brace and that has helped a lot.

Jamie called and told me to be there at 5am on 12/31 Wednesday morning. I guess I am starting the New Year off right.

I cannot eat solid foods on Tuesday and have to eat clear liquids only. Tonight is my last supper. I am dreading the starvation tomorrow.

I think that I am going to go out and have a Ribeye steak. Of course, that will not do much to help the gout. But, it should be a nice treat.

Pre-Surgery Instructions

Surgery Date:12/31/2008
Weight: 268

Forgot to mention that Dr. Clements gave me a script for Prevacid to begin taking now.

Need to order the vitamins and get all of that shipped to be here before the surgery. They have to be chewable.

I received a list of foods to go buy that I will need after the surgery.

Told not to eat anything the day before surgery but clear liquids, broth etc. Nothing after 10pm. They gave me directions for all of this stuff

Nothing big really but thought that it was worth mentioning.

Is anybody out there?

Surgery Date:12/31/2008
Weight:268


I am wondering if anyone is actually reading my blog on gastric bypass? I'd love to have a few comments posted to let me know that you guys are benefiting from my story.

I am going to keep posting to let you all know how this goes.

Keep in mind, if I have complications with this or don't make it through surgery, then this blog will just stop. If you don't see me posting within the first couple of weeks of January, then you will know what happened. It is unlikely, but that is the only reason that I can imagine that I would just stop these post.

Knee is Better - Surgery is a GO!!!

Had my pre-surg appointment with Dr Clements at UAB. Let me give you some details on that.

Showed up late and ended up waiting about an 1 hour on him. Go back to the exam room and it went really quick. Nurse Practitioner came in and said, "So, you are here for pre-surg on a lap band procedure." Of course, that is not ocorrect. She seemed highly agitated that the paperwork was not correct and started furiously going through it to correct the mistake. I told her that I was originally slated for the lap band but had changed through Jamie and had been approved for the bypass. Jamie failed to communcate that back to my chart. Not good.

Anyways, Dr Clements came back and read me the riot act on my surgery. 1% chance of death, etc, etc. I have noticed that everything here is very scripted. We did discuss my recent attack of gout and my concern that it was going to impact my recovery. I wanted a proactive plan to deal with it. He seemed to brush over that and I really didn't like that. Basically, he boiled it down to hydration and drinking your water. I know that it is not that simple and it irritated me that he didn't understand that I wanted a plan. He just doesn't understand the agony of a gout attack. Anyways, I let it go.

Of course, I got ready to go and was walking out the door and was then directed to go to pre-op on the bottom floor of the Kirklin Clinic. They sent me down to pre-op, which was an extremely irritating encounter. First, the front desk girl was browsing ads on the internet for real estate and there were several patients in line. The real estate browswer girl just kept going through her ads. It is never a good sign to see that going on in a work setting. If they are screwing off like that in the open, then the shop is probably not well managed and the experience is going to be really bad. The girl that worked with me handed me a bunch of papers and was told to go fill these out. I hate that. All of this stuff I have filled out at least 5 or 6 times. Why do they make me fill out the same papers over and over? If I am handed a form to complete a list of home meds one more time, I think I am going to just scream. You fill out all of this stuff and then they can't even be sure of what procedure you are having. Jeez. So, after 30 minutes or so in the waiting room, I go back to the back and am put in a very hot,stuffy room. Where I wait for almost 2 hours to see the anesthesiologists. Now, I know that this doc is going to talk to me the day of surgery. Why do I need to talk to them now? I ended up waiting in this room and finally at COB I get a nurse practitioner to come in and ask me a few questions about prior history and allergies. Then, she tells me I can go!!! I have waited multiple hours to talk with a doc that never shows up and then get a nurse asking me questions that I have already been ask many, many times. But, it is just part of the red tape with todays healthcare. It is no wonder that the cost of that is so very high.

Anyways, I did confirm the 12/31 date and got the list of things you need to do for the surgery. I guess I am ready to go. I am over most of the pre-surg jitters and am just now ready to get it done and over with.

This all happened on Monday.

Yesterday, I went to the Ortho surgeon and he said that I had either a Meniscus tear in the knee or either an extreme attack of gout. Gave me a steroid shot under the knee cap. That was painful. I am better now and the shot should get me through the bypass. I might have to have surgery next year for the tear. But, have got a short term fix for now to relieve me of the intense pain.

Pain is Getting Better

Gout attack is easing off. I was able to walk for the first time last night. It was nice not to be on crutches.

I spoke with Dr Clements assistant and she said to expect another attack of gout after the surgery. But, that if I would drink water it might be avoided.

Got an appointment with Dr Clements on Monday at 1pm and am going to discuss the gout issue and how to avoid it. How do they treat an acute attack without NSAID's? I was told that I could never take NSAID's again. How is that going to work?

Not sure, but that will be the conversation that I will have with him Monday.

Reschedule on the Surgery

Decided since the gout was so severe, that the surgery didn't make a lot of sense for next week. But, still due to talk to Dr Clements on Monday. I may change my mind on this decision and continue with the orginal 12/17 date. But, Dr Clements does have a slot on 12/30 and I decided that it might make since to get that slot. So, called Jamie today and told her to go ahead and reserve the 12/30 date.

On a side note, spent the day in the ED with gout. CT Scan and Ultrasound. No pemanent damage and no blood clots, just bad gout. Doc said that I had to go to physical therapy ASAP to prevent my leg from staying permanently in a retracted state. Basically, my left leg is in a "V" shape and hurts a lot. I cannot straighten it, at all. Doc says that the leg might stay like that if I don't get into physical therapy.

Heard a new drug was coming out soon for gout.

More Gout Pain

I continue to struggle with an acute gout attack in my left knee. Went to the ER Friday night and they gave me a steroid injection. Also, gave me Colchicine and I tried that this morning. Not sure if it is going to work our not. Surgery is in doubt for next week. I have been on crutches since last week.

More pain that you could realize. If I wait till next year, then my insurance changes and all is in doubt. Where do I go from here?

Extreme Gout Attack

The past 3 days I have had an extreme gout attack in my left knee. Unable to straighten my leg because of the massive swelling, I ended up going to the Emergeny Room. It was the most incredibly painful experience of my life, utter torment for hour after hour.

I got a shot of steroids at the hospital and was given Colchicine. I am laying here in the bed and still cannot straighten my leg our walk. It is Sunday and this started on Friday.

Gout

I read a post by a doc on the web that mentioned the inevitable severe attack of gout after bypass surgery. I am really concerned with the possibility of that happening. Does anyone out there have any experiences with gout after bypass surgery? My doctor said that I can never take an NSAID again. How's that going to work with the gout?

I am extremely worried about this. Gout is extremely painful and I don't think that I can deal with another extreme gout attack.

Support Group Meetings

Dr Clements requires 2 visits to the UAB support group for bariatric surgery. I have been to one. It is a bunch of overweight people sitting around talking about their upcoming surgery or the surgery that they have had. It was ok to meet others similar to myself but I really did consider it a waste of time. But, Dr Clements assistant sent me an email yesterday and wanted to know how I was doing. Of course, I asked about the support group. So, she has me done for next Thursday at 6pm. I should have kept my mouth shut. It would not be bad if I did not have to drive for 1.5 hours to get there. I wish that I could skip it.

Case Management and Pre-Op Appointment

I got a call from Jamie with Dr Clements' office and she wanted to schedule my pre-op appointment. I live in Montgomery and have to drive to Birmingham(80 miles). The appointment is set for 12/15. But, since my surgery is scheduled for 12/17 I am thinking of just taking off from work starting on 12/15.

Also, I got a call from case management today from Anthem-CA. There were offering a nurse to be available after the surgery by phone. I appreciated the call and that they were offering the services.

I am feeling better about the surgery but am still a bit nervous.

Sleep Apnea

Sleep Apnea is the main reason for moving forward with this surgery. For about 18 months, I was unable to wear my mask and was completely exhausted from day to day. It was a living hell. With the help of a nightly dose of Ambien, I am now able to sleep with the mask. Without the Ambien, I would not be able to use the mask.

Above all, I am just shocked at the state of medicine. The best that they can do is this medieval instrument that forces air into the lungs. Billions of dollars spent on healthcare and that is it. Shameful.

It is my hope that I can box up the mask after surgery and move on from that.

I think that sleep apnea is much more complicated than just a blocked airway. I did not start having problems with apnea until after I started on Testosterone Replacement Therapy. One of the side effects of TRT is sleep apnea. Why are the two related? Further, when I was young I was just as big, why didn't I have problems with OSA then?

Struggling with the Decision

I am not sure I have made the right decision. The drastic change to my internal organs just seem so much to me and the extreme risk of death. I do not know why but I have this overwhelming thought that I am not going to make it through this procedure. I am starting to get really scared about this.

Getting Nervous

The date was moved up by several weeks thanks to my employer changing insurance coversage. So, now it is in about 3 weeks instead of several weeks away. I am starting to get really nervous about the whole thing and wondering if I made the right choice. Jeez, I know I have to do it. But, it is really starting to scare me. I was preparing to go through this whole process to prepare and that has all been escalated.

I am afraid of the pain and the potential for death. But, the death that I face each night as I glow to sleep with sleep apnea is a worse risk long term. But, I am scared anyways.

Did I make the right choice?

Iron Bowl

I can't let this day go by without mentioning the win of Alabama over Auburn in the Iron Bowl. It was a great victory 36-0 and the Alabama Crimson Tide certainly deserved this one. Hopefully, we can go on next week and beat the Florida Gators in the SEC Championship game. (Did I mention that I am a HUGE Alabama fan!!!)

To Tell or Not to Tell

I have wondered what to do about informing my employer about the procedure. I finally ended up telling my manager but I really do not want others to find out. In the announcement to my direct reports, I told that them that I was going to be out for an extended amount of time for health reasons. Nothing more. With the boss, I felt that I should be more specific.

But, I am sure that when it comes up in meetings, I will get the 3rd degree. I hope that they do not ask and I certainly will not tell.

How much am I obligated to tell?

An insurance curve ball...

I learned yesterday that my company will stop the type of policy that I had originally been approved with. My original surgery date was set for 1/6. But, with the change in policy I could not risk losing my coverage or an increase in amount. So, I decided to change my date to 12/17. My coverage with this policy would end on 12/31 so I wanted to get the surgery before that date.

This really sucked and was a last minute change by my company. (One of many bonehead decisions by these execs, but that is a blog for a different day.) This meant that I would have no last Christmas feast!!! Plus, there is an obvious risk of death. So, I would hate for something to happen to me in surgery right before Christmas. That would be really bad for my familty and children. But, decided to go forward anyways.

The Story Continues...

Well, around August of 2008 I tried to make an appointment with Dr. Ronald Clements at UAB. I chose him because he is supposed to be on of the best. UAB has a center of excellence in this area. Anyways, his assistant sent me a book to fill out and told me that they would make the appointment when they had received certain forms back with my proof of insurance.

To reach Dr Clements:
Department of Surgery
Division of Gastrointestinal Surgery
University of Alabama at Birmingham
1503 3rd Avenue South
Birmingham, AL, 35294
ronald.clements@ccc.uab.edu
Website


I finally got all of that together and sent it in and the appointment was set for October. On the day of the appointment, we were all put into a group. It was awkward. Everyone knew why we were there, it was obvious. Like a herd of cows meandering around Kirklin Clinic. Anyways, we had a group meeting with reps from the doc's office. Finally, we met with the surgeon as a group and then individually. I was certainly leaning toward the lap band but he strongly urged me toward the bypass. He seemed sold on the bypass and not so much on the lap band. He quoted the research that it was less effective. I had a lot to think about. Anyways, I was done with that and ready to move on to the real effort of getting the insurance approved.

Insurance approval came in the form of 1) Letter of Medical Necessity 2)Nutritional Consult 3)Pychological Consult. The problem was that no one really knew what the insurance took to satisfy these requirements. So, I started with monthly weigh ins with my family doctor and made an appointment for the Nutritional and Pysch Consults.

During the interim time period here, I decided to go with Gastric Bypass. I only had once shot here and it seemed that I could not risk a failure. There was a chance that the lap band could fail. I just could not risk it.

It was clear to me on the days of my Nutr and Psych Consults that the process was all red tape and a waste of time and money. To top it all off, I had to do the two consults on different days, which meant that I had to take time off from work two times. I was charged over 600 dollars fo the Psych Consult and it was a joke. I had a 45 minute discussion with Dr Lokken and then a series of pysch test. The testing seemed to be centered around research at UAB and had little to do with my case. The conversation with Dr. Lokken was basically a series of questions that she read off to me. It was a joke. Plus, the questions that she was reading had all been answered by me in the questions that they had been sent to me previously in the mail. The wait was horrendous and then to top it all off, it took them 2 weeks to get the report back to Dr. Clements. The Nutr Consult consisted of me sitting with another patient in a room and lectured by a diabetes educator for an hour about the 4 food groups and that "a 3 ounce piece of chicken fits nicely in the palm of your hand". I swear if I hear some pinhead nutritionist or Weight Watchers person say that to me one more time, I think I will lose it.

All the red tape out of the way and it was time for the Insurance coordinator(Jamie) with Dr Clements to submit to insurance. This was really a very quick process. Jamie said that it might take a few weeks, so that it what I was expecting. Instead it took a few days and I found out earlier this week that it had been approved.

Context...

Weight = 276

Well, let me start by telling you a bit about myself. I am a 40 year old male with 3 kids and I live in Alabama. I am around 270lbs and have been overweight since I turned 24. I have been consistently unsuccessful in losing my weight and have tried many methods to lose weight. Anyways, it has been a seesaw for most of my adult life.

Well, about 6 years ago I developed gout. This was the beginning, I was 34. Then, about 2 years later I developed low testosterone. Around this same time, I was having significant problems with fast heart rate and palpitations. I ended up going in the hospital a couple of times with these problems. Finally, I had a sleep study and found that I had sleep apnea. My fatigue had continued to get worse and things were just not good.

Anyways, with the positive sleep study, I get a CPAP and am sent home to go make this CPAP thing work. I cycled through a few doctors with all saying that I should go home and learn to sleep with the mask. The problem was, I couldn't. Plus, I was becoming increasingly worse and had started to disconnect from reality at times. I was absolutely so tired, I could not process day to day activities. I began to contemplate disability, since I was increasingly unable to work. I had severe panic attacks and just varying degrees of misery. Plus, the heart palpitations were really bad. I got an atenlol to lower my heart rate.

Add to all of this, the gout was worse than ever.

I went to a ENT, on research about pillar implants for the sleep apnea. It cost me $1800 dollars, since the insurance company did not consider it an effective treatment for obstructive sleep apnea(OSA). The procedure was incredibly painful and I was in pain for several weeks. The back of my throat felt like there was something there. Anyways, all of this, and it did not help.

My OSA continued to become increasingly worse. I was awakening several times a night and to top it all off, I had developed a serious case of insomnia. It was hell. I started to take Ambien for the insomnia but that made the OSA worse, which in turn made the sleep worse. It was a vicious cycle.

Meanwhile, the docs were pretty much worthless. Actually, beyond worthless, because they stole my hope and took my money. One pill to the next and one script after another. In case you haven't figured it out, I have a very low opinion of doctors and the medical profession. I should know I work in healthcare and know them. Most of them are sleazy and money hungry, they are also given way to much credit in the intelligence department and way too little credit in the ego department.

So, a few weeks ago I began to toy with the idea of a lap band, based on a nurse friend's recommendation. Nothing else worked, so I figured that the only path out of this living hell was something really drastic. The Lab band seemed like the solution. Out of this chaos, I started to make appointments and calls to begin the process of looking into this surgery.

To be continued...