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!
