FAQ Part 2: COVID-19

Hey everyone!

What a crazy time we are living in right now with COVID-19 going around. There are so many thoughts and emotions going through each of us right now, so I'll just keep this short, sweet, and to the point. The goal here is just to answer a few more questions I've been getting lately around my weight loss surgery and COVID-19.  Enjoy!

Thinking about COVID-19, are you considered more at risk due to your recent surgery?
Great question! This is actually probably the number one thing my doctor and I discussed at my last appointment on 3/10/20.  At that time we knew this pandemic was coming, but it hadn't quite hit us as hard as it has today, or will continue to.  To keep it simple, he basically said no, I'm not at a higher risk.  Due to being so far out from surgery, my body has had enough time to heal and build my immune system back up.  He also noted due to my age and overall good health, that according to the information we had at the time, I am in a lower risk category already.  He of course suggested following all of the recommended protocols from the CDC, but did not think I need to stay out of work longer or take any additional precautions.

Are you still working?
Yes, thankfully right now I am blessed to have a job that is continuing to push forward and allow us to work.  We are all on an official "work from home" type set up, as in none of us meet in the office anymore.  However, my role is 80% individually field based so I am still going out as needed to our properties to complete visits, stock inventory, etc.  Thankfully all of the homes I visit are vacant and our company has provided cleaning supplies to each of us, so I am at very little risk while I'm working.

Will you continue to be paid if you can no longer work due to illness or a stay-in-place mandate?
This one is a bit harder to answer.  Right now, the answer is yes.  My company has said for now it will continue to pay hourly employees if a stay-in-place mandate is issued and we can't work from home.  There are multiple layers to this for me, as yes a mandate would eliminate my ability to do field visits.  However, at the same time there may be other projects I can work on from home to continue pay.  Ultimately, I just don't know yet, and neither does the company, which is honestly a bit terrifying.  I'm trying to not get too ahead of myself and worry about it, but I am being very intentional with my finances right now and saving every extra penny I can in the event my paychecks stop.  I think the ultimate answer to this question will rely heavily on IF a stay-in-place mandate is issued, and for how long it lasts.  In terms of illness, our company has provided each employee extra paid sick time so I should be covered there.

Did you have enough supplies if a stay-in-place mandate is issued?
Yes, I have plenty of supplies - food, cleaning, meds, paper goods, etc.  One perk of my recent surgery and living alone is that my meals are quite small in size now.  One pack of chicken lasts me easily for 4 meals, so I should be good to go and don't need nearly as much as other people do.

How are you handling all of the COVID-19 craziness right now in general?
Overall, right now I'm in a fairly good head space regarding life and COVID-19. Don't get me wrong, I definitely have moments of anxiousness around the whole thing, but I've tried to stay away from social media and the news as much as possible to stay level-headed.  I find I'm the most anxious when I read other people's worries/fears around this, or when I watch the 100000th update.  My priority right now is taking care of my self and making sure I follow the guidelines.  For me, this has involved a lot of self-care at home.  My favorite self-care activities right now are long walks with Jax in this GORGEOUS Spring weather, long hot epsom salt baths with essential oils, opening the windows to let the fresh air in, and spring cleaning small areas here and there. If you aren't getting outside at least once a day to enjoy this weather, stop what you're doing and go for a walk now!  I literally cannot get enough of this weather, it is giving me life!

Can you share an overall update on your recovery, how you're feeling physically, how much weight you've lost, etc?
Sure! I am honestly doing really well physically right now.  My strength is back, my heart rate issue has gone away, I'm tolerating food very well, and I'm increasing my exercise slowly each day.  I can honestly say that where I am today, I am glad that I did this surgery.  I still don't see a massive change in my appearance, but I did put the photos below side by side the other night and can see the loss quite a bit in my face, woohoo!!! There are days I still doubt that this surgery will get me to the number on the scale I'd like to be, but I know in time it will happen.  As of today, I've lost 50 pounds in total, 31 of which I've lost since surgery (steadily losing around 2 lbs per week right now).  That is no small feat, and I am quite proud of myself!  In terms of food, I'm up to around 1/3 cup of volume per meal, and occasionally I can stretch that to 1/2 cup depending on what I'm eating.  The goal is to be at 1/2 cup by the 3 month mark, and I'm just over 6 weeks and on track! I find that my stomach tolerates meat the best when it's very moist and covered in some kind of sauce.  The only food my stomach has not tolerated well was either green peas or a roast I made one night.  I'm not 100% sure which one caused the issue, as it didn't hit me until the following morning, but I have not tried either again since. On the other hand, the absolute best thing I've had since surgery was our family's Ritz Chicken casserole.  That is the only dish I have finished every bite of leftovers on, and I'll definitely be making it again soon!  I've also found some bean and protein pasta options that are allowed right now, and while I can't eat much of it, they have definitely helped ease my craving for pasta!  I definitely still crave the things I'm not allowed to eat right now (breads, fried food, real pasta, etc), but I'm counting down to the three month mark where I can be more adventurous in the foods I try.  Honestly though, I'm doing really well and am very thankful for that!

(Left - December 29, 2019 ---  Right - March 14, 2020)

Back to work!

I officially started back to work today!  My morning started with a VERY early 8am team meeting, followed by a meeting with my manager to catch up on everything.  I was out for 5 weeks, which is basically an eternity when you work for a start up company. There were a lot of changes while I was out, so I was a little worried going in today about the learning curve to catch up.  Thankfully, I work with a fantastic team and I hadn't missed as much as I thought and I will be able to get back up to speed fairly quickly. It was also so nice having that team meeting on my first day back - it really helps to energize me when we all come together for trainings and get some time out of the field.

Overall, today was much easier on me physically and mentally than I expected.  The 6am wake up call to get to work by 8am was rough, but that has nothing to do with the surgery - this girl just LOVES her sleep, haha! Around 12:30pm I was able to come back home to break for lunch and then spent the afternoon here combing through emails and various messages I received while on leave.  Don't be fooled though, once I clocked out for the day I immediately enjoyed a much needed nap on the couch! Tomorrow will consist of continuing the same catch up processes, with quite a few online training modules I need to complete.  I am very thankful to have a slow start back into work, and am looking forward to next week as I resume normal pace. 

Thank you to everyone who checked in today, and over the last few weeks.  It feels so good to get back to "normal" and find my routine again.

Weight Loss Surgery - FAQ

What type of surgery did you have?
There are three different types of weight loss surgery available today, and I chose the duodenal switch procedure.  You can read more about that procedure here, but basically they removed 80% of my stomach and re-routed my intestines.  In a very non-medically correct version, basically I can no longer eat as much as I used to and my body won't absorb as much of what I do eat.  Highly recommend reading the above link for more accurate information haha.

Is that surgery risky?
Of course!  All surgeries have risks.  The main long-term risk with this surgery is the possibility for malnutrition.  Because of this, I have to work diligently to get in 80-100g of protein, and at least 64 oz of hydrating fluid in every single day.  I will have on-going appointments with my medical team the rest of my life, including lab work, to ensure I don't experience this.

How much weight will you lose?
One of the main benefits of this surgery is that it typically provides a higher percentage of weight loss in patients when compared to the other surgery types.  My medical team expects that I will lose 80-100% of my excess weight.  Excess weight is calculated as follows:  pre-surgery weight - BMI ideal weight = excess weight. With that in mind, I can expect to lose around 140-175 lbs.  That number of course will vary from patient to patient, and will heavily depend on my ability to meet the diet and exercise goals throughout the next couple of years.

How much weight have you lost already?
To date, I have lost 46 pounds from my highest pre-surgery weight, which was between Thanksgiving and Christmas.  A lot of that weight was lost prior to surgery via the liver shrinking diet, but I have lost 27 of those pounds since my surgery date on February 6th.

How are you feeling? 
How I feel physically varies day to day.  Yesterday (3/4/20) I felt very strong, met my protein goals, and was more active than usual.  Today however, (3/5/20), I feel very sluggish, little to no appetite, and am very tired.  Both of these types of days are normal and will vary as my body continues to heal.

Can you tell a difference yet?
Not really, or at least not like I thought I would after losing 46 pounds.  I see the loss mostly in my ankles and feet as they've stopped swelling to the point I had to tighten my tennis shoes. Prior to surgery I had to go up in shoe sizes because my feet were so large.  Other than that, I've seen the loss slightly in how my clothes fit.  A pair of leggings that were tight prior to surgery fit comfortably now, and a few shirts fit a little looser. However, overall, my clothes fit almost identically to how they did prior to surgery.  This will all come with time, and they've told us often that it takes the brain the longest to catch up and realize how far a patient has come.

How much and what can you eat now?
Right now I am in the soft food diet stage.  The name of that is kind of deceiving, as there are a lot of foods that are allowed that folks wouldn't consider "soft", such as meats.  Right now I can eat about 1/4 - 1/3 cup volume of food per meal, and I'm eating 4-6 small meals per day.  Some items I'm loving right now are yogurt, scrambled eggs, 1/4 slice whole wheat toast, ground turkey, chicken, peas, carrots, peaches, applesauce, and mashed potatoes.  It is critical that I eat my protein first at every meal, and then if I have room I can add in veggies and carbs. At each meal right now, I eat around 2oz, or 1/4 cup, of protein per meal and then I can usually add in 1 tablespoon of a veggie or carb in depending on how full I am. I will be on this diet through the 3 month mark.   Some items that are not allowed right now are: pasta, rice, fried foods, stringy melted cheeses, processed meats such as sausage, raw vegetables, veggies or fruits with skins intact, any meat that requires a knife to cut it, nuts, protein bars, popcorn, etc.

Will that be your serving size forever?
No, but my servings will always be smaller than what many are used to.  One of the goals on my current diet is to slowly increase to 1/2 cup volume per meal by the 3 month mark.  At 3 months I can begin eating any foods that my body can tolerate, and the portion size over time will likely never be more than 1 cup volume per meal.

Are you hungry at all?
Surprisingly, yes.  Most days I feel hungry when it comes time for a meal (every 3-4 hours).  However, there are days where I don't feel hungry at all, and sometimes there are just random meal periods where I don't feel hungry. A lot of hunger can be confused for head hunger, i.e. craving food out of habit and not real hunger.  Because of this, I don't allow myself to snack between meal periods and make sure my meals are always measured out per the diet guidelines.  One of the common phrases WLS patients use after surgery is that "we now eat to live, not live to eat".  This has been a critical realization for me, as I do have to force myself to eat on the days where I don't feel hungry to avoid health issues.

If you're not hungry, how do you know when you're full?
I can ALWAYS tell when I'm full at a meal.  Always!  I will forever need to eat slow and chew my food very thoroughly, and my body tells me immediately if I've eaten too quickly or not chewed enough.  The most common symptom of that, for me, is feeling like the food is stuck in my chest.  When that happens, I intentionally stop eating, take a few deep breaths, and don't resume eating until that has gone away.  My body also lets me know when I'm full, which is typically just a very full feeling. They also taught us to watch for other signs such as, hiccups, runny nose, or sneezing while eating as these can be indicators of fullness.  I get hiccups a lot, and it's true it's an indicator that I'm full.  I never push myself to eat more once I'm full as I don't want to induce dumping syndrome.

What is dumping syndrome?
Dumping syndrome happens when a WLS patient has eaten too much, too fast, or eats foods high in starch, sugar, or fat. When this happens symptoms are often nausea, sweating, dizziness, abdominal pain, or other symptoms.  Thankfully I have no experience any of this since introducing solid foods back into my diet, but I'm also very careful to avoid it.

When can you begin an exercise program?
Technically I am allowed to exercise now, since I'm past the 3 week mark, as long as my exercise does not include anything that engages my core.  However, due to my slow recovery I have not attempted any exercise other than walking yet.  I will officially be cleared for all exercises at 6 weeks, and my lifting restriction of 20 pounds will be removed at that time as well.

When will you return to work?
As of right now, the plan is for me to return to work on March 12, 2020. If I'm cleared for that return date, I will have been out of work for 5 weeks.

How has your work responded with you being out of office for so long?
My company has been great about this entire process.  I filed for FMLA coverage, which was approved with no issue.  I was also able to obtain short term disability coverage for my time out of work, which ensured I didn't lose any pay.  I am VERY fortunate to work for a company that pays 100% short term disability up to a certain point, and my leave was covered in full. I am so grateful for that! My supervisor and coworkers have also been great about checking in on me over this process, and ensured my job responsibilities were covered while I've been out so I could focus on rest and recovery.

How have people responded to hearing you had weight loss surgery?
I have been blown away with all of the support I've received from everyone I've told about this surgery.  Initially I was hesitant to make my decision public, but thankfully everyone has been supportive.  My family in particular has blown me away with their support and words of encouragement.  I was also lucky enough to become friends with one of the girls in my pre-op class, and we talk regularly on facebook as a support system to one another. A lot of patients don't make their decision public out of fear of judgement or disapproval, but I can honestly say that has not been my experience.

What tips or advice do you have for others on this WLS journey?
1. Follow the plan provided to you by the team.  They truly know what they're doing and will set you up for success if you allow them.
2. Listen to your body.  You know if/when something is off, don't ignore it! Don't hesitate to call the medical team if you aren't sure what to do.
3. Drink, drink, drink! Whatever you do, don't let yourself get dehydrated. And take your vitamins!
4. Use your tool.  This journey is exactly that, use it to your benefit!
5. Don't force protein drinks after surgery if it's making you nauseas.  Contact your medical team and figure out a better plan.
6. Be patient with yourself.  The mental challenge of this process is not easy - talk to the medical team when you need it!
7. Real food is coming :) the liquid stage is only temporary! Try the pre-soft food items at the 10 day mark as the dietician allows.  You'll feel human again after some applesauce & mashed potatoes!

Have a question I didn't answer above?  Simply leave me a comment and I'll add them in!

Weight Loss Surgery, Pt. 2

If you made it through the first long post, major props to you!  Warning though, this post may be even longer.  However, these next few phases of my surgery journey were the most difficult and critical to where I am now.  If interested, keep reading below!


Post-Surgery:
I ended up being sent home on Sunday, February 9th.  I thought from hearing others' experiences before surgery that I'd be able to go back home on my own and be pretty self sufficient.  However, that was not the case for me and I ended up going back to my parents' house.  It felt so good to get out of the hospital, and I was thrilled to be reunited with my pup! The doctors ended up sending me home with about 10 different medications to begin/continue using. During post-op they sent us home with 3 prescriptions for post-surgery, so I honestly was not expecting to go home on so many more.  One of the hardest parts post-surgery for me was figuring out my medication regimen, as they all had different schedules and it was very difficult to keep up with. Writing it all out on scrap paper ended up being the easiest option at the time, but it still wasn't easy to maintain.  While I loved being home, I was still struggling day-to-day with fatigue and meeting protein and fluid goals.  I vividly remember feeling like my entire body was so heavy that it would take all of my energy just to lift my arms to grab the phone or TV remote.  I remember having a hard time focusing on TV shows or conversations in general.  I ended up messaging my medical team a couple days after leaving the hospital to flag how I was feeling and to note that one of my incisions appeared more open than the others after taking a shower.  My surgeon's nurse reassured me that my symptoms were not of concern at the time, and likely lingering effects of the anesthesia and medications I was on, but she gave me symptoms to watch for incase they worsened. The nausea was hands down the most difficult part of my entire recovery.  The only protein shake I could moderately tolerate was Ensure milk chocolate, but after drinking that for a day it too started to make me gag and turn my stomach at the thought of drinking more. At that time, I was lucky to get 6-8g of protein in per day, and I needed to be at 40-60g/day.  The nausea also made it increasingly difficult for me to drink clear liquids as well, as I didn't want to put anything on my stomach.  I didn't actually throw up other than the first night in the hospital, but I constantly felt like I was going to.

Post-Op ER Visits:
On February 11th, I was finally feeling pretty good at home. I was feeling so good that I even talked to mom about the possibility of having Corey to take me home after he came over for dinner that evening.  That day was honestly the first full good day I'd had since surgery, and I was feeling so encouraged. Earlier that day I messaged the dietician to see if I could try some tomato soup with Fairlife Skim Milk in an attempt to get more protein in without a shake, and they approved.  So that evening of the 11th around 7pm, while Corey and my family ate dinner, I tried some tomato soup.  One sip of that soup and the nausea came back in full force.  I immediately pushed the bowl out of the way and I had to sit at the table for a bit, trying to hold back tears I felt so defeated.  I had also tried just some plain milk, and milk with protein powder added in, which too made my stomach turn.  Shortly after that sip I had to leave the table and go to the bathroom because I thought for sure I would throw up that time.  Nothing ever came up, but when mom came in to ask if I was ok I just burst into tears and all I could do was shake my head no.  Y'all, I felt absolutely awful!  We decided then to call the Bariatric Fellow on call at the hospital to talk with them about my symptoms and determine what I needed to do.  They suggested that I come into the clinic the following day to be evaluated.  I slept ok that evening, with the help of nausea meds, and the following morning I called their office the second they opened and they were able to get me scheduled for a 10am appointment.  When you go to clinic they triage and take your vitals first, and my heart rate was really high at that time (130+). I just remember feeling incredibly weak, nauseas, and overall awful.  I was finally able to meet with one of the fellows that morning and immediately broke into tears when she asked me how I was feeling.  I described to her all of my symptoms:  achy, nauseas, on-going diarrhea, limited intake of liquids and protein, etc.  After a quick exam and taking my vitals again the fellow noted that she wanted me to get admitted back to the hospital for dehydration and to run some additional testing.  However, the hospital was on divert that day and they had no beds, so I had to go to the ER.  I was triaged in the ER within about 30-45 minutes of our arrival, and I thought for sure that was my call back, but nope...another 1-2 hour wait expected.  I had never been in the ER before and let me tell you I NEVER want to go back again.  EVER!  A little over an hour later and we got called back and got a bed in the ER. They immediately got me connected to IV fluids, ran urine and lab samples, and scheduled me for a CT scan of my abdomen to check for leaks or any other surgery complications.  While we waited for the CT results I was on at least my 2nd bag of fluids, maybe even third, and was starting to feel better.  The WLS team wanted me to try and get a full 8oz (30g of protein) bottle of ensure down.  It took me about an hour but I was able to complete that bottle - the first since surgery.  Honestly I struggled getting that protein in, but I didn't think I had a choice and forced it down.  The CT results ended up coming back clear, and because they saw improvement with getting protein in and fluids they decided to send me home that night (worst decision ever!). They also prescribed a different nausea med to try that evening since the Zofran and Phenergan were no longer knocking out my nausea completely.

The direction when I went home from the ER that day was to focus on protein and liquids, so both mom and I assumed I needed to get another bottle of ensure in that evening before bed.  So later that night I tried a bottle again and the nausea started to come back, as did the achiness.  I had to stop drinking it at that point, but got maybe half of the bottle in.  I remember being worried about the queasiness I felt that night and immediately took some more nausea meds and decided to go to bed.  Around 1am I woke up needing to use the bathroom, and the diarrhea and nausea were back in full force again.  After having diarrhea 2-3x in about 30 minutes, I went and took some more of the new nausea meds they had prescribed, and I almost immediately had to run to the bathroom and starting throwing up.  I was dry heaving more than anything, very little came up, but I felt absolutely terrible again.  It was about 2am at this point, and I knew something was wrong so I called mom's cell to wake her up and had her come to the bathroom.  We called the fellow on call again and they told us to come back to the ER immediately.  So at 2am on February 13th, mom and I grabbed our stuff and headed back to Durham Regional ER.  When we arrived that time the ER was packed, with very few seats available and filling fast.  It took over an hour to get triaged that night, and I had diarrhea at the ER four to five more times.  I was also still incredibly nauseas, but never actually threw up in the ER, though I almost wished I could to get rid of that feeling.  When we finally got triaged the nurse told us the wait for a room was 3-4 hours.  I just cried and begged her to call the fellow on call to see if they could just admit me.  We never heard back from that nurse or the fellow, so I don't know what happened with that conversation. After at least 3 hours of sitting in the ER waiting room with another man vomiting and a lady yelling about chest pain, we FINALLY got called back to a room around 6:30-7am.  It took at least another hour after that for a nurse to come in and actually put in an IV and start fluids. To say I was exhausted and feeling terrible is an understatement at that point.  The team was also worried that I may have CDiff and the nurse they gave me made me use a portable potty (aka a chair with a puke bucket attached below) to give them a stool sample in my room.  I have never been so embarrassed in my life.  That moment was just adding insult to injury.  They wouldn't even let me use a regular bathroom to pee until that test came back.  I told mom that moment was worse than having to use a hole in the ground in Africa when I was so sick.  Anyways, the nurse finally tried to give me an IV and you could tell she was so nervous and ended up sticking me but it wouldn't take.  She sent another nurse in who thankfully got an IV on the first try.  They started pushing fluids at that point and told me I was going to be admitted and they were getting a room ready for me upstairs (thank the Lord!!!!). Around 9:30am I finally got into a private room upstairs and they told us they wanted to do another upper GI X-ray to rule out any leaks or other complications the CT may have missed.  For the Upper GI X-ray you have to drink this awful chalky contrast drink while they run the scans.  I have to give major props to the X-ray technician though as she told me to go at my own pace and if I felt like I was going to be sick at all to stop.  I stayed in the hospital that night of course, and the following day the surgeon came in to let me know that all of the tests they had done came back negative and all looked good, which means they had ruled out surgery complications.  However, hearing my symptoms my surgeon was pretty sure the cause of all my issues was dehydration, a rough recovery, and a stomach virus as well.  He noted that the achiness I was feeling was not a standard symptom they see, and that he too had a stomach bug the week before.  We will never know 100% if it was a stomach bug or just an awful recovery, but he seemed pretty sure.  During my surgeon's visit that day he also recognized that the protein drinks seemed to be compounding the issues and he finally gave me the BEST news ever.  He told me to stop forcing protein and focus on hydration.  He said if I felt even a tiny bit nauseas or gagging with protein to stop immediately and go back to clear liquids. I could have hugged him in that moment y'all.  This was the BEST news I had gotten, and I immediately stopped drinking the shakes.  I was feeling much better on February 14th after tons of fluids and no protein, and was able to be released that night.

Follow Up Appointments:
After leaving the hospital on February 14th, I truly felt so much better.  No longer having to force protein made a world of difference and I was finally having multiple days in a row with no nausea. I was scheduled for a follow up visit on February 19th, and ended up seeing a different surgeon that day as mine was not in clinic.  That day I honestly felt pretty good, just still very weak.  When they took my vitals everything looked great except my heart rate which was at 122 while sitting. The surgeon that day was honestly stumped at why my heart rate was so high.  He ruled out the obvious causes like a blood clot, bowel obstruction, etc as I had no swelling in my legs, no pain, etc.  He noted at that time a slight chance it could be a pulmonary embolism (PE) but he wasn't convinced and we both agreed I'd head home and get checked again at my official 2-3 week post-op appointment the following Monday. That surgeon also approved for me to advance my post-op diet to the soft food stage early so that I could start getting some protein in.  I honestly believe my heart rate that day was due to how few calories I was getting in - I don't think my body had anything to pull on except my heart.  That night I got to start eating some scrambled eggs and praise the Lord they sat well and I felt SO good after eating them. After a great weekend with the Snyder family, I ended up going home to my apartment on February 22nd.  It felt so great to be home and I was honestly feeling really good at that point, despite the lingering fatigue.

The following week, on February 25th, I returned to clinic for my official post-op group.  My heart rate was still high that morning, despite having eaten that morning, but I continued on to the group portion of the class anyways.  I felt off during the first 30 minutes of that group, to the point I almost asked to see a doctor, but then those feelings went away and I felt good again.  The group appointments are always long and include multiple meetings with the clinical team, so I didn't get to the last section of my appointment with the surgeon until around 3-3:30pm. The PA ended up coming in first and she of course was concerned to see my heart rate so elevated and brought the surgeon in to see me.  My surgeon wasn't convinced it was a PE, but he thought maybe it was dehydration again.  They decided I should be sent to a CDU unit for observation, fluids, and labs, but they had no beds and I got admitted to the hospital...again.  Thankfully they were able to direct admit me that time, so I messaged the family to update them and figure out a plan for Jax, and drove over to the hospital.  I was pretty quickly taken to a room and the nurse quickly had the IV team come in.  I ended up needing the ultrasound team to put the IV in, which further lead them to believe it was dehydration (side note: that part was not fun, but my cute little niece FaceTimed me while they did it and acted as a great distraction!).  I honestly felt fine that time going into the hospital, but I was super frustrated that it may be dehydration as I had focused SO carefully to meet my 64oz each day and knew 100% I should not be dehydrated.  Mom and I talked and both agreed we were not leaving the hospital this time without some answers and clear direction on how to avoid another trip.  My lab work did show some low electrolyte, magnesium, and potassium levels so they continued to push fluid as well as magnesium and potassium.  I ended up getting a total of 8 bags of potassium and 2 potassium pills while in the hospital that time to get my numbers back up to where they should be. The team ruled out dehydration, but continued to push fluids anyways, which I was totally fine with! They did note that those low levels could lead to the higher heart rate, but even my surgeon still seemed stumped as to why my heart rate was so high. Due to that, mom and I insisted on seeing a cardiologist before I was sent home to be 110% sure nothing was wrong.  They ended up running an EKG that afternoon and after talking to the cardiologist they scheduled an Echo as well to rule out any issues.  The cardiologist came in and saw me later that afternoon and reassured both mom and me that she wasn't really concerned with the heart rate, especially after looking at the EKG and heart monitor reports they'd been running which both showed no issues.  She was pretty sure my body was just slowly recovering and my heart needed time to catch up to the quick weight loss I had experienced.  The cardiologist's PA even told us that really my heart rate should be up to 165 when exercising and they wouldn't be concerned until it hit like 190+ and stayed there.  However, to be safe they still ran the echo.  By the time they decided to run the echo it was too late in the day so I ended up having to stay a second night this go round.  I had the echo the following day, which came back clear, and I was discharged shortly after.  Long story short, the heart rate was concerning at first to my medical team because it could indicate an infection or other surgery complication.  We ruled ALL of those issues out, and had a cardiologist confirm my heart was healthy.  The plan from there was to continue my diet and try to get protein via food, remain hyper focused on hydration, and walk as much as I can to strengthen my heart up.

So where am I now?:
I came home on February 27th and have been at home ever since.  I'm getting stronger every single day, and slowly increasing my step count daily to help strengthen my body and heart.  I'm doing great on the soft food diet stage, and so far (knock on wood) I haven't eaten anything that my body doesn't agree with!  I have had no diarrhea or nausea since that second ER trip, and am so very VERY grateful for that!  My medical team did think it was a good idea to push my return to work date back to March 12th (originally March 5th), just to be sure I had an extra week to heal and build some strength. This journey so far has been much more difficult than I could have ever imagined.  I'm asked often if I'm glad I did this, and I don't know that I have an answer for that yet.  The mental side of this process is very difficult as I try to adjust to new food and life habits.  On the other hand though, I'm down 46 pounds from my highest weight (between Thanksgiving and Christmas), and 27 pounds of that is just since surgery.  I don't see the weight loss on my body yet, other than my feet and ankles, but it feels so good to see the number on the scale dropping and knowing this process is working. I am looking forward to my 3 month post-op class where my diet restrictions are lifted and I can eat any item my body can tolerate.  I will of course eat very small portions for the rest of my life, but right now I'm still restricted on what items I'm allowed to eat as my body finishes healing.  Overall, I'm grateful that my medical team was so thorough and did their due diligence to follow up and rule out any issues when I was not feeling well.  I'm also eternally grateful to my mom and family for all that they've done for me over the last few weeks.  I truly could not have done any of this without all of them by my side, especially mom who was with me every time I had to go into the hospital.

I know these posts were long, and honestly there is still a lot of information I haven't covered yet.  However, I hope this gives everyone a little more insight into the process I've been through.  My next post will be a FAQ guide where I'll try to answer more of the specific questions I receive frequently. Thanks for sticking through and reading all of this!

Weight Loss Surgery, Pt. 1

On February 6, 2020 I had weight loss surgery - specifically the duodenal switch procedure!  Warning, this post is long but I wanted to document each step of the process/my journey up through surgery day.  Post surgery post coming next!

Background:
There are a lot of stigmas around this type of decision, such as folks thinking it's an easy or lazy way out.  To be honest, I'm guilty of once thinking that way myself, but I could not have been more wrong. For years, multiple doctors have had told me that surgery was needed for me tor maintain long-term weight loss .  For the longest time I told those doctors no.  After all, other than the number on the scale I thought I was perfectly healthy.  I had never struggled with high blood pressure, diabetes, heart issues, or anything else.  However, when I watched my mom start her weight loss journey to overcome diabetes, I knew something had to change on my end to avoid the same battle down the road. Around the same time my family had professional pictures done, and when those came back I can honestly say for the first time in my life that I hated what I saw (photo below).  I was letting life slip by, and letting myself miss out on so many memories with my family and friends. In 2019 I also hit the highest weight I've ever been in my life, and even with an intentional efforts to increase my activity the number on the scale continued to steadily climb. The combination of all of these items finally led me to say yes to my doctor and begin the long journey towards surgery.

Pre-Surgery Requirements:
What many people don't know about bariatric surgery is that it is considered to be an elective procedure, and most insurance companies have very specific steps an individual must complete before surgery can be considered for approval. To start this journey I applied via the Duke Weight Loss Surgery (WLS) office and was scheduled to attend an information session on July 9, 2019.  Mom and I attended this class together and were blown away to see how far WLS has come.  At that meeting I also found out that my insurance company required 6 months of consecutive visits with my primary care provider (PCP) documenting weight loss attempts. The WLS clinic also required me to complete specific lab work, document 1+ weeks of food logs, meet with a psychologist, and complete an endoscopy before surgery would be considered. While I had met with my PCP for years regarding weight loss, we had not met for 6 consecutive months so I had to begin that process with them all over again.  Looking back, I'm actually very thankful that my insurance company had this requirement in place, as it forced me to slow down and properly prepare for the journey ahead. So, from July - December 2019 I worked to complete each step required. My insurance company ended up denying the endoscopy, so we did an upper GI X-ray instead.  This still allowed my medical team to view my stomach and intestines to rule out any issues that may complicate surgery, and was actually MUCH easier for me to complete!  Once all of my steps were completed, my medical team scheduled my surgery for February 6, 2020 and submitted to my insurance company for approval. On January 23, 2020 I received an email from my insurance company confirming that my surgery request had been approved!

Pre-Op:
On January 21, 2020 I attended my official pre-op class at the Duke WLS clinic.  One of the greatest things about Duke is that they required patients to attend specific sessions with various members of the clinical team, and other patients, to properly prepare for surgery.  At this pre-op visit we reviewed all of the risks of surgery, went over the pre and post op diet, met with the surgeon again, and had ample time to ask any final questions we may have. On January 22, 2020 I began my official pre-op diet, more formally known as the Liver Shrinking Diet (LSD).  The LSD was a low carb, no sugar, high protein focused diet that was intentionally set up to force your body to shred the fat and sugar around the liver which in turn makes surgery much easier and safer.  I was on that diet until the day before surgery, and on the day before I had to complete a full 24 hour clear liquid diet only.   The LSD was not as hard as I expected, but I did have moments of really struggling with hunger and cravings.  There was a very specific meal schedule we had to follow, with small measured servings of specific food categories at each meal, which made the process pretty easy to follow.  I struggled more with the clear liquid day, but thankfully that was only 24 hours! Overall, leading up to surgery I felt very strong and confident in my choice to have this surgery.

Surgery Day:
February 6, 2020 was the big day! We (mom and I) had to arrive at the hospital around 7:15am, where they took me back to the pre-op area and got me ready for surgery.  I was lucky and actually had Amy Nipper as my nurse, who used to go to church with our family.  It was so nice to see a familiar face, as my nerves were of course a little higher at that time. Once they finished the preliminary steps, mom was able to join me while we waited for them to take me back to the OR.  When they finally rolled me back to the OR, around 10:30am I believe, I remember there being SO many people in the room. There were quite a few students present as well, and I clearly remember everyone giving me various directions as they tried to get me positioned correctly on the table (turn left, turn right, move this arm up, move this leg over, etc). Fun fact about this surgery is that they actually complete the surgery with you almost completely upright by lifting the table.  Because of this, there were specific ways I had to be positioned before I was given the anesthesia. After about 15 minutes the anesthesiologist finally gave me the happy gas and meds to put me to sleep.  I remember the meds burning SOOO badly in my hand IV, but thankfully I don't remember a single thing after that!  The surgery was about 4 hours long (though I have no idea how long it actually lasted haha) and then I woke up in recovery.  My biggest fear with this surgery was being nauseas afterwards, as this was one of the risks they went over in detail.  However, I was given multiple anti-nausea meds prior to surgery and in the OR, so on the day of I didn't actually think it would be an issue.  Boy was I wrong!  I don't remember much in recovery, other than them telling me that's where I was, but when I woke up in my hospital room the nausea was awful.  I was also having terrible back pain across the middle of my back from how I was positioned during surgery, and pain around my top incision site.  I remember seeing mom when I woke up, and eventually my dad, but it was at least an hour later that I realized Corey was also in the room (haha sorry babe!). The rest of that day of course consisted of lots of sleep and constant nurse visits, but I also threw up a couple of times and was just SO uncomfortable. The following day I was much more alert, still pretty nauseas, and my back and incision area were still hurting.  We found out later that they had removed my gallbladder during surgery, and the pain at the incision site was where they use a tool to hold the liver out of the way which is why it was sore. That day we also began clear liquids and protein intake with 1 oz servings at a time.  Clear liquids were no issue for me, but the protein shakes made the nausea worse with each sip.  I had dad bring some of the protein shakes from home that I loved prior to surgery to see if those would work any better, but no such luck.  That was just the start to a long road of learning my post-surgery body could no longer tolerate protein shakes. Another common occurrence after surgery is that your taste buds can change almost instantly. I definitely experienced this in that everything tasted SO much sweeter than it ever had before, at times to the point I couldn't tolerate some items.  I did end up taking Oxycodone twice in the hospital for pain, always at night to help me sleep, but quickly was able to switch to just Tylenol and Gabapentin. I was also having some trouble with esophageal spasms (another common occurrence with this surgery) which made taking pills more difficult as it felt like they'd get stuck in my chest on the way down.  The nurses pushed various anti-nausea meds pretty much the entire time I was in the hospital, with Phenergan being the most successful but it also knocked me out. While we were able to manage the pain and stay in front of it before I went home, I never felt like we got in front of the nausea as we were constantly chasing it.  I was able to walk laps and get enough protein and liquids in though that they ended up sending me home after 3 nights.


Post-surgery details to follow in the next post!

I'm back!

Wow, 5 years! That's how long it's been since I last posted on this blog.  A lot has happened in that time, far too much to try and recap here in detail, but it's been a very busy and wonderful 5 years.  Below are just a few of the top highlights over the last few years that have shaped me into who I am today.


April 2017:  My sweet love bug, Jax, joined my family.  He is now 3 years old and I can't imagine life without him.

February 2018: I became an aunt! Chloe Grace has been a bigger blessing and joy in my life than I could have ever imagined!  Chloe is now 2 years old and by far the funniest little girl I know. I love her so much, and I LOVE being an aunt!

January 2020: My second niece, Kinsley Faith, was born! The love I have for those two girls is immeasurable.

February 2020: I had weight loss surgery! More to come on this in the next blog post.