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Bariatric Surgery Appointment 1

Yesterday I had my first visit to the Bariatric Surgery Center at UVA.  It was an overwhelming amount of information and emotion as J and I sat there and listened to the experts tell us about this journey I am about to embark on.

The morning started with me being off schedule.  If you know anything about me, one thing I have serious anxiety about it time.  I can not be late.  It doesn’t just stress me out to be late, I have borderline panic attacks – my heart beats faster, I start to sweat, I breathe heavier.  There is a physical reaction to being late that is hard to explain to someone who doesn’t view time the same way.  So I had a schedule of when to get up and I missed it by 20 minutes.  And from there my timing went out the window.

The 45 minute drive to Charlottesville finally got started (almost on time) and we made a quick stop for breakfast as I had not taken the time to do that before leaving.  Finally we made it to the hospital – almost 10 minutes after I had scheduled to be there to catch the shuttle bus from the parking garage to the building where the surgery center is.  But we had missed it by about – you guessed it – 10 minutes. And they only run every half an hour.

We then started to walk out to the West Building.  I had to be there 15 minutes early for my appointment for check in.  The paperwork said if you were late, you could be turned away from the 2 hour seminar that is required to start this process and was scheduled for 8am sharp.  The building is not that far but it is on a hill, and I was already starting to hyperventilate from being late, and I was walking too fast which kicked my asthma in, and by the time we got to the building, a mere 8 minutes before my appointment I was wheezing and huffing and puffing as if I had just run a race.

So up to the 4th floor, sign in on the sheet, and wait for them to call my name.  Then finally, I was called, checked in, and then waited.  The seminar actually started about 8:20 as someone was out sick and others were covering for them.  Now, I know to many of you it seems like this is where I could have calmed down about being late as it worked out in my favor…glass half full right?  But the thing is, the threat was real for me to have missed this chance.  They only hold these seminars once a month, the guidelines had been clearly laid out about lateness, I had taken an entire day off work (not an easy feat) and there is so much on the line that I would have been devastated to lose my spot this month.

Anxiety was starting to take on a new form at this point – fear.  We were finally led into a small classroom and someone told us what each of our specific insurances required to have this surgery.  For me, this will mean psychological testing (to ensure that I don’t have any barriers that could lead me to make a decision I am not ready for) and 6 months of medically supervised weight loss.  In other words I need to work with a doctor or nutritionist for 6 months, document my attempts to lose weight, and have all of that sent to the hospital/insurance company before I will be allowed to come back and have the surgery.

A very nice nurse then came in and she told us about the physical changes that come with surgery – what happens to the stomach and the intestines when you do this, how food is then processed in contrast to how it does now, and she talked about how food volume is different after the surgery.  She talked about the types of surgery (only 2 are offered there: the gastric sleeve and gastric bypass).  She talked about a food diary and the importance of seeing this as step by step change and how it is not the easy way out.  The medical info matched everything I had read so there was little surprising about it.

Finally, to round out the seminar, a nutritionist came in to talk about food post surgery: the importance of protein, cutting sugar and fat, adding exercise, and starting to make small changes now so that by the time you have surgery you are prepared.  She advised you to try the types of foods you can have after the surgery now so you can find brands and types you like.  And most importantly, she talked about how these small changes now will set you up for success later.

It was a lot to take in.  We were let back into the waiting room for step 2.  I was called back to a room where I had my weight and vitals taken.  Then the nutritionist, Elizabeth, came in and she talked to me about my specific food issues…highest and lowest weight as an adult, what diets have you tried, how much do you exercise, what are your pitfalls when it comes to food.  And I told her – honestly.  She thanked me for that but really, what good would it do me to lie about it?  She can’t help me if i don’t tell her the truth.

We made 3 specific goals to start with:

  1. Behavior: Set an alarm to have breakfast (and stop skipping breakfast)
  2. Exercise: Start doing 2 10 minute walks each day – 1 at lunch time and 1 after work
  3. Food: Reduce fast food eating to no more than once a week.

That doesn’t seem all that intimidating when you see how small the steps are.  But in terms of the long-range viability, they are huge.  Each is patterned to a specific weakness of mine and each will help me achieve something until it is time to set a new goal.

The surgeon came in while we were finishing the nutrition info and then it was time to talk surgery.  Dr. Fason asked me about my medical history, talked about the types of surgery a little and asked if I had a preference, and in the end told me it was my decision.  Either would work for me, but I needed to be comfortable with the final choice.  It was like music to my ears.  That is what I had been waiting for a doctor to tell me.  This whole time, I have felt like I had no choices and here he was telling me it was my decision to make.  I asked a couple of specific questions:

  • First, I have an overwhelming fear of being intubated.  Intubation is when they insert a tube down your throat to attach you to a breathing machine – a ventilator.   This procedure is necessary when you are under general anesthesia for surgery as the anesthesia paralyzes the muscles of the body – including the diaphragm – making it impossible to breathe on your own.  Here’s the thing – I worry about my vocal chords.  I don’t really want someone shoving a tube down my throat and then having to pull it back out the same way.  I knew someone who had to be intubated for her asthma and she has never sung again.  Now the difference is of course that she had to have it done in an emergency vs a planned surgery, but the threat is real.  And while I know that singing is now what I do for a living and I will still get a paycheck if I can’t sing, I don’t know that I want to survive not being able to anymore.  It would for me be like (and please forgive the analogy) the Little Mermaid giving up her voice for a change to walk on human legs.  It got her what she wanted technically, but it is no way to live.
  • Secondly, I asked him about the cancer and treatment for it while undergoing this process.  He told me the exact opposite of the oncologist – he said to take care of the cancer first and the weight loss is optional surgery.  We can always plan that for later if I need to move it due to the hysterectomy.  I will touch on this later, but it was as I had expected – the cancer has to take precedence over anything else at the end of the day.

After meeting the surgeon, the final meeting was with his nurse, who came in to introduce herself and to send me down for blood test to check on vitamin deficiencies, sugar (for diabetes) and other issues that could pop up later.

We had planned to be there until 2 pm and we were done by noon.  J and I left and went out for lunch.  My mind was running a million miles a minute by this time and honestly it is going to take me a while to read all they gave me and absorb the information.  Next is to call my regular doctor today and make plans to come in and start the supervised diet plan.  And calling my insurance company to see what is going to be covered during this time.

Finally, I have an appointment with a new oncologist next week and I think that will fill in some of the rest of the missing pieces here.  Is a hysterectomy completely out of the question?  Do I need to wait for the next biopsy to see if the current treatment is doing any good?  If I do need to lose weight first, how much before we can consider the hysterectomy?  And finally, what do we do if the IUD treatment doesn’t work?  What other options are there?

I have enjoyed my time at UVA Medical Center with the exception of the oncologist.  They have been kind and caring and treated me with the utmost respect.  Now to find an oncologist who will do the same.

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