WLS World

blog visit

2008-07-08T19:22:00.006-04:00

almost 20 months out

2008-07-02T19:30:00.000-04:00

Food Intolerance doesn't mean forever me with the DS

At being almost 20 months out, I am FINALLY able to drink some carbonated soda. I thought I would never be able to enjoy having a refreshing drink. Ok, I still am unable to deal with drinking any carbonated soda with caramel such as Diet Coke or Diet Pepsi. I am able to drink Diet Fanta Zero. I think this is considered a WOW moment. One of the beauty with having the DS is that your stomach does NOT stretch from the carbonation of soda. There is no such thing. You do have your real stomach that is intact. Only the bottom curvature of the stomach is removed. The upper portion of the stomach has been untouched. In addition, you have your plyoric valve that does make a huge impact to how food and liquid is process and the gases of the carbonated soda since it moves it along, not have it sit or hang out in your stomach. We have a stomach, not a stoma.

For those that don't about my journey, I went through hell with food intolerance from almost everything I ate. My food selection was extremely limited during my 1st year post-op, since almost everything I try to eat made me sick. It as not due or contributed to the DS. It was after surgery and my intestinal tracts taking a little longer than normal to heal. It actually took 12 months to recover anf function correctly, but NEVER had any complications. I was a very slow healer. After I was a year out, I continued to try to reintroduced food that was on my list that caused me severe negative symptoms from intolerance and am now able to eat it with no negative effect whatsoever.

One of these intolerance I had was to carbonated drinks that cause horrible cramps and pain in my belly. Not anymore. Although, I have tried out some Diet Pepsi, still have cramps from it. Tried out Diet Coke same thing. It must be the caramel, I am sure. I drank Fanta Zero and wow, no cramps, pain or feeling awful. So, I guess this orange drink is a choice for me and don't even have to let it get flat. Just pour it or right out of the can when I open it. FIZZZZZZ. Yup, I can drink it with all the sizzle and bubbles it has.

Fanta Zero has zero calories, zero carbs and even zero caffeine. The caffeine being zero is what interest me to buy it and taste test it. I know we are all different when it comes to intolerance and other issues, but hell, this is a huge thing to me because it tells me that having the DS you are able to eat and drink almost anything. Just need to have patience and give it some time, like me it took almost 20 months. It's all good....

100 lbs lost

2008-06-25T19:08:00.000-04:00

19 months postop

2008-06-14T18:57:00.000-04:00

I am 19 months postop. Time flies. I have been extremely busy with life and enjoying it. I live as though I never had bariatric surgery since I do not have to watch what I eat. I see many postops from other sugeries speaking alot about calories in versus calories out. But, that just does not apply to the DSer. I eat because I want to and not freak out or worry if I will gain weight, especially at times the amount or frequency. I am still not able to eat much. But, then there are times, I am able to eat a medium size portioned plate of food. I make sure most of my protein and nutritional value is obtained from bulk food. I know I have to live on using protein powder for life, since I am unable to eat that much to get my protein that way. I usually eat either cereal, grilled ham & cheese, western omelet with cheese , grilled salmon or even a cheeseburger for breakfast. I make sure my first meal is high in protein. I also noticed that I have to eat 5-6 meals a day. I will not able to get over 80gms of protein using the 3 meals, 2-3 snack per day plan. I make sure my snack time is a meal that consist of some sort of protein that is at least the minimum 24gms per serving.

I sit back and realized one of the beauty of having the DS is I never exercised and still lost weight and have no saggy or loose skin. I am 44 yrs old and expect some sort of skin issue, but I don't. My highest weight was 305 lbs. I am right now at 139 lbs. Other than that, I like to readjust my vitamins and supplement as often as needed and according to my schedule and agendas. My bloodwork at 19 months postop is STILL great and within range. I have not once or ever had any deficiencies. I did have vitamin D deficiency prior to surgery and was placed on Drisdol therapy for it. But, since having surgery, all my vitamins, iron, panels and other levels have been amazingly good. I have not once since after being 12 months postop, had any reactions to eating food as I did prior to that. I am still unable to have certain sugar subsitutes and had to observe sugar alcohol amount or suffer severe stomach cramps.

I get A LOT of PM from members here that are pre-ops and especially post-ops. Many are interested and even drawn to know more about the DS surgery and how it works. I do get RNY post-ops asking about vitamins and supplements and even food choices and even help them with their vitamins and supplements. Many post-ops from the Texas board private message me regarding my food log and do like reading what I post. They find it very informative. I am a bit taken back because there are some who write to me that don't want the other members to know they are struggling with their RNY, there are others who just don't want others to know they are dealing with weight gain and there are others who are beginning to have a hard time dealing with certain issues that they didn't expect. To each their own how they want to reach out to someone and who they want to know about what they are going through. But, they are struggling with their weight and disappointed they have to subject themselves to having to use the 5 day pouch test or the liquid protein test or whatever they call it. They are tired having to still worry about what they eat and food being their enemy. All I can do is provide them support and guide them to help them out. They know I am discreet and won't disclose what we speak of. Many are ashame to post about their struggles on the board. I can understand. Paying it forward doesn't mean to just help those get surgery. Paying it forward also mean and MANY forget that it is to help those who are post-op as well.

There are some RNY postops who are struggling with their health and bloodwork. They ask me a lot of questions about vitamins, proteins and supplements. They appreciate that I take the time to listen to them vent and that I post and share info that may help them with their struggles and post-op life. I may not have the RnY, but these postop who do have the RNY look up to me and know I am sincere to help them. They just don't see the support or help from others on the board that they need. They tell me their peers are struggling as well and can't see how they can help them, if they can't help themselves. I think those on the TMB would be surprised who I have been helping with their RNY struggle and work with them to sort solutions to their problems. I may not have RNY, but they rather reach out to me than to their fellow peers. Life is odd sometimes.

Some are also very disappointed in the way postops lower themselves to insult me when a person ask a question, seeking feedback and they come on in to post as though it is about them. I had a woman who wanted feedback regarding VSG vs RnY. The VSG is a part of the DS. Thing is we have been posting back and forth privately and she was offended by by a RNY postop who posted to not provide her with any answers or support, but to incite drama when there wasn't any. I told her, people like that I ignore because they are showing their true ignorancy and class level they are. She thanked me for posting all the info to her and to open her mind to other options to think about. She didn't appreciate what this postop posted, since she said they did not answer her question or helped her out at all. She said I was very straight forward and didn't see any bashing from me. She did said, the other RNY man was stirring the pot and to even insult instead of being polite to answer her question regarding what I wrote and if there was any misunderstanding or incorrect statement. She was disturb how he replied to me and with such degrade, it turned her off to post again to the TMB. I told her, I just ignore them because my reply was to help her and any pre-op out there. What matters to me is what she thinks and if my input helped her in her journey that is she taking to WLS.

Overall, I live a good life without much worry about dieting or having to obssess myself with the scale. I always invite members whether pre-ops or post-ops of various surgeries to visit and read the DS board. Many message me how different and easy going life is with the Ds since we don't care about calories or fat. They still find that amazing. Right now, I am helping out 4 postop RnYers who are longterm and struggling in one way or another.

One has reactive hypoglycemia and she was never diabetic. It has been hard on her and she thought those who have RNY are cure of diabetes. She learned it doesn't and can even develop diabetes (reactive hypoglycemia is a form of diabetes) when you never had a history of it pre-op.

Another RnYer is 5 yrs postop in dire need of support. Her health and emotional state is very messed up. I will be there for her and work with her to get her back on track.

Another RnYer is 3 years post-op and eventhough she exercise and eating right, she is regaining weight. She is now going from one diet after another and done the 5DPT that she says is a useless waste of time and gimmick. She has tried everything and nothing is working. Her carb is very low, she is eating high protein, low fat and low calories. Yet, there is no success. She wants a revision to the DS after reading all the success other RnY had with their revision to it. She is disappointed she wasted her time with having the RnY.

Another RNYer is a regular poster and well known to the TMB. She is struggling and don't want the others to know about it. She is ashame and see her friends are having problems with postop issues too. I have been communicating with her back and forth. She came to me to help her. Eventhough, I am not RnY, she feels comfortable talking to me about her issues and receiving help to get her back on track.

That is what paying forward is about, helping others without taking sides or feeling you need to belong or be accepted among others or to feel you need to be a part of their group just to fit in.

18 months postop

2008-05-14T18:54:00.000-04:00

I am 18 months postop. I haven't been on OH much. Life moves on and I have a good and busy life that I love. I am at goal at 140 lbs. I wear a size 8 in clothes. I am not boney or skinny. I still have my curves and my skin looks great. At goal, I do not have saggy skin. I do have a slight flab here and there, but my body skin is overall firm. Due to WLS, one of the things I noticed is, it will not leave you perfectly toned or your skin looking very firm. Also, bear in mind, I am 44 yrs old. My upper inner thighs, you can see most of the flab. My stomach does not hang, sag or looks wrinkly. That is a good thing appearance wise, since, I will not need plastic surgery. My arms don't look bad either. I don't have batwings that needs concern or to hide. It is very slight and not significant that anyone can sees it. I do wear a lot of sleeveless shirts and halter tops that show my bare arms from all angles.

As I have written about in my previous blogs, I do readjust my vitamins and supplement alot to work with what is needed for the moment. I have stopped taking the Magnesium Oxide, extra multivitamins chewables from Bariatric Advantage and vitamin D3, as well as cut taking iron at night. I will see if it will cause any difference or decrease with my next bloodwork. I adjust my requirements as needed and according to my bloodwork. The minimum required is taking multivitamins and calcium citrate for life. Those are a must and taken seriously. This is my daily regimen at present:

Morning when I wake up:
1 BA iron chewable

Breakfast:
1 Centrum Performance
1 BA 400mg Calcium Citrate chewable

After Breakfast Snack:
1 Bariatric Advantage 400 mg Calcium chewable

Lunch:
1 Centrum Performance
1 BA 400mg Calcium Citrate chewable

After Lunch Snack:
1 BA 400mg Calcium Citrate chewable

Dinner:
1 Centrum Performance:

After Dinner Snack:
1 BA 400mg Calcium Citrate chewable

I am taking in total
elemental iron 1x a day
multivitamin 3x per day
calcium citrate 2000mg per day

Next month, I am sure it will change since I will add D3 again. RIght now, my bloodwork level are very good. For now, this is my regime.

One of the things that is taking up most of my personal time and interest is renovating my galley kitchen for the apt that I have in the city. I own a house in the suburbs, but love my city apt that is close to all and easy accessible to what the city has to offer. I am personally designing the style and working out the budget for it. My hubby is an architect and he is my critic to what I do in the drafting and designing stage. He even install Chief Architect program on my laptop. That is a professional 3D architectural design and drafting software that architect and interior designers use in their field for home designing from the foundation. The program cost $3000, then add the galleries of items that some you have to buy.

Most of the work will be done by my father who is an engineer and has is also a licensed contractor with a jouneyman license as an electrician and licensed plumber. He has over 40 years experience and who best to tackle my project than my dad. Besides, I will save over $10,000 in labor cost. I will assist in the construction as well as other family members. I have been carefully choosing the materials and appliances that is to my preference. I am demolishing, guttering and rebuilding the kitchen from scratch. I have been searching for what style I like and narrowed it down to Tuscan Style with Contemporary Look. I have a few things set in mind for my kitchen design. I was considering stainless steel appliances, but opted for black appliances to match the light maple or oak cabinets with Stonemark granite cinnamon sand countertop. For the wall, I am planning on having what is known as Vintage Layer in which is a glaze finish similar to smooth leather or soft suede causing a subtle and dramatic effect. My walls will be in a rich dark burgundy wine base coat with the top coat glaze effect of black. I need to take pics to show, when I have a chance. The ceiling, I plan to install ACP decorative thermoplastic panel that has a look of tin. This is very vintage and was used in the turn of the century. It will give another dramatic effect to the Tuscan style Vintage Layer effects for the walls. Not sure if I will use the same for the backsplash or something else for style.

I have already picked out

* side by side refrigerator with water/ice dispenser
* wall paint color with Vintage Layer style effects
* ceiling decorative paneling
* ceiling and undercabinet light fixture
* pull out spray faucet
* wall and base cabinets
* glass insert for wall cabinet
* granite countertop

Still comparing
* ranges
* dishwasher
* range hood
* sink
* flooring
* base and ceiling moulding
* 115v dryer
.
This project will take months to finalize before getting started on the actual work, since I want to make sure of my design and finalized it that I am satisfied with it longterm. I also want to make sure I budget correctly all my expenses for the materials and other stuff needed to complete this renovation in full and stay within budget.

DS is a modification of the BPD

2008-05-08T14:26:00.000-04:00

The DS is a modification of the BPD. The DS works through an element of gastric restriction as well as malabsorption. The stomach is fashioned into a small tube, preserving the pylorus, transecting the duodenum and connecting the intestine to the duodenum above where digestive juices enter the intestine. Compared to the BPD, the DS leaves a much smaller stomach that creates a feeling of restriction. Anatomically, the main difference between the DS and the BPD is the shape of the stomach – the malabsorptive component is essentially identical to that of the BPD. Instead of cutting the stomach horizontally and removing the lower half (such as with the BPD), the DS cuts the stomach vertically and leaves a tube of stomach resembling a banana that empties into a very short segment of duodenum. The stomach portion of the DS (duodenal switch) surgical procedure reduces the size of the stomach. But, because it DOES retain the pyloric sphincter, it also retains NORMAL STOMACH FUNCTION. Hence:

* no dumping
* no stoma
* no marginal ulcers
* no strictures
* no 'getting something stuck'
* no reason NOT to drink with meals
* no need to chew food to mush
* no food or medication intolerances.

The bilio-pancreatic diversion with duodenal switch allows food to bypass part of the small intestine so that you absorb fewer calories and significantly reduces the absorption of fat. It also restricts the amount of food you may eat. Portions of the stomach is partially removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum which is known as a partial intestinal bypass and NOT a gastric bypass, since you DO have a functional working stomach and your pyloric valve is kept intact. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the large intestine. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed. This procedure has 2 components. A limited gastrectomy is when your stomach is decrease from its orginal size to about 1/3 and similar to a banana (the RNY does not have a stomach, but a stoma hence gastric bypass due to pyloric sphincter removed). A smaller yet, portion of an intact stomach pouch and pyloric sphincter results in reduction of food intake while inducing weight loss. The second component of the operation is a construction of a long limb Roux-en-Y with a short common channel. This creates a significant malabsorptive component which acts to maintain weight loss long term. The length of the common channel may be adjusted in lengths from 50-175 cm for malasbsportion to take place. The results of these adjustments in length variant reportedly carries fewer complications and with comparable weight loss. The DS, also known as BPD-DS surgery is unique, since, it is the only current procedure that allows you to eat normal quantities of food and still achieve weight loss.

Food normally moves along the digestive tract, digestive juices and enzymes digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold about 3 pints of food at one time. When the stomach contents move to the duodenum, the first segment of the small intestine, bile and pancreatic juice speed up digestion. Most of the iron and calcium in the foods we eat is absorbed in the duodenum. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine until eliminated.

BPD-DS alters the digestive process. The surgery causes a combination of restrictive and malabsorptive process. The restrictive limits food intake by creating a narrow passage from the upper part of the stomach into the larger lower part, reducing the amount of food the stomach can hold and slowing the passage of food through the stomach. The malabsorptive do not limit food intake, but instead partially bypass the small intestine from the digestive tract so fewer calories and nutrients are absorbed. The surgery hencefore, creates a Y shaped intestinal tract for the purpose of separating the biliopancreatic secretions from the food for a certain portion of the passage of food down the alimentary limb. This introduces an element of deliberate malabsorption (the bile acids and pancreatic enzymes are needed to solublize and break down fats, complex carbohydrates and protein, in order of decreasing malabsorption) and is for the purpose of enabling and maintaining weight loss by creating malaborption of those calorie sources. Biliopancreatic diversion with duodenal switch are complex surgeries that should only be done by a very experienced surgeon.

The DS was first reported by Dr. Doug Hess in 1986. This type of surgical procedure was declared a beneficial and effective form of bariatric surgery for the treatment of morbid obesity disease by the Federal Government under the Medicare program on February 2006. It was endorsed by the ASBS (American Society of Bariatric Surgeons) back in 2003. Any medical insurance carrier who claims or still calling the DS 'experimental' is not up to date with current approved medical procedures. Another reason may be that they do not have a qualified DS bariatric surgeon listed on their database roster to accept for assignment and approval for medical service render. Hence appeals are set for motion and the medical insurance carrier will have to pay for surgical and bariatric services OUTSIDE their network since they do not provide and lack of it within their network coverage.

17 months post-op

2008-04-14T18:50:00.000-04:00

I am 17 months post-op. The month of April has been extremely busy with various agendas and projects going on. So far, everything is going well and life is back to where it was prior to the fiasco of becoming and being imprisoned by morbid obesity. I am wearing size 7/8 and think I like this weight and clothes size. I am bouncing between 145 and 150 lbs. I have gotten down as low as 143 lbs. I am not sure, I want to lose anymore weight. Overall, I feel comfortable where I am at and the weight looks good on me since I do have curves on my body.

Below is my current regime of vitamins and supplement. It varies as time goes by, being constantly readjusted as needed:

When I wake up:
1 Bariatic Advantage Iron Chewable (29mgs)

Breakfast time:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate (800mgs)

After Breakfast Snack:
1 Bariatric Advantage High ADEK Multivitamin Chewable

Lunch:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calicum Citrate Chewables (800mgs)

Dinner:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate Chewables (800mg)

After Dinner Snack:
1 Bariatric Advantage High ADEK Mulitivitamin Chewable

Before Bedtime:
1 Bariatric Advantage Iron Chewable (29mgs)

2x a week:
Solaray Dry Vitamin E (400 IU per serving)
Jarrow Formulas Biotin 5mg

1x a week:
Drisdol, Calciferol Vitamin D2 (50,000 IU)

The following regime is working very well for my current situation. My blood work has not shown any deficiencies and my body is not showing any signs or symptoms of deficiencies either. If there are any signs, symptoms or results of deficiencies, it will be reevaluated and adjusted accordingly.

I get many private messages about this, is what do i eat mainly on a daily basis. Instead of answering each person, let me just post it here on my blog.

Top 5 breakfast I eat:

1. 4oz grilled salmon, seasoned with Goya adobo, cooked in alittle olive oil and butter (35gms protein)

2. western omelet with milk, onions, red & green peppers, ham, mushrooms, american or cheddar cheese (21gms protein)

3. 1 cup Special K with red berries cereal with 4 oz Lactaid fat free milk with 3 tbsp Champion Nutrition 100% Pure Whey Protein Stack vanilla flavor (20gms protein)

4. grilled cheese with ham and tomatoes or bacon and tomatoes (16-21gms protein)

5. Optimum Nutrition 100% Whey Gold Standard Rocky Road protein with 12oz milk (36gms protein)

Top 5 lunches:

1. grilled salmon

2. Chef Boyardee spaghetti and meatballs

3. chili made with Goya chorizo, Nathan's hot dog, black bean, Bush baked beans, canned tomatoes, ground beef with cheddar cheese, sour cream and cilantro

4. chicken breast (grilled, fried, stuffed or saute)

5. tuna sandwich made with mayo, Miracle Whip, onions, scallion, pickles, lemon, mustard on white bread

Top 5 dinners:

1. filet mignon or ribeye steak, coleslaw, with either baked potato, butter and sour cream or white rice with cuban style black beans, grilled or steamed vegetables (zucchini, squash, pumpkin, sweet white potatoes, yams, onion and/or portabello mushrooms), canned mexicorn

2. salisbury steak, mashed or baked potato, butter and sour cream or potato salad or macaroni salad, coleslaw, canned mexicorn

3. crabcakes, rice pilaf with shrimp and spinach, coleslaw

4. chicken either grilled, stuffed, stewed, fried with baked potato, sour cream and butter or Stovetop stuffing or steamed, grilled or saute vegetable medley, macaroni salad or coleslaw

5. meat, spinach or eggplant lasagna or stuffed shells made with spinach, ground beef, ricotta and mozarrella cheese

Top 10 food I occasionally eat (no particular order):

1. Jamaican beef patty with melted cheddar or mozzarella cheese

2. monfongo with pork crackling, lots of garlic and mojo sauce

3. roast beef sandwich with mayo, salt and pepper on white bread

4. corned beef hash made with tomato sauce and onions, white rice and canned mexicorn

5. beef negamaki with a house salad with avocado, crab legs and Japanese ginger dressing, miso soup

6. Nathan's hot dog with cheddar cheese, grain mustard, onion sauce, sauerkraft on warmed bun

7. cheeseburger with bacon and mushroom, 2 White Castle cheeseburgers or 1 small Burger King Whopper Jr. with cheese

8. Homemade broiled tilapia parmesan, crabmeat stuffed mushroom, coconut shrimps with pina colada sauce or grilled, fried, saute, breaded shrimps, lobster, crab, fish

9. gyro with onion, tomatoes, lots of tsatziki on pita bread

10. breaded mozzarella sticks with marinara sauce, chicken parmesan with mozarrella and marinara sauce or those Tyson bbq chicken tenders

Top 5 daily drinks:

1. Lactaid fat free milk (I don't like the taste of skim, lowfat or whole milk)

2. Tropicana Light & Healthy orange juice

3. Tang orange drink

4. Kool Aid tropical punch with splenda

5. Nestle water

I do drink sweetened ice tea (but have limited it, to only when I go out to eat)

Current food intolerance:

1.Anything made with asparatame, acesulfame-k or saccharine such as Nutrasweet, Sweet & Low, Equal, Spoonful, Sunette or Sweet One

2. Anything with certain amount of sugar alcohol in it

3. Any carbonated drink or soda (including diet) and even if left to be flat

4. Any diet drink such as Crystal Light, diet ice tea, etc

5. ??? (I have no other food intolerance that I am aware of)

5 leisure snacks I will indulge in, every once and awhile:

1. Smart Food white cheddar popcorm

2. Entenmann's chocolate chips cookies

3. Haagen Dazs strawberry cheesecake ice cream

4. homemade cream cheese sugar cookies made with Splenda

5. brownies, pumpkin pie with graham crust or pecan pie

I can only eat:

1. 1/2 NY style thin pizza with heavy toppings

2. 3 to 4oz of beef or poultry

3. 1/2 to 3/4 cup of rice any style

4. 1/2 small or 1/4 medium potato with sour cream and butter or cheese, chives and bacon bits or cheddar cheese, chili and cilantro

5. 1/2-3/4 c pasta with meat marinara or seafood(able to digest fresh pasta better than dry pasta)

Basically, at 17 months post-op, I do not eat much in portion. Another thing that people inquire about is gas and bowel movements. With the DS, all is controllable and a person knows what will trigger then to have food that will make them gassy. There are some DS post-op who eat high calorie and high fat food. That is an option if you want to eat such and not mandatory. My average calorie intake is about 1200 and I am not much into eating fatty food. But, the option is there if I want it. With the DS, calories and fat is not of concern since most is not absorbed. That is why most DSers do not gain weight, worry or focus on counting calories or how much fat they are eating. With the DS, you also malabsorb complex carbs, as high as 50%. But, it depends on the DSer internal length of various limb and common channel. I know I do not malabsorb 50%. I malabsorb about 30-40% of the complex carbs. We have to take focus on simple carbs which is sugar since it is what will cause a DSer to gain weight.

Protein is very important and it is what is focused first when eating. After that, is carbs. I also focus on vitamins that I can get from food. One other important daily thing is fluids. I try to aim for more than 64oz, but I don't always meet that amount. I am still struggling with no desire to eat and when I do eat, it is very small amount usually 5 teaspoon max or 1/4 to 1/2 cup worth of food per meal serving. Due to that, I rely heavily on my protein supplements and mixing it always with milk to get alittle more protein out of it. 1oz of milk is equal to 1 gm protein. I do drink a lot of milk and it is my preference of choice to drink. But, only Lactaid fat free milk.

I like to eat these whenever the mood fits:

1. Lay's or Wise potato chips plain, bbq or sour cream and chives or onions flavors

2. Dorito's corn chips with sour cream

3. soft ice cream with melted marshmallow

4. cheesecake, cinnamon raisin, pecan or cheese danish or buns, corn bread, blueberry muffins, banana nut bread

5. General Tso chicken or Kung Po chicken or shrmps

On a daily basis:

I will drink multiple times, Optimum Nutrition Gold Standard Rocky Road Protein with 8, 10 or 12oz of milk that ranges from 32 to 36 grams of protein. I usually drink this as my snack. This will also provide me with meeting my protein quota for the day, since there are many times and days that I have no desire to eat or even feel hungry to need to eat.

As I have written before, with the DS you malasbsorb 80% of the fat you eat and malabsorb a ballpark between 30-60% of the calories and 20-50% of the complex carbs. With any WLS, the DS also does not malabsorb any simple carbs, BUT do malabsorb complex carbs. Therefore, calories and fat are not focused much upon, only carbs and the most important thing protein. With the DS, you can malabsorb from 25-40% of the protein. The calories, carbs and protein malasorption varies from DS post-op to post-op according to length of their common channel, small bowel, alimentary and biliopancreatic limbs. The only way to actually determine how much a DSer malabsorbs is through a control study in which the same amount of calories, carbs, protein and fat is given during a set period of time, then it is calculated through their waste (excrement) to determine how much is being absorbed and malabsorbed through their system. The only fact that is known is a DSer is able to malabsorb 80% of the fats and 0% of the simple carbs (sugar).

people interested and inquisitive about the DS

2008-04-13T18:47:00.000-04:00

I get lots of private messages on this OH site with people interested and inquisitive about the DS. Not only pre-ops, but a lot of post-ops of other surgery types. They are amazed with my food choices and what I am able to eat and not get sick, negative side effects or gain weight.

They also ask me about the vitamins I have to take and if I am required to take 50,000 IU of vitamin D3 daily as the other DSers do. I tell them honestly, that even with the RnY, you still have to take certain and various vitamins for life. I usually tell them it is not the quantity, but the type you need to take and it is adjusted accordingly with each blood result as needed. I also inform them that each DSer take different type of vitamins and nutrients since we are all not alike. But, there is 2 basic vitamins and supplements that is a must and minimum requirement to survive and be healthy as a DSer, which are multivitamins and calcium citrate. As long as those 2 are the core to the daily regime, anything else taken is based according to each's health and blood test. The requirement needed may change with time or if there are any deficiencies or high value that may be considered excessive or out of range.

One thing, that must be taken into consideration is the use of taking megadoses of certain vitamins and/or nutritients that may cause toxicity, adverse reaction and allergies to either food or your surroundings. The megadoses usage also includes post-ops with malabsorption issues. Some DSers take 50,000 IU of vitamin D3 every single day. That is an option and not required or considered mandatory. I do not need to take such amount daily. Taking 50,000 IU once a week or 2-3 times a week is suffice and safe for the body. Taking it every single day and for a long time is questionable and if longterm use causes any effects to the health that may not be positive. It should be done with observation to monitor diligently, take awareness at the amount and length of time and have knowledge that such extremely high and excessive amount taken every single day for a long period of time may affect your health in a negative manner.

I take Drisdol which is vitamin D2 calciferol. Vitamin D3 is Cholecalciferol. Although, it is D2 ergocalicerol, its main purpose is for my body to absorb the calcium from the stomach and to help with the functioning of calcium in the body. It is what is meant for my condition and what is being monitored. Ergocalciferol is for treatment of vitamin D deficiency osteomalacia, hypoparathyroidism and hypophosphatemia, which is an electrolyte imbalance.

There are those who take D3 at 50,000 IU daily. That is fine for them as long as they know how to monitor the amount they are consuming safely, that is suitable for their needs and how it improves their health. It all comes down to your current medical health, what your blood results are saying, what disorders or deficencies you have and what are the proper treatment of medication and nutrients for your body as well as health needs. Vitamins and nutritients are revised as needed per person and according to deficiency or current values of interest.

For those who want to take solely to whoever is on the net giving advise regarding vitamins, etc, should know, it is NOT on a professional level to dispense, but personal views and opinions, To each their own. I prefer to work with my medical staff who are medically trained and licensed in medicine and health care. I will not place my life or health to rely on a person I don't know of their background, if they have licensure in healthcare or nutritional education from any salesperson with a pitch because they say so and so works for them or others. The job of a salesperson is to make that sell using whatever tactic they can to convince you and make that profit. It may work for some, but with other factors in our health should be considered and what is the longterm effects taking such, I work with what is needed for my current health and adjust as needed. If I need to take D3, it will show in my blood results and will work with adding it, if needed to improve my health.

People can take megadoses of 50,000 IU vitamin D3 daily for a short set time. But, NOT for a prolong period or even permanently as for the rest of your life on a daily basis. You have to be realistic and truely understand what you are doing and how it actually works and affects you when taking it longterm. Your body is not meant to take megadoses every single day for months or even years. Just like medications, vitamins and nutrients have to be adjusted with time. People have to ask questions to the medical professionals, physicians, research it online or even verify the source indepth that taking extreme amount known as megadoses of D3 at 50,000 IU daily for a prolong amount of time might cause vitamin D toxicity. You are able to take vitamin D in high doses, for a temporary amount of time and be safe and healthy for you, but not for too long amount of time. Take it for certain amount of weeks will not cause harm to your health. Taking it for a prolong period or even permanently will cause toxicity from calcium formation that will harm your organs, such as your kidneys, heart and lungs. This is permanent damage to your organs.

Buyer beware and do your background inestigation, research and homework. Don't rely, depend or take a person's recommendation to sell you stuff as being the sure thing at face value. Salesperson's job is to convince you to buy their product and on a regular basis as you become a recurring client to their sales. Taking megadoses of vitamin D3 for short period is OK. But for prolong period or to take it permanently, you have to be aware of its consequences to your health. Below is my current regime of vitamins and supplement. It varies as time goes by, being constantly readjusted:

When I wake up:
1 Bariatic Advantage Iron Chewable (29mgs)

Breakfast time:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate (800mgs)

After Breakfast Snack:
1 Bariatric Advantage High ADEK Multivitamin Chewable

Lunch:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calicum Citrate Chewables (800mgs)

Dinner:
1 Centrum Performance multivitamin
2 Bariatric Advantage Calcium Citrate Chewables (800mg)

After Dinner Snack:
1 Bariatric Advantage High ADEK Mulitivitamin Chewable

Before Bedtime:
1 Bariatric Advantage Iron Chewable (29mgs)

2x a week:
Solaray Dry Vitamin E (400 IU per serving)
Jarrow Formulas Biotin 5mg

1x a week:
Drisdol, Calciferol Vitamin D2 (50,000 IU)

The following regime is working very well for my current situation. My blood work has not shown any deficiencies and my body is not showing any signs or symptoms of deficiencies either. If there are any signs, symptoms or results of deficiencies, it will be reevaluated and adjusted accordingly.

Readjusting my vitamins

2008-04-08T18:43:00.000-04:00

I will readjust my vitamins and supplements this weekend and remove the extra BA vitamins chewables during snack time and take the magnesium oxide with my vitamins and calcium citrate during my meals. I do not need to take the extra 2 multivitamins (it was an option), since I am using Centrum Performance now. Therefore, no more supplements during my snack times, since I am readjusting it and moving what is needed. In the morning iron, during breakfast the Centrum, calcium citrate chewables and magnesium oxide, lunch the same , dinner - ditto and bedtime iron. These are my essentials now:

daily regime
1 iron chewables 2x daily (total 58mg)
1 Centrum Performance 3x daily
2 calcium citrate chewables 3x daily (total 2400mg)
1 magnesium oxide 2x daily (total 800mg)

Morning when I wake up:
1 Bariatric Aadvantage iron chewable (29mg)

Breakfast:
1 Centrum Performance
2 Bariatric Advantage Calcium Citrate chewable (total 800mg)
1 Magnesium Oxide 400mg

Lunch:
1 Centrum Performance
2 Bariatric Advantage Calcium Citrate chewable (total 800mg)

Dinner:
1 Centrum Performance
2 Bariatric Advantage Calcium Citrate chewbles (total 800mg)
1 Magnesium Oxide 400mg

Bedtime:
1 Bariatric Advantage iron chewable 29mg

every other day to 3x a week
serving taken separately throughout the day
1 dry vitamin D3 10,000 IU (2x for the day, total 20,000 IU)

I am planning on having more home cooked meals done. At least, I know what ingredients go into the preparation, instead buying the ready made ones or going to the restaurants and trying to decipher each ingredient or how fresh it is. I am beginning to enjoy making restaurant type of food at home and it keeps me busy as a hobby. I feel like a gourmet chef and have fun entertaining with it once set at the table. I do make enough food to last for a few days and give me a break cooking every day.

What is the surgery I had all about?

2008-04-08T14:31:00.000-04:00

The Duodenal Switch, although a bariatric surgical procedure for weight loss, is NOT a gastric bypass.

This type of method keeps a portion of the duodenum in the food stream. The preservation of the pylorus means that food is digested normally in the stomach before being excreted into the small intestine. The outer curvature of the stomach pouch is removed known as partial gastrectomy that restricts food to be consumed as well as limit the amount of food intake, especially fat to be absorbed into the body which is caused by the intestinal switch. This effectively restricts its capacity while maintaining its normal functionality. The BPD-DS procedure keeps the pyloric valve intact in which helps eliminate the possiblity of dumping syndrome, ulcers as well as stoma closures and blockage known as strictures. The intestinal tract is divided into 2 limb sections (the food limb and the biliopancreatic limb) that are reconnected and meet together to what is known as the common channel (the end limb portion of the small intestinal tract) and moves on to the large intestine. The food limb is also known as the alimentary limb, where the food is digested. The biliopancreatic limb basically processes the digestive juices. When both meet at the common channel at the bottom of the small intestines, the food and digestive juices mixes together and moves further on to the rest of the digestive tract system.

In plain English, with the BPD-DS, you have 2 intestinal tracts, one tract is to digest the food and the other tract is to digest the gastric juices in which both tracts known as limbs meet together again at the end of the small intestines. This is what a Duodenal Switch function is primarily about and explained in the simplest and generic form without getting in depth, if the above synopsis is too technical to comprehend.

The advantages of having the Duodenal Switch procedure are:

You have a more normal stomach that allows for better eating quality

You can drink with meals

There are no dumping syndrome since the pylorus is not removed

There is a minimal risk of having ulcers

There are no strictures that will occur

The intestinal bypass is partially reversible for those having malabsorptive complications

Carbs can be well absorbed, yet must be careful

The disadvantages of having the Duodenal Switch procedure are:

There is a chance of chronic diarrhea and possibly smelling stools and gas. This can be contributed to your dietary intake and can be controlled to avoid occurring

Malabsorption can lead to anemia, protein deficiency and metabolic bone disease in up to 5% of patients

You must keep a regime for daily intake of vitamins supplements for life, especially calcium, vitamin A, D, E and K

16 months post-op

2008-03-13T18:41:00.000-04:00

Tomorrow, I will be 16 months post-op. I haven't been updating my blog here, since I have been busy with life that does go on and moves on. I have other things in my life to keep me busy than to be online. I did spend a lot of my time and even hours being online prior to having bariatric surgery. I even was popping online alot, for the first year after having surgery. Now, I am hardly online. The reason I log onto OH is from email alerts I receive from private messages here. If I don't have any alert, i don't visit OH. I get a lot of people inquiring about my surgery and asking about how it is to live with the DS. I know how important it is when you are researching your options and want to know about different surgeries. Many people have interest in the DS and its benefit. I explain the facts about it, the pro and cons, but mostly reply to threads based on my personal experience living as a post-op DSer. Although, there are some that have the same type of surgery, everyone's journey is different and that is important to alway let people know about. I don't really have much to say except, I am doing well in health and life. No risk or complications and haven't experienced any negative side effects since hitting my 1 year mark. I live as though I never had surgery and that is amazing.

With the DS, there is high malasborption. I am waiting word from my surgeon to validate information in regards to the actual amount of malabsorption that a DS has from calories and protein. I know as a fact per Dr. Rabkin, the DS malabsorbs 80% of the fat and 40% of the complex carbs. DSers does absorb 100% of the simple carbs. Once I get the facts, I will post it here about calories and protein malabsorption. I just want it validated by my surgeon who is also a well known researcher whose work been published on various WLS. He does LapBand, RnY, DS and VSG. I have received info that DS malabsorbs 80% of the calories and others say its 60%. My surgeon will provide me with the correct info on that. I've also requested on what is the actual protein absorption for a postop RnY that can be use as an average, as well as the difference for the distal and proximal. I am interested to know how it compares with the DS. Protein intake is very important for a post-op and it is very important the actual amount your body can/does absorb. RnY and DS do not absorb 100% protein. I know many list their food charts. But, the protein consumed that is entered, in reality, are not adjusted for a person with WLS. The charts are meant for a person who is non-op, not WLS.

I am still unable to drink any carbonated drinks (soda). I tried some and it just gives me an instant bellyache. Although, I was a diet pepsi vanilla addict. I don't miss it or think of it. I was speaking to my PCP about this and was told that caramel based sodas, whether diet or regular does causes kidney stones and can be seen by elevated red blood cells. My bloodwork are within excellent ranges. I was inquiring about diet soda. I found this fact about sodas and kidney stones quite interesting. There are sugar substitute such as aspartame (Nutrasweet and Equal) and saccharine (Sweet N Low), when I ingest it, makes me ill to my stomach. This also goes for sugar alcohols. Most sugar alcohol gives me terrible bellyaches. Sucralose (Splenda) is the only sugar subsitute I am able to ingest and cause no negative side effect. Kinda weird, but it is all based on its molecular formula that affects me.

Sucralose has C12H19Cl3O8, apartame has C14H18N2O5, saccharine has C7H5NO3S as their compoud. The general formula for sugar alcohol is H(HCHO)n+1H. I've noticed sucralose does not have any nitrogen element. Yet, it is found in both apartame and saccharin formula. This might be the cause to my negative reaction of severe bellyache and cramps to certain sugar substitute. Regarding sugar alcohol, I need to do further research on it.

I have gone from size 8 shoes, to size 7 shoes. I wear a size 10 in some clothes and size 8 in other clothes. I haven't lost the butt and still have breast mass that has not deflated, sag or droop with WLS. I do not have any saggy, loose or fabby skin on me at 16 months post. The only exception that is noticeable happened to be my thighs. My batwings are hardly noticeable. I will NOT need a tummy tuck, arm reduction, breast or body lift, which is great news for me. If I ever have any type of surgery that related to my WLS, it would be to tighten my inner thighs. But, it isn't that noticeable either.

Hubby bought me a bikini and it is beautiful. The best thing about this bikini is that it will camoflauge certains scars (not stretchmarks) I have that are not WLS related. I do have a lot of scars along my pelvic area. It is very noticeable and obvious upclose. I am extremely light skin and the scars have faded to my skin color. But, you can tell, if you are observant they are scars. There is nothing I can do about that. No plastic surgery can cut those away. I just learned to live with it. The bikini bottom has enough coverage to cover the scars that go mostly around my lower hip area and front. I was thinking wearing a bathing suit, but this year I will wear a bikini in which I haven't done in over 10 years. I need to take an umbrella with me since I cannot let the peak sun touch me. I suffer from severe sunstrokes. We used to go to the beach at sunset. This year, we will be at the beach while the sun is up in the sky. It's a big deal for me to wear a bikini after all these years, to have lost all the weight to look good in a bikini and to actually be at the beach wearing a bikini and have the sun beaming. Life is good.

20,000 postop follow-up for 13 years

2008-03-11T19:39:00.000-04:00

20,000 postop patient of various surgeries were compared to each other. The key word is cure and reduction to provide a control to the disease of diabetes. From data finalized in this research of 13 years follow-up of postops, there was a 98.9% improvement with the contribution of the DS, compared with 83.7% with RnY and 47.9% with Lapband.

Bariatric Surgery
A Systematic Review and Meta-analysis
Henry Buchwald MD
JAMA
October 13, 2004
Vol 292, No. 14

source where I obtained info from:

http://jama.ama-assn.org/cgi/content/abstract/292/14/1724

http://jama.ama-assn.org/cgi/reprint/292/24/3040.pdf

http://jama.ama-assn.org/cgi/content/full/jama;293/14/1728-b

Below is a chart outlining the differences following weight loss surgery in the cure and or reduction of diabetes and other serious morbid obesity related diseases reported by Harvey Buchwald, M.D. in his meta analysis published in 2004. In this study over 20,000 postoperative bariatric patients were followed for up to 13 years.

Obesity Related Illnesses that Improved/Resolved Following Weight Loss Surgery:

Gastric Band RNY DS
Diabetes Mellitus 47.9% 83.7% 98.9%
Hyperlipidemia 58.9% 96.9% 99.1%
Hypertension 43.2% 67.5% 83.4%
Sleep Apnea 95% 80.4% 92%

From Page 7

Cormorbidity Outcomes

Diabetes. When defined as the ability to discontinue all diabetes-related medications and maintain blood glucose levels within the normal range, strong evidence for improvement in type 2 diabetes and impaired glucose tolerance was found across all surgery types. Within studies reporting resolution of diabetes, 1417 (76.8% [meta-analytic mean, 76.8%; 95% CI, 70.7%-82.9%]) of 1846 patients experienced complete resolution. Within studies reporting both resolution and improvement or only improvement of diabetes, 414 (85.4% [meta-analytic mean, 86.0%;95% CI, 78.4%-93.7%]) of 485 (mean change, 71.53 mg/dL; 95% CI, 49.37%-93.69 mg/dL [3.97 mmol/L; 95% CI, 2.74-5.2 mmol/L]; n=296 by meta-analysis) compared with unselected populations (means change, 13.33 mg/dL; 95% CI, 10.81-15.86 mg/dL [0.74 mmol/L; 95% CI, 0.60-0.88 mmol/L]; n-2092 by meta-analysis.

There was a difference in diabetes outcomes analyzed according to the 4 categories of operative procedures. With respect to diabetes resolution, there was a gradation of effect from

98.9% (95% CI, 96.8%-100%) for bioliopancreatic diversion or duodenal switch to

83.7% (95% CI, 77.3%-90.1%) for gastric bypass to

71.6% (95%CI; 55.1%-88.2%) for gastroplasty, and to

47.9 (95% CI, 29.1%-66.7%) for gastric banding.

The percentage of patients with diabetes resolved or improved showed different results (Table 5 [page 9]); this variation from the trend solely for diabetes resolved may be due to the far greater number of patients assessed for this variable (n=85) in the total population.

From Page 10

Resolution of diabetes often occurred days following bariatric surgery, even before marked weight loss was achieved. Resolution of diabetes was more prevalent following the predominantly malabsorptive procedures (bioliopancreatic diversion or duodenal switch) and the mixed/restrictive gastric bypass in contrast to the purely restrictive gastroplasty and gastric banding procedures. In addition, there appeared to be a gradation of diabetes resolution as a function of the operative procedure itself.

98.9% for bioliopancreatic diversion or duodenal switch

83.7% for gastric bypass

71.6% for gastroplasty, and

47.9% for gastric banding.

The putative extent and time relationship of the different operative procedures to diabetes resolution or improvement after bariatric surgery may be related to some of the changes in the gut related hormones. The hormonal milieu, or the relative balance of forgut mediators, is differently affected when the distal stomach is bypass, or a partial gastrectomy is performed, and the enteric contents are separated from the bioliopancreatic stream in the upper small intestinal tract. The study of the impact of the various bariatric procedures on leptin, grehlin, resistin, acylation-stimulating protein, adiponectin, entro-glucagon, cholecystokin, and other gastrointestinal satiety mediators receiving increasing attention.

William B. Inabnet, MD

2008-03-08T18:38:00.000-05:00

Positions and Appointments
2003-present Associate Professor
Clinical Surgery
Columbia University College of
Physicians & Surgeons
New York, NY
2003-present Associate
Attending Surgeon
New York-Presbyterian Hospital
Columbia University Medical Center
New York, NY
2003-present Chief
Endocrine Surgery Section
New York-Presbyterian Hospital
Columbia University Medical Center
New York, NY
2003-present Co-Director
New York Thyroid
Parathyroid Center
New York-Presbyterian Hospital
Columbia University Medical Center
New York, NY

Clinical Specialties
Minimally invasive thyroid and parathyroid surgery
Laparoscopic adrenal and pancreatic surgery
Laparoscopic bariatric surgery

* Appendectomy
* Bariatric Surgery (DS, LapBand, RnY, VSG, Revision)
* Colon Resection Surgery
* Gastrectomy
* Gastroesophageal Reflux Surgery
* Hemorrhoidectomy
* Laparoscopic Cholecystectomy
* Liver Biopsy
* Lumpectomy (Partial Mastectomy)
* Lung Biopsy
* Radical Mastectomy (Total)
* Splenectomy

Education and Training
Nov 1996-Oct 1997 Fellowship
Surgical Endocrinology
Cochin Hospital
Paris, France
Pr Yves Chapuis
July 1992-June 1996 Resident
General Surgery
Rush-Presbyterian -
St. Luke's Medical Center
Chicago, IL
July 1991-June 1992 Intern
General Surgery
Rush-Presbyterian -
St. Luke's Medical Center
Chicago, IL
1991 MD
University of North Carolina
at Chapel Hill
Chapel Hill, NC
1987 BS
University of North Carolina
at Chapel Hill
Chapel Hill, NC

Board Certifications
American Board of Surgery

Professional Experience
1998-2003 Assistant Professor of Surgery
Mount Sinai School of Medicine
New York, NY
1994-1996 Instructor of Surgery
Rush Medical College
Chicago, IL

Professional Honors
Strathmore's Who's Who
2003 Edition

American Registry
Top American Surgical Specialists
2002 & 2003

NY Magazine
Top 100 Laparoscopic Surgeons
2002

SAGES Video Achievement Award
2001

SAGES Video Achievement Award
2000

General Surgery Department Award
Chief Resident of the Year
1996

Chief Administrative Resident
1995-1996

Surgical Sciences Research Award
1994

Surgical Sciences Award
Intern of the Year
1992

Professional Societies
and Committees
Societies

American Association of Endocrine Surgeons
American Association of Tissue Banks
American College of Surgeons
American Society for Bariatric Surgery
American Society of General Surgeons
American Thyroid Association
Association for Academic Surgery
Association Francophone de Chirurgie Endocrinienne
French National Academy of Surgery
French Surgical Association
International Association of Endocrine Surgeons
International Federation for the Surgery of Obesity
International Society of Surgery
New York Surgical Society
Society for Surgery of the Alimentary Tract
Society of American Gastrointestinal Endoscopic Surgeons
Society of Laparoendoscopic Surgeons

Comittees

Chair
American Society for Metabolic and
Bariatric Surgery Research Committee
(ASBS)

Society for Metabolic and
Bariatric Surgery Program Committee
(ASBS)

Executive Council
American College of Surgeons Committee
for Video-Based Education

Selected Publications
Costen E, Gagner M, Pomp A, Inabnet WB.
Decreased bleeding after laparoscopic
sleeve gastrectomy with or without
duodenal switch.
Obesity Surg, in press

Inabnet WB, Quinn T, Gagner M, Urban M,
Pomp A.
Laparoscopic Roux-en-Y gastric bypass in
patients with BMI<50: A prospective randomized
trial comparing short and long limb lengths.
Obesity Surg, accepted.

DiGiorgio M, Daud A, Inabnet WB, Schrope B,
Urban-SkuroM, Restuccia N, Bessler M
Markers of Bone and Calcium Metabolism
Following Gastric Bypass and Laparoscopic
Adjustable Gastric Banding.

Books

Inabnet WB, Ikramuddin S, DeMaria E.
Laparoscopic Bariatric Surgery.
Lippincott, Williams, & Wilkins Sept, 2004

Gagner M, Inabnet WB.
Minimally Invasive Endocrine Surgery.
Lippincott, Williams, & Wilkins March, 2002.

Abstracts

Inabnet WB, Rogula T, Gagner M.
The safety and efficacy of alternative energy
sources in endoscopic thyroidectomy.
Surg Endoscopy 2003, 17:S304.

Comeau E, Gagner M, Inabnet WB, Herron D,
Quinn T, Pomp A.
Symptomatic internal hernias following
laparoscopic bariatric surgery.
Surg Endoscopy 2003, 17:S219.

Kim CK, Kim S, Eskandar Y, Krynyckyi BR,
Inabnet WB, Machac J.
The efficacy of dual-isotope substraction vs
dual phase parathyroid scintigraphy for directing
targeted surgery.
Radiology 2002

Kim CK, Kim S, Eskandar Y, Krynyckyi BR,
Inabnet WB, Machac J.
Any separation between abnormal foci and
the lower pole of thyroid on Pinhole Sestamibi
Parathyroid Imaging is highly suggestive of
Intrathymic/anterior mediastinal Parathyroid
Adenomas.
J Nucl Med 2002

Kim CK, Kim S, Eskandar Y, Krynyckyi BR, Zhang Z,
Knesaurek K, Inabnet WB, Machac J.
Appearance of Descended Superior Parathyroid
Adenoma on SPECT Parathyroid Imaging.
J Nucl Med 2002

Kim CK, Kim S, Eskandar Y, Krynyckyi BR, Haber R,
Machac J, Inabnet WB.
Efficacy of Parathyroid Scintigraphy (PS) vs
ltrasonography (U) for Directing Targeted
Surgery (DTS).
J Nucl Med 2002

Kini S, Gagner M, Gentileschi P, Nandkumar G,
Inabnet WB, Herron D, Pomp A.
Laparoscopic bariatric surgery for
super super obese patients (BMI>60):
a comparison of Roux-en-Y gastric bypass
and biliopancreatic diversion with duodenal switch.
Obes Surg 2001; 11:158.

Quinn T, de Csepel J, Kini S, Gentileschi P, Ren C,
Pomp A, Herron D, Inabnet WB, Gagner M.
Laparoscopic biliopancreatic diversion with
duodenal switch: the early experience.
Surg Endo 2001; 15(Suppl 1):S158.

Inabnet WB, Gagner M.
Endoscopic thyroidecomy: patient selection,
technique and preliminary results.
Surg Endosc 2001;.

Chapuis Y, Dousset B, Inabnet WB, Ozier Y,
Luton JP, Houssin D.
Facteurs prédictifs des complications opératoires
après surrénalectomie trans-péritoneale
vidéo-endoscopique.
Ann Chir 1999; 53:677.

Inabnet WB, Pitre J, Bernard D, Chapuis Y.
Comparison de paramètres hémodynamiques
à l'occasion de l'exérèse par vidéo-endoscopie
et voie traditionelle de phéochromocytomes.
Ann Chir 1999; 53:677.

Inabnet WB, Vogler RC, Arikan E, Sancar A.
Parasites are the most frequent pathogens of
acute gastroenteristis in southeastern Turkey.
Fax 1990; 5:77.

Otolaryngologist's office

2008-03-02T14:23:00.000-05:00

I called my Otolaryngologist's office and ask the receptionist that I want him to return my call, that it is an emergency. Within an hour he called. I told him, I am choking in my sleep and awaken trying to grab my breath. My throat, my middle and right side of my chest (the lung and trachea area) hurts. I told him, I called the same day when I get out of the sleep study to make an appt to see him right away, but the receptionist told me it takes 2 weeks for the data to be analyzed by him and that I cannot see him before the 2 weeks. I told him, she refused to give me a date to see him this week and I cannot wait 2 weeks because of the severity I am suffering. He agreed and was bothered that the receptionist said such a thing. He told me to call Jackie, the senior receptionist an hour from our talk to get an appt for Wed Mar 3, 2004, 2 days away. I am glad, I can get thing done right away.

2008-01-08T17:50:00.000-05:00

My kid brother, Joe, such a badass. Rides bikes like a cowboy rides a wild stallion. Need for speed...runs in the family. I used to jet 100 mph in my black decked out fully loaded black Honda Prelude Si. Those were the days, sighh. Never got a ticket and never been in an accident. This video was taken recently, so let me share. That is his son in the video with the black car.

holding at 197

2007-12-18T15:05:00.000-05:00

Quick update, doing well and holding at 197. Not bad, but, most important thing is, I am feeling healthier and getting my energy back as each day comes. I have a lot of people who have given me support and I interact with. Some on a daily basis, other on a weekly basis, others when we can catch up with each other. I have friends here as well as in other places and sites. What does count is the quality of time together to share in thoughts and laughter. I do have a sense of humor, enjoy joking around and everyone knows it doesn't get out of hand or cross boundaries.

I want to post here my luv to 3 persons that has been there for me as my WLS mentors. To my Texan divas Erika (5 yrs post-op), Janice (3 yrs post-op) and Shawn (4 yrs post-op and no longer on this site), thanks for all the support and being there for me. I know we can joke and it doesn't mean a thing except bring laughter to one another and to others. I will limit my hello salutes to these 3 persons. Much luv and respect to them and the others who know who they are.....

1 YEAR UPDATE

2007-11-15T18:34:00.000-05:00

It has been a year since I had my Bilio-pancreatic diversion with duodenal switch. I will try to sum up my experience and what it has been like for the 12 months.

The surgery took 5 long hours to perform. I was in step down ICU for 3 days after surgery. My post-op recovery was horrendous and extremely painful. I truly had pain from HELL. Eventhough, i was on pain killers from morphine, codeine and even percoset, it didn't help me much. I was also being injected everyday with heparin to prevent clot formation from developing and that was good. In the recovery room, i was helped by the nurses to get up and walking 4 1/2 hours after surgery and it was very difficult and again extremely painful. As i said, my severity of pain was on a level BEYOND 10. To be honest, my post-op pain lasted for 28 days and nonstop. I thought I would die of the pain alone and the pain killer wasn't helping. I learned to deal with it as I recover. After day 28, the pain suddenly stopped and was relieved of the misery. It actually took me almost 5 months to recovery unlike some it takes only 2-4 weeks, the most 6 weeks. Yes, it took me 18-20 weeks to recover completely. This is not normal or average. But, this is what I experienced and what I had to deal with.

Regarding my post-op experience, I went through an ordeal with food intolerance and was one of the rare DS post-op to actually develop dumping syndrome exactly what an RnY experience. How do i know this? Beside my surgeon explaining it does happen although rare to have such effect from food intolerance, my 3 best friends who are all RnY post-ops were there with me and for me, as I developed various episodes and they seen me go through it. These symptoms included nausea, vomiting, cramping of the stomach, dizziness, even feeling fatigue, sweating and feeling my heart palpitate. FOr me, it was not caused by rapid gastric empting on me since I do not have a gastric bypass. It happened with food intolerance such as bread, english muffins, pasta, pizza crust, anything with a crust basically and especially with poultry which was very bad experience for me. I avoided these food and tested every 3 months to see how it goes. The bread and pasta, crust items I was able to overcome and not have the experiences I stated above within 6 months. The poultry took a total of 10 months to be able to tolerate but with moderation. I can only be able to eat at max 2 oz and no more. I still get a bad cramp in my stomach, nausea and at times a clammy feeling and sweats.

I have 3 mentors that have been there for me since day 1 od my surgery. I have known them for over 3 years and we have become the best of friends to be sisters at the heart to count on each other through good times and dark times. They have been there for me and supported me every step of the way. Those from OH know them as Erika (EyptianEyesDiva 6+ yrs RnY post-op), Janice (Just Janice 3+ yrs RnY post-op) and Shawn (4+ yrs RnY post-op and who is no longer a member on OH). We have actually become family to one another. For me, these 3 are my sisters and I love them to death. So what, if they are RnY and I am DS. That doesn't matter. what matters is the support and them being there for me, guiding and providing their experience to help me out, especially when I needed it most in person, on the phone and online. They learned alot about my surgery as I learned alot about theirs. I appreciate all they have done for me and they know it. We are not only good close friends that have developed throughout the years and from that become sisters of the heart and lean on each other and trust one another, even when we have our darkest times and secrets we can't tell anyone else. We are each other's anchor to one another in time of need and to vent. They helped me throughout all my difficulties that I experienced with food intolerance and advice what to do when I went through my phases. It took me 10 months to overcome my food intolerance and for those dumping episodes to completely vanish. I still have slight issues with poultry, but it isn't as bad as before. I still cannot do any carbonated diet beverages or even diet drinks. It gets me very sick and it is one exception in which I still go through dumping syndromes. Any diet beverage just gets me sick and BAD.

Other than that, I am doing well and have my health and life returned back to me. My weight loss has been gradual and steady pace. I did not lose weight rapidly as some do. One positive thing about losing weight at a slow pace was I do not have any loose, saggy or flabby skin. I did not lose my breast or my butt either. I am still packed in those areas and firm too as some have seen from my pics on my profile and in person. Ao all that money for plastic surgery will be spent on taking a trip and jetsetting to europe with Shawn, Erika and hoping Janice will too. We are all saving for our airfare and spending money. Life of 4 women who were all over 150 lbs overweight living life again and with a bonding that we each know what it is like to be morbidly obese and the suffering that came with it. We conquered the deadly disease of morbid obesity and able to live life as normally as possible.

One day opportunity knocked on my door, I welcomed it and here I am a year later talking about it.

Stats

2007-11-14T18:28:00.000-05:00

DATE CURRENT WEIGHT WT LOST TOTAL LOST BMI
Nov. 14, 2006 247 0 0 45.1
Nov. 22, 2006 228 19 19 41.7
Dec. 14, 2006 215 13 32 39.3
Jan. 14, 2007 209 6 38 38.2
Feb. 14, 2007 198 11 49 36.2
Mar. 14, 2007 191 7 56 34.9
Apr. 14, 2007 189 2 58 34.6
May 14, 2007 185 4 62 33.8
Jun 14, 2007 180 5 67 32.9
Jul 14, 2007 177 3 70 32.4
Aug 14, 2007 170 7 77 31.1
Sep 14, 2007 168 2 79 30.7
Oct 14, 2007 165 3 82 30.2
Nov 14, 2007 161 4 86 29.4

initial weight = 305 lbs BMI = 55.8
surgical weight = 247 lbs BMI = 45.1

with DS, I have an excessive weight loss total of
86 lbs or 80.4% in 1 full year, enough said.....

Since I get so many private messages inquiring....

2007-10-16T18:12:00.000-04:00

About Me

I AM STRAIGHT FORWARD, VERY CONFIDENT AND BOLD
TO SPEAK MY MIND WITHOUT FEAR OR INTIMIDATION

I am Dominant, NOT submissive. I am not one to switch and rarely give up control or to be told what to do. I will be an equal, but am NOT one to allow or be consider less. I am a leader, not a follower and am not easily impressed by people or things in life.

I am an avid fencer which is the science of armed combat bludgeoning weapons manipulated by hand as well as a western style form of martial arts. I specialize in collegiate, classical, flick and Olympic competitive style as well as in the the fighting European methods of swordsmanship, especially rapier. The art of fencing uses 3 particular type of weapons - epee, foil and saber swords. It's all about footwork, blade work, bouting, timing and parry/retreat protocols. Epee and foil swords are my preferred weapons. I have practice the martial art way of the samaurai since 1984.

Turn offs

* People that have poor hygiene is a HUGE turn off for me.

* Fakes, liars, users, deceiver, backstabbers and those that can't say what they mean.

* Hypocrits that act aloof or ignore a person online to impress or please others. Yet, act all chummy offline, privately or off the boards where no one can or will know they communicate with one another.

* Those that CAN'T SPEAK UP and GET TO THE POINT without tripping or dragging their tongue to the floor.

* Those that need or have urge to be in a clique, group or clan to feel accepted, recognized, confident or sense of empowerment.

* Those with the need to have a following or groupies attached or clinging on to their every word or action.

* People wanting to be on my friend's list, but don't have the common courtesy to interact or communicate with me or even bother to introduce themselves.

* Members requesting to be on my friend's list with an empty profile and no information to base their journey on or what they are seeking from me.

Turn ons

* men's cologne

* good hygiene

* those that demonstrate leadership qualities WITHOUT the need for their to be ego stroked or praised every single time.

* those with true and sincere intention to friendship with no ulterior motives involved.

11 months post-op

2007-10-14T18:14:00.000-04:00

I am 11 months post-op. I am currently at a stall for the past 3 weeks and don't let that bother or get to me. I look at it, as my body needing its rest to catch up with all the activity it has been going through with all the weight loss and distributing itself. These past 11 months have been a positive experience and I don't have anything negative to say about. My weight loss has been gradual and not rapid. I did not lose my breast mass or have any loose, saggy or flabby skin as other have encounter with the only exception to my upper inner thighs that is not that significant of a concern to me. I made sure I was able to control my weight loss not to be more than 10 lbs per month. More than that and your body's skin elasticity may be effected. That is my take and personal opinion on it. Also, other factors that need to be considered is the length of time a person has been morbidly obese and age. As for me, I am 44, but have been very much active in life and sports prior to the disease of morbid obesity taking over me like a prisonment sentence.

I posted a full body pic to my pic folder here on my profile and I am wearing a see through short tank top with no bra, exposing my breast. I did that to show my breast are not saggy or has lost it volume. I am also wearing a fitted velvet short skirt to show my body frame and curves. This shows my torso and especially my sides and tummy do not have saggy skin since in that picture I do not have on any undergarments (bra or panty). Next month will be 1 year since I had my DS surgery. I do not make a deal about it, but some of my friends are all giddy that I made it to 1 year already. I will give a 1 year overall summary next month in regards to my journey.

The only thing I wanted to write about it since having surgery is my teeth has been affected by it. It can happen in ANY bariatric surgery whether RnY, DS, etc. My last tooth on my left side, the wisdom tooth has a cavity and was eroding/decaying. One thing is, I have never in my life had a cavity or any tooth problems. I never even had plaque. So, this is a 1st for me and my wisdom tooth there has been chipping away. I thought it was from the nuts I was eating and later on it came out thinking it was stuck there, eventhough I brush my teeth and rinse them daily. Well, that tooth has to be extracted and will go Monday October 15th with my hubby to have it done. I will update on that next month. I just didn't expect my teeth would be affected by the bariatric surgery. So, if you do have any type of weight loss surgery, do make an effort to be seen every 6 months. I was due for my visit and that is how I became aware of my tooth condition and what is going on with it. I have always had healthy and perfect teeth. i never even had braces or any work done to my teeth ever. So, this is a 1st for me and my 1st tooth extraction.

I placed a video log in the front of my profile for this month as an update to what is going on and you can see how I look at this stage of the journey. Anyway, that is all I have to say and until next month, when I will give my full 1 year summary list of events on the pro and cons of it all. Until then....

11 months post-op

2007-10-08T18:16:00.000-04:00

In a week, I will be 11 months post-op. I've been extremely busy with various itineraries. I know a few want me to visit here more often and post on the boards. But, I do not have time for that and do have a life outside this site and a productive one, especially socially. Life has been good to me and things are going well. Next month, it will be a year since having surgery. Honestly, I never kept tabs to any of my other surgeries and I had several. The bariatric community here and on other forums that I am on, are quite tight knit to sharing that common bond to their weight loss and to know each other's surgical dates. They also like informing others what is going on in their journey as a motivational pull and support system, as well as, the meaning to belong or identify with a certain group and feel the acceptance they might not had before with other peers or even ever with any other connection with the same interest they have. People come from all walk of life to be a part of a forum. Some I have observe like in actual life do have mental issues as well as passion to their surgery. There is various bickering and debates that go on from what is the difference between so and so surgery to people providing info about other surgeries and those that have the surgery taking offense to the misinformation ensuing clashes. SOme misinterpret what is written to be narrow and not widen their thoughts process. I have always had a mind to think outsdie the box, meaning I do not limit myself or what is wriiten or interpreted as always related within topic. I avoid a lot of people here and have learned it just depends on the individual in their way of thinking and their reason to be here.

To many, their WLS date is a new life to restart or reborn to be celebrated yearly like a birthday or anniversary. To some, it is that important in their life. Personally, I do not feel that and it is just another surgery to me.I have had a few life saving surgeries performed on me. I think, I do not feel that connection or emphasis as other here who are post-ops is due to the fact, I was of normal weight all my life and never had to deal with weight issues growing up or into adult until 1999, when I was in my mid-30s. I was active, had a social life, great career and educational path, athletic, very much into various sport and well like by family, friends, colleagues, peers and acquaintances. Although, I did suffer from MO and SMO for the past 7 years that have past, I do not hold it to be a psychological issue or needs to be dragged on reliving it over and over again with me or have any negativity about it. It happened, I lived it, took care of it by receiving the medical treatment needed being surgery and moving on..

I post on the various boards on this site and do entries into this blog because of friends here that have interest to know what is going on in my post-op journey and how I am doing. I appreciate their concern and inquisitive minds to whatever I write here.. I do provide support and friendship to those who interact with me regularly. I am not one to advertise or post about how I helped someone or who I have met in person or post praises. That is left to be discreet with me. I am a lowkey person and not one that needs to be in the spotlight, praised or post about. I do not place my bariatric surgery post operative journey as being prevalent in my life. I had the surgery and do what I must in helping me with improving my health and losing the weight as the contributing factor to it. I do not speak, mention or make regular or frequent topic of conversations about my postop lifestyle to those who are my postop friends online or offline. We just move on with life and talk about other revelant things. Most of my post-op friends are longterm being over 3 years out. If anything is of concern, we will talk about it. But, the topic of our WLS is not a daily, weekly or a constant conversational piece. Life does go on. My life does not revolve around my weight loss or the surgery. I have more important things in my life and to accomplish. My bariatric surgery is a small portion to my existence and like other surgeries I have had, it was done to help with my health. I don't talk much about my weight, how much I have lost or what dress sizer smaller I am. Just not my style. If I am having issues, I call my surgeon's office and seek advice or whatever is on my mind. I do not rely on members here who are relatively strangers from all walk of life to give me any advice or guidance when it come to concern about my health. If it is about food, vitamins or protein supplements that is the limit and not beyond that for input. If they are friends, I would speak them on the phone or in person and touch base. If I do post, it is not on medical questions with my health status or what is concerning me that is not going well, such as having a headache, experiencing hair loss (I've actually got the answer from my surgeon) or what over the counter med is ok to take. Come on folks, leave that to calling your surgeon's office and not rely on anyone posting here when it comes to your personal health. I post things based on my personal WLS EXPERIENCE and limit it to that when it comes to someone asking certain questions. I know anyone who gives me feedback on their personal experience if I ask something, I appreciate it. Beyond that, I view certain inquiries posted as something to have doubt and do not take as being completely valid or convinced of its certainty. I do research anything that strikes my interest and share the information found.

When it comes to people on this site, I am extremely selective and guarded person when it come to whom I interact with especially on such open website with multiple forums. I know there are members here who seek approval, acceptance, need to identify or belong to a certain group or clique. As for me, I am not one to be easily influenced or drawn to other's comment, compliment, opinion, hearsay, gossip or nonsense. I am not impressed or have any admiration or praise for any person here. As I said, I am extremely selective and guarded with whom I interact and communicate with. My time here is positive and jovial. I am here because I do have friends that want to be just friends, joke around, need support and interact in a positive manner. I have met a few in person and do communicate with them offline. I do not need to post to them to acknowledge them or vice versa. I am not into belonging to any group or take sides to be liked or accepted. I don't want to be involved, absorbed or have connections with such. I enjoy the privilege to be on my own and post freely anywhere I want and please.

I have on this site a few members that I can say are worthy of being friends, since we do interact and communicate with one another and it is sincere. This is suppose to be a support site as well as a place to socialize. Yet, I am very cautious with who approaches me. I don't really know who to trust here, who can be said is really a friend, who has ulterior motives, who is playing mind games or is on a prowl and who is just pernicious. I can't always read or figure out who is the person behind the screen and what are their true intentions to communicate with me. For that reason, don't take it personal if I seem aloof or do not respond/reply to your private messages or threads. If you want to interact with me, say hello and be nice. Let's get to know each other out in the open and build a friendship or support system from there, if that is what you are seeking. Just understand, nothing more beyond that and I do not need my ego stroked either. Just be a friend and not a fake one..

post op DS survey

2007-10-02T18:22:00.000-04:00

As unusual as the questions seems, these are EXACTLY how I received it when asked by pre-op and those who have other surgeries (RNY) curious about the DS. They felt it was comfortable to contact and ask me. Although, I am only 11 months postop.

I was asked in a few message from various people and I quote them do "I pass gas all day long", do I know anyone who "wears diapers" because they heard from others that a DSers has nonstop diarrhea and uncontrollable leaking stools that stains their underwear, 3 persons actually ask specifically about if Dsers need to wear adult diapers.

The other questions ask are there "any passing of gas or bowel movement and is it true does the smell "lingers" upon the person" because they "heard" that a postop smell like flatuence and the bowel movement all the time and especially after such event. For me, the answer is no and for others the same answer as mine. So, it is a fallacy. I posted a DS survey to see what the majority feedback from others would be and to see for themselves without outside influence of hearsay and straight from those that had DS.

1. Do you have diarrhea or loose watery stool?
no. only time it happened was my first 2 weeks postop

2. Do you ‘go’ 4-6 times or even more in a day?
no, the most i go on average is once a day in the morning

3. Do you pass gas all day long?
no, not all day. there are certain food such as almonds that gives me a lot of gas, but not all day long

4. Is your gas or bowel movement so offensive that it lingers on you 5 mins. AFTER it occurs?
no

5. Do you have body odor that is due to having a DS?
no

6. Do you suffer from pain or bloating?
i am still under a year postop. and do get slight belly ache when eating nuts such as almonds and pistachios. i am unable to eat chicken completely, but am able to eat small portion about 2oz worth.

7. Do you have a lot of hair loss?
no, i lost alittle bit at the front at about 3 months postop and it stopped few weeks later. no more hair loss after that. it was due to the 5 hours being in surgery and known as shock from anesthesia.

8. Do you have intolerance or get sick eating any type of food?
still have issues with poultry, but not as bad as before that it made me throw up and go thru what is similar to dumping syndrome. i had intolerance until 5 months postop to bread and pasta. i thought it was due to white flour but it wasn't since i was able to have pancakes. that intolerance disappear. still cannot eat much poultry, just very small amount. i am unable to drink anything that is carbonated even when flate. almonds and pistachos gives me belly aches, but not cashews or salted peanuts.

9. Do you wear diapers?
no. when this question was sent to me, i found it very odd, but some heard from others that DSers have to wear adult diapers due to having uncontrollable bowel movements and leaks.

10. Do you have any intestinal problems or other complications since having a DS?
none. my intestinal problems were actually remedied since having DS

11. What is one thing you have daily to eat or drink?
milk, i enjoy drinking milk everyday as well as have to have my ready made nestea or lipton sweetened ice tea. i enjoy eating grill cheese. i concentrate on high protein and eat mostly seafood such as shrimps and salmon as much as i can.

12. What are things you are able to eat?
basically anything i have taste tested and eat except i still have a slight issue with poultry but able to eat 2oz with it causing an issue. more than that and it affects me.

13. Is there any food you are unable to eat or tolerate?
poultry that is more than 2 oz.. i am able not to eat more than 1/4 palm of almonds or pistacho. i am unable to tolerate any time of carbonated drink, even if it is flat

14. How much protein are you required to have each day?
80-120 gms per day but i usually have about 60-75 daily

15. What are some things you take/eat to meet your daily protein intake?
it is either

optimum nutrition rocky road protein powder that give me 34 gms of protein for 1 serving

for meat its - ground beef, ribeye steak, beef franks, italian sausages, hamburger

eggs, cheese

lobster, shrimp, crab or salmon

all these are high in protein

16. What vitamins and supplements do you take on a daily basis?
adek, centrum, iron, calcium citrate. every once and awhile i take biotin and vit e. i take prescribed vit d (drisdol) because i have a deficieny since my pre-op days and still take it

17. Are you able to eat and drink with your meals?
yes and always do

18. What is a typical menu for a day -- or post what you ate yesterday or today.
bkfast - either a optimum nutrition rocky road with lactaid milk OR western or eggs over easy/bacon/2 white toast OR cherrios with milk and some unflavored protein powder OR a grilled cheese.

lunch - tuna sandwich OR mcd's crispy chicken wrap OR burger OR pizza with any topping i want OR a grilled salmon

dinner - rice & beans with meat on the side OR pasta with meatballs OR shrimp scampi OR ribeye steak OR some seafood. i like some steam or grilled veggies such as zucchini, carrots, peans, sweet white potato OR mashed potatoes

19. Has your personality or perceptions of things changed since you had surgery?
i am more out of my shell and have more confidence about myself. overall, i am still me within, just my outside image, my body is different

20. What are some things you can say the DS helped you with regarding your health and life?
no longer suffer from sleep apnea (off cpap machine)
no longer suffer from chronic diarrhea
no longer have heart arrthymias (off heart medication)
no longer have high blood pressure
no longer confined to a chair or bed because i can't move
no longer have to worry if i am under stress i will gain weight due to my cortisol being overactive
i am able to move about without feeling exhausted
i am more flexible and able to do things without assistance
i am more active and participating in sports
i look more presentable looking and not hiding or running away from the camera
able to go out and not shy away from the public

Great Feuds In Medicine

2007-09-22T18:01:00.000-04:00

Controversy is a hallmark of new ideas in medicine. Medical care has been filled with controversy since Hippocrates.

In a recent book written by Hal Hellman, “Great Feuds In Medicine: Ten Of The Liveliest Disputes Ever”, (Hal Hellman. 237pp. New York, John Wiley, 2001. ISBN 0-471-34757-4) he demonstrates how difficult it is to bring new knowledge into medicine.

He highlights the human frailties involved in advancing medical care. The controversies described in his book cover a broad span of time, from the work of Harvey in the early 1600s to research on the human immunodeficiency virus in the 1980s. He focuses on a number of pivotal moments in medical thinking, when dramatic ideas transformed medicine. The book demonstrates that time and again new ideas in medicine were followed by controversy, upheaval and challenges before the new treatments were accepted.

Weight loss or bariatric surgery is a new and rapidly developing area of medicine. Due to this, it is not surprising that it is full of controversy. The types of weight loss surgery offered in America today include a great variety of different forms of surgery and not limited to the 3 popular known as Lapband, RNY and DS. Below is the full list of what is offered for treatment for morbid obesity. It is upto the individual to carefully research and decide what is best for them and what they are willing to deal and live with post-operatively.

TYPES OF WEIGHT LOSS SURGERY
Open Roux-en-Y Gastric Bypass
Laparoscopic Roux-en-Y Gastric Bypass
Silastic Ring Vertical Gastric Bypass (Fobi Pouch)
Micro pouch Gastric Bypass
Antecolic Laparoscopic Roux-en-Y Gastric Bypass
Long Limb Gastric Bypass
Biliopancreatic Diversion
Biliopancreatic Diversion with Duodenal Switch
Gastric Band
Laparoscopic Gastric Band
Laparoscopic Adjustable Gastric Band
Vertical Banded Gastroplasty
Laparoscopic Vertical Banded Gastroplasty
Others

9th month post-op

2007-08-31T17:53:00.000-04:00

I have been extremely busy and unable to give a 9th month post-op update, until now, when I am able to sit here and type it out. I am 9 1/2 months out of surgery.

During my 8th month post-op (July going into August) , I was at a stall for about 3 weeks. That didn't bother me for I know my body needed the rest from all the work it has been going through regarding weight loss. By the 4th week, BOOM!!! I began to lose weight and it was a total for the entire month 7 lbs. From August 15th to August 31st, I have lost a total of 2 lbs.

I have been concentrating on my protein intake and haven't been doing so well with it. The reason for this is that I am not hungry and do not have desire to eat. I actually have to sit and say come on eat and get your protein. I have a friend who is a bodybuilder. This guy has a body of The Terminator. He recommended I buy the Optimum Nutrition 100% Whey. OMG!!!! This protein powder is the BEST I have ever tasted!!!! I got the Rocky Road. It is smooth and have a great texture and flavor. No need to put it in a blender or anything. Use a spoon and there are no lumps. It has 24 gms of protein, add to it 8-10 oz of milk and you have a total of 32-34 gms of protein. I have it in the morning and sometimes drink one serving as a snack or before I retire for the night. Can't go wrong with having your fluid intake and protein quota met.

After 8 years, I am able to wear stiletto and high heel shoes once again. I missed that and it feels great! Besides, I have the legs for it. I have posted pics of myself and of course my legs, breast, etc in my photos profile.

I know many that had bariatric surgery that speak about saggy and flabby skin. I have been blessed. My tummy area has no saggy, loose or hanging skin and my legs are firm and tight as you can see from the pics. I have hardly lost any breast mass. I have hardly lost any hair either. I think it is due to having my weight loss be gradual and not rushed. Now that I have sorted the protein problem due to lack of eating (but I do eat, don't get me wrong, I am NOT anorexic), I will concentrate more on my vitamins and supplements that I have also have not been up to par with.

Many whine about their weight loss not being fast enough or not enough amount. I don't care for that for I have my health back and most important my life. I am able to do things now that I was unable to do before and I am beginning to blossom and come out of my secluded shell once again.

8 months postop

2007-07-16T17:48:00.000-04:00

Well, I am 8 months postop. What can I say? Things are going well with the exception that I have no desire to eat anything making that a bad choice in which I have to keep tabs on since that will cause my body to go into starvation mode, whack out my bloodwork levels and also causes the body to stall (which the latter doesn't bother me one bit). I care more about my health and that it doesn't go spiraling down. I have lost a total of 70 lbs which is not bad and a good pace, since the average for weight loss should be 10 lbs per month and at 8 months -70 lbs is good. I am wearing a size 9/10, but honestly I think clothes size are one size larger than what they were when I wore them back in the days. I will, when I have a chance, add a video blog on here. but, right now, there isn't much to say about my journey, except, I have to keep away from legumes and nuts. Those cause me to be a deadly gas chamber of nonstop flatus and I am not kidding. Nothing else causes me to pass such noxious nonstop gas as eating beans and almonds.

My hearing is diminishing and I can barely hear anymore. I had to see an otolarynologist today. He cleaned my ears so I can have me hearing test on Friday. This is not caused or contributed to bariatric surgery. Totally isolated situation. For a very long time, I did not want to disclose or let anyone know I am partially deaf. It isn't something I want to talk about or create topic since I was not born with this disorder or does it has anything to do with genetics. It was due to an event that occured and am unable to hear sound through my right ear. When people talk or I listen to the tv or radio, it sounds as though people are mumbling, whispering and quite muffled. I did have hearing aids before and it isn't something I wanted to wear because I didn't want anyone to know. Now, with the advancement in medicine and technology, they have very small hearing aids not noticeable. Let me get my hearing tested and take it from there. This is life. It is what it is and I make the best of it.

I don't like talking about my family but will, since I think the reason I have not been eating is the stress and worry over them. First of all, my mom had a stroke in her eye. I am in the process with the ophthalmologist for her treatment and surgery that is scheduled. Her eye pressure was extremely high and it cause damage from the hemorrhaging. Her eyesight will not be what it was before. My mom is 78 and taking 3 different types of eye medications for her eye to keep her pressure and condition under control.

My son-in-law started his combat training and soon after that will be on standby and leave to be redeployed from Spetember to November, yes re-deployed back to Iraq as an infantry soldier. He was with the 4th Infantry Division when he did his service and just returned back home in December 2006. This will be his 2nd tour as a combat soldier in Iraq. He will be stationed for 15-18 months. This is serious. stressful and difficult times of worrying again for his safety and return when his tour of duty is completed. My daughter wants to stay in Germany and loves it there. I have plans to go there next year, as well as, do alittle jet setting. We will go to London, Swizterland, Luxenburg as well as go around Germany and do a 3 city Italy excursion to Milan, Rome and Venice. My daughter wants me to go to my paternal family homeland which is Poland. I don't know if I will. Time will tell. Hope everyone is doing well.

Research. studiy and overview of BPD-DS through noted bariatric

2007-07-08T18:06:00.000-04:00

Roux-en-Y Gastric Bypass: The "Gold Standard" is getting tarnished

The Roux-en-Y (RNY) has a number of significant disadvantages. The chief problem with the RNY is its high failure rate at nearly 50%.

Dr. MacLean LD of the Royal Victoria Hospital and McGill University in Montreal, Canada, found in his 5-year longitudinal study that nearly half of the super-obese patients were a failure with the RNY.

Dr. Bloomston of the University of Florida College of Medicine, Division of Digestive Disorders, only 26% of super obese patients returned to within 50% of their ideal body weight.

Dr. Smith of Salt Lake, Utah, found after a 7 year review of 3,855 patients who had the Roux-en-Y, the average weight loss was 77.5 lbs.

Even when a review of the effectiveness of the RNY procedure in the general population (as opposed to just the super obese), long-term studies consistently show weight regain beginning after 3 years. Excess weight loss decreased to a range of 50-60% at 4-6 years and only 47-49% at 10-15 years.

Dr. Mitchell of the Neuropsychiatric Research Institute in Fargo, North Dakota, reported that 3 of his subjects "weighed more at long-term follow-up than before the operation.

Dr. Wolfel from the Department of Surgery, University of Erlangen-Nuremburg, Germany concluded that the RNY failed to provide "adequate or prolonged control of morbid obesity" and that "none of the 1119 patients ever moved out of the category of "morbid obesity".

Even if it weren't for the ineffective weight loss followed by weight regain, additional multiple problems with the RNY make it at best a poor second-choice surgery to the biliopancreatic bypass with duodenal switch. The weightloss that is achieved through the RNY appears to be primarily dependent upon the removal of the pyloric valve, leaving the individual without a regulator of food movement into the small intestine. This results in the well-known phenomena called "dumping syndrome" which can cause an individual to feel sick or even faint. Supporters of the procedure actually refer to this unpleasant side effect as a benefit because it helps the patient form an aversion to sugar.

The extremely small "pouch" (approximately 1 oz) created in the RNY procedure to replace the stomach causes vomiting whenever the patient eats even the slightest amount beyond what the pouch can handle. In addition, the patient cannot eat and drink at the same time. Meat intolerance is reported in the majority of the patients, even 7 years after their operation. Patients will vomit or get food stuck in their pouch if food is not mashed into the tiniest peaces before swallowing.

An additional problem with the Roux-En-Y is the occurrence of ulcers.

Dr. Sanyal of the Department of Medicine at Medical College of Virginia, Richmond, Virginia, reports a rate of stenosis and ulceration of 12.5% and 12% respectively. MacLeans reported, "Stomal ulcer occurred in 16%". Wolfel reported a 12% rate of ulceration.

Ulceration is practically absent in the BPD/DS procedure. The complications caused by the RNY procedure are not limited to the first months/years following the surgery. In a recent 13-16 year follow-up of 100 patients, Dr. Mitchell states "68.8% (of the patients) reported continued problems with vomiting and 42.7% with "plugging, 42.9% had heartburn and 31.6% reported diarrhea… 8 had died". Dr. Wolfel in a 10-year follow-up study of transected and stapled gastric bypass along with horizontal gastroplasty, reported a 39% rate of vomiting, a 45% rate of heartburn and an 18% rate of cramps.

Biliopancreatic Diversion with Duodenal Switch: The Platinum Standard

The original Biliopancreatic Diversion procedure introduced in 1979 by Dr. Scopinaro used a distal gastrectomy. This procedure has been known as BPD/DG.

In 1989, Dr. Hess of Wood County Hospital, Bowling Green, Ohio, combined DeMeester's Duodenal Switch procedure with Biliopancreatic Diversion to the new BPD/DS procedure. The resultant procedure achieved gastric restriction with normal gastric function including the pyloric valve. Marginal ulceration and the dumping syndrome were eliminated. Dr. Hess sums up the primary advantages of the BPD/DS procedure:

"There is no isolated stomach, no foreign body or band required. There is preservation of the pylorus, no dumping syndrome, no marginal ulcers, and good weight loss".

According to Health Net's "Guide to Evidence-Based Medicine" - the "Clinical Practice Guidelines" for physicians, the Biliopancreatic Bypass surgery (BPD) is a procedure that bypasses a large part of the intestine with a concomitant resection of the excluded part of the stomach." Sugerman reports, "The biliopancreatic diversion has had excellent weight loss results".

Dr. Deitel of Mature Medicine Canada, North York, Ontario, Canada, reports: "The BPD has produced the most effective and sustained loss of excess weight of any of the operations thus far". Forestieri in discussing the merits of restrictive versus malabsorptive processes notes, "Without a doubt, the BPD gives good results in terms of weight loss and more stability than gastric restriction procedures". Dr. Hess found that after an 8 year period his "super obese" patients (BMI >50) continued to have a weight loss in the 70% excess.

Dr. Balsiger, Department of Visceral and Transplantation Surgery, Inselpital, Unitversity of Bern, Switzerland, reports that BPD is "arguably one of the most effective bariatric procedures in inducing and maintaining weight loss".

Reports of the efficacy of BPD/DS shows

Dr. Hess reported excess weight loss of 80% at 2 years and 70% at 8 years.

Dr. Marceau adopted the duodenal switch procedure and reported 73% excess weight loss at 51 months.

Dr. Baltasar reported excess weight loss of 70.1% at 1 year, 75% at 2 years, 75% at 3 years and 81.2% at 4 years.

Dr. Rabkin reported a mean excess weight loss of 73% at 4 years.

In summary, the BPD/DS have reported long-term weight loss in the range of 69%-80%. BPD/DS are the most effective procedures for weight loss in existence today.

Safety of the BPD/DS procedure:

Having shown the efficacy, the key remaining question becomes the safety of this procedure.

Operative and late mortality rates of the BPD and BPD/DS procedures are shown to be comparable to other gastric bypass procedures.

Dr. Deitel reported that with the duodenal switch modification of the BPD: "This procedure is followed by surprisingly few complications, mainly some soft stools and malodorous gas in a minority".

Dr. Forestieri reported that surgical complications of BPD are comparable to the gastric restrictive procedures. Postoperative complications are reported to be somewhat higher. Forestieri also reports, "BPD, on the other hand, requires careful management only when complications occur, as they do in a limited number of cases. Forestieri concludes, "When all of the above factors are considered these two types of surgeries are both viable options for the treatment of obesity".

Liver Failure?

Dr. Grimm, Dept of Internal Medicine (Gastroenterology Division), Naval Hospital, San Diego, California, reported a single case of liver failure and Langdon reports two cases of liver failure.

However, Grimm reports that the patient was non-compliant and anorexic. "She refused most oral medications prescribed in hospital, including metronidazole".

Dr. Langdon reports one patient "refused surgical takedown on multiple occasions" and the other patient "began (drinking) alcohol surreptitiously". And Grimm also reports "the rarity of liver disease after BPD contrasts sharply with the situation after the JI bypass …."

Dr. Murr, reported a single case of liver failure in a series of 11 patients. However, he also notes that this patient "refused to take the prescribed mineral and vitamin supplementation and never saw her physician".

In his series of 440 patients, Dr. Hess reported only a single instance of liver failure, which was associated with multiple organ failure. He concludes, "that liver disease is not a problem with this procedure".

Dr. Baltasar reports on a single case out of a series of 125 patients of liver failure.

Dr. Marceau reports, "After surgery, both liver function and morphology improved to the point where 3 out of 12 with preoperative cirrhosis were no longer considered cirrhotic after 10 years.

Metabolic Complications:

Protein Malnutrition (PM):

Dr. Totte reports only 2 cases of protein malnutrition in a series of 180 patients, and "in both cases the problem was attributable to a precise cause unrelated to the surgery." One patient "took up drinking, smoking, and cocaine abuse", while the other patient, her twin sister. In both cases a restoration of intestinal continuity left both patients in good general health. A third patient was reversed because "she was not able to reset her self-image of the new slimmer person" .

Dr. Hess reported in 1998 that 8 out of 440 patients (1.8%) undergoing the BPD/DS patients required revisions due to protein malnutrition or excess weight loss. Rather than choosing a fixed limb length, Hess chose to measure the small intestine and make the alimentary limb 40% of the total intestinal length while the common channel was made to be 10%. The mean common channel was increased from 50cm as in Scopinaro to 75cm.

Dr. Hess increased the common channel from 50cm to 100cm, his yearly revision rate on BPD/DS is only 0.1% per year compared with 1.7% for the BPD/DG Scopinaro procedure. This 17 fold reduction in revision rate demonstrates a substantial benefit of the BPD-DS Hess procedure over the BPD Scopinaro procedure.

Dr. Marceau also reported a reduction in hospitalization rate for malnutrition dropped from 1.72% per year with the BPD/DG procedure to 0.93% per year with the BPD/DS procedure.

Dr. Marceau on BPD and protein malnutrition concludes, "There are differences in surgical techniques that may account for the different results and different interpretations" and there are "3 factors that influence the degree of protein deficiency"

1. the size of the remaining stomach
2. the degree of restriction to nutrient ingestion
3. the initial nutritional state of the patient

In a modified version of the BPD/DS where temporary gastric restriction was obtained by use of a self-dissolving band, Dr Vasallo reprted "At 2 and 3 years follow-up there has been no case of dysproteinemia".

To summarize, PM rate between 1-3%. PM can be reduced by careful selection of the

gastric volume
common channel length
total alimentary length

In extreme cases, protein malnutrition can be resolved by elongation of the alimentary or common tracts.

Iron Deficiency/Anemia:

BPD/DS procedure has fewer problems with anemia and iron deficiency than the "gold standard" Roux-en-Y gastric bypass.

Vitamin Deficiency:

Dr. Baltsar reports "liposoluble vitamins should be monitored, but so far none of our patients have presented deficits".

Dr. Marceau reported that the serum levels of vitamin B12 were actually increased slightly in the BPD/DS procedure and the percentage of patients with abnormal serum B12 levels was 3% both pre and post operatively.

Dr. Clare reported that the incidence of Vitamin A and D deficiency in a group of patients with equal bilio and alimentary limbs was 0% and 1.4% respectively.

Dr. Marceau reports that serum levels of Vitamin A, B12, folic acid, phosphorus and magnesium were unchanged when compared to pre-operative levels.

In conclusion, fat-soluble vitamin deficiencies are rare and easily controlled through oral vitamin supplements. Vitamin B12 deficiency is not a problem whereas it is a problem in the RNY procedure.

Calcium Deficiency/Bone Loss:

Dr. Hess reports, "If the patients take their vitamin D and calcium they can maintain the proper levels and in some cases increase their calcium and vitamin D to levels higher than those before surgery."

Dr. Murr reports that two "noncompliant patients" who refused to take supplements developed metabolic bone disease. Murr also noted that for the distal gastric bypass there were no problems with bone demineralization; however, the common channel length was also modified from 50cm to 100cm.

Dr. Clare states that "A major factor in the appearance of disturbed bone metabolism is patient non-compliance with respect to diet and nutritional supplements. Fortunately, it responds to aggressive medical treatment" Clare did reported 3 cases out of 504 that required reversal due to disturbed bone metabolism, and "each of these patients had shown very poor compliance with respect to the recommended nutritional supplements."

Dr. Marceau recently reported that "10 years after surgery, overall bone density has not changed at hip level and the decrease at spine level was minimal (4%), much less than what was expected for aging alone…. In 33% bone density was increased … and in 15% density decreased more than was expected for ageing alone".

In conclusion, 10 years after surgery calcium loss appears not to be a problem with the BPD procedure.

Sufficiency of Data Regarding the Biliopancreatic Bypass:

Over a thousand BPD/DS procedures are done each year. The metabolic complication rates have dropped dramatically now that it is common practice to make the alimentary limb length 40-50% of the total intestinal length.

In 1998, Dr. Hess reported on a series of 440 patients who underwent BPD/DS followed up to 8 years.

Dr. Hess 1998 report covered 465 patients who underwent BPD/DS a mean of 4.1 years prior to his report. A recent report by Dr. Marceau included 909 BPD/DS patients studied over 10 years.

Dr. Baltasar 2001 report covers 125 patients who underwent BPD/DS.

Dr. Rabkin in 1998 reports on 105 patients who underwent BPD/DS.

Dr. Brolin stated in 1996 "It seems likely that a consensus panel on the same subject would be worthwhile in the next decade to carefully evaluate such procedures as biliopancreatic bypass …" . Specifically VBG has been shown to be rather ineffective, while BPD/DS has been shown to be safe an extremely effective.

There now exists a large body of evidence to show that the Biliopancreatic Diversion is safe and effective as long as the common channel length is increased to at least 75cm and either the gastric volume or the length of the alimentary limb is increased 150 ml compared with the original values proposed by Scopinaro of 250cm.

Several thousand patients have been reported on with follow-ups as long as 20 years. Over the last 3 years there have been numerous peer-reviewed articles showing the long-term safety and efficacy of this procedure.

Staple food for me since having the DS

2007-07-01T19:37:00.000-04:00

For breakfast, it's usually one of these

grilled salmon
western omelet with cheese and homefries
grilled ham & cheese or bacon, tomato and cheese
Special K cereal with milk and 3 tbsp Champion Nutrition vanilla protein powder
Optimum Nutrition Rocky Road with 10-12oz milk

For Lunch, it's usually

chicken
hamburger with grilled mushroom, bacon, onion and cheese on a bun
grilled Nathan's frank with Jack Daniel's bbq sauce, onion in sauce, mustard, melted cheddar cheese on a bun
steak
lobster
crabcake
shrimp (any style)
pasta any dish
rice any dish
cuban sandwich

For Dinner, it's basically whatever I want

steak dishes
chicken dishes
ground beef dishes such as meatloaf, lasagna, picadillo, etc

Japanese cuisine - beef negamaki, california rolls, teriyaki, miso soup, gyoza, tempura, sukiyaki, let me add house fried riceand general tso cause i can these

Latin cuisine - paella, monfongo, sweet plantains, rice and beans, tamales, alcapurria, canoas, pasteles, fricase, croqueta, octopus salad, churrasco

Greek cuisine - gyro, souvlaki with lots of tsasiki on both if these, dolmades

Mexican dishes such as taco, steak burritos, quesadillas, chili, fajita, nacho

Snacks is basically a meal for me and I have ON Rocky Road protein with milk to meet my protein quota or I may have with it or on its own - yogurt, protein enriched chocolate pudding, banana, etc

I do and can have drinks with my meals at the same time. It will not and does not wash or flush out the food. It will not cause a DSer stomach to be full before eating or cause them that they will are unable to eat due to the being full from drinking fluids, due to the contribution of having their pyloric valve intact and true stomach untouched (just the bottom curvature has been removed). This will make a DSer live like a non-op since there is no gastric bypass involved. The drinks I have on a usual basis are

milk (regular or lactose free, doesn't make a difference)
Tropicana Light & Healthy orange juice (DS can drink regular orange juice)
Koolaid with Splenda (either tropical punch or cherry flavor)
papaya shake made with frozen papaya, milk and Splenda
Tang
ice tea (but limiting it, due to caffeine)
Orange Fanta Zero soda (DSer can drink carbonated soda and it will not stretch their stomach!!!)
Various Protein supplemental powder with 10-12oz milk

Every once and awhile, I can and will have

tiramisu
creme brulee
flan
ice cream
cheesecake
cake
pies
cookies
pudding
croissant
english muffin
donut
etc.

50% of the calories and 80% of the fat for the above delicacies are malabsorb in huge amount. 40% of the complex carb are also malabsorb. The simple carbs are not, yet I do not have an issues that it will cause me to gain weight, since I have eaten these sometimes 3-4x for a week with no effect or seen the scale move up in pounds. NOT ONCE in the 20 months since, I have been postop. I have eaten up to 220g carbs for the day and still it will not cause any weight gain for me since that only comes out to 132g of carbs for me.

Most important thing for me is protein first and I try to get at least 20g as a minimum per meal with a minimum of 90-100g daily. If I know it will not reach my quota, I take shakes throughout the day. I only consume the protein drinks because I am unable to get all my protein from food. Next important thing is complex carb. I like to limit it to a maximum of 160g of carbs daily with DS absorption calculation. After these 2, I am able to enjoy having some simple carbs with a limit to be 50g carbs daily as the maximum for the day. Although, I try not to go over that, just to be conscious, eventhough as I said, that amount hasn't affected my weight and I have gone as hig as 80g simple carb and still has no effect on me.

been extremely busy with various projects

2007-06-21T17:45:00.000-04:00

I have been extremely busy with various projects. It is nice that I am what you can say picking up where I left off prior to where morbid obesity stole my life and imprisoned me for close to 5 years. It has been almost 8 months since I had my surgery. There has been NO rollercoaster ride that has impacted me negatively. Just nicely paced and controllable. Once I did hit my 7th month, I did have a condition that I do not want to eat. Why? No idea, it just happened. I am not anorexic. I do make it that I consume food, whether I want to eat or not. I make my intake be food of high protein values. I make sure I do drink my milk with Unjury, as well as drink water and ice tea for my fluid intake daily. I haven't been up to par with my vitamins and supplements. I do take a few here and there, but for some reason and I am sure it happens to many, you get tired of the regime of popping 10-15 pills/fluids/chewables vitamins a day. I alternate using swallow form and chewables pills, as well as vitamins in fluids format. I am just in a funk phase right now. As long as I am aware of my situation and doing what is right to take matters and have it corrected, I am ok.

I do not do physical support groups, not my thing. I am been to 2 different ones. My support system are my friends that have been my mentors and I known for 3 years or more. If you are into going to support groups gathering, good for you. What counts is you have some type of support and someone there for you, even if it is 1 person that understands the phases you have. Alone and without not known 1 person and going through certains emotions that is all normal to experience would have been a difficult road and even psychological, if as I said you are all alone. I have WLS friends (RNY and DS), who I can share experiences with. My closest friends are there for me and prior to surgery, know the ups and downs they have gone through and myself. Even now, some are 3 and even 6 years post-ops and they come to me who is only 7 months post-op for advice and support. Honestly, it doesn't matter that I am 7 months and consider a beginner to all this. We all need some sort of anchor and someone to tell it like it is to help out with the struggles and inquiries we have, even if you are years post ops. I may not be over a year out, but I can understand their challenges because we all been through one, one way or another and prior to surgery although I did not know what it was like, I can understand and help them work out their dilemna. I have 4 WLS post op friends (Shawn, Janice, Erika and Rebecca), who I connect to and when I have an issue or they have an issue can count on each other for support and not limited to WLS. There are other post ops that I interact with, can talk,or relate to and even joke around with.

I had a duodenal switch, my 4 friends all had RNY. So what we have different procedures. It is all bariatric surgery. I am not one to glorify or get into discussions about one WLS vs. another WLS and is better than another. Give me a freaking break on that. The main concept is that they all are bariatric surgeries to help improve medical conditions and it is up to the individual to decide what it best for them.

I was considered high risk to have bariatric surgery and after surgery, spent 3 days in a step down ICU and it was not easy for me. I stayed 4 days in the hospital and my post op recovery was HELL due to 27 days of nonstop pain within. This is not normal, but it was expected due to my circumstances. I have taken the pain killers, but it wasn't enough to make the pain go away, it was always there. I dealt with the horrible experience and although as I said it was HELL during that time, I made it through and recover from it. I did not have complications or risks. It was just internal sensitivity to the surgery from rearrrangement and alterating of my organs. My 4 friends were there for me and even seen them. I am extremely selective who I want to meet in person and it takes time to size you up as to what your intentions are, is it platonic friendship or you wanting something beyond that.

Moving on, I think alone, I would have been depressed and even confused as to what in carnation did I do and why is this happening to me. I did called my surgeon's office a few times and he has been very attentive to me every single time. I have not been depressed since having surgery and I haven't had any doubts or complications with my surgery either. So, whether you go to a physical support group or have friends online and take it a step further as to talk on the phone and even meet them in person, that is what counts, having someone there that you can share your ups and downs with. My postops friends I have had a pleasure to see and become good friends with. Although, we all live in different states, they are the ones I count on and can call when I have an issue and vice versa. They can contact me whenever they want and like I said, it is not limited to just post-op topics.

On a side note, I have been contacted and offered 2 very prestigious jobs. One is teaching undergrads in an Ivy League University and the other as a consultant to a very well known organization. The salary for one of them is in the $100,000+ figures, the other one is in the upper $90,000+ range. I will interview both and may accept one of them, if it suits me and my criterias. This will be a key to placing myself back to where I was prior to this deadly disease of morbid obesity almost taking my life in more ways than one.

One thing that happens to many is they forget where they were before they had their surgery. I am not only talking about paying it forward, I am talking about their sincerity and compassion to others that are in the same boat they were and remembering what it is like. Some seems, once they have the surgery and appear more acceptable to those that see them whether in person or online have a certain arrogance, selfishness, narcisstic, become aloof towards others and become cliquish to those that are post-op, even have a certain sexual prowlness and provocative attitude about themselves since losing the weight. Those out there that reads this, don't forget what it was like being MO and how people shun, mock and even ignored you compare to now that people want to be connected to you and even friends since you have lost the weight and look appealing to their eyes, but didn't before. Be true to yourself and don't let this post-op thing get to your head that much, that you forget what and how you were prior to it all and you yourself judge beauty and who you want to interact with based on their physical aspect as well. We are all humans here and it is true people judge you by your outer shell (your body) and looks. Don't forget to understand and remember what it was to struggle with MO and even SMO and how people treat you now because you "look acceptable" compare to then that you did not spark their eyes, mind or interest. Think about it, when someone compliments you or even try to flirt with you. Would they, if you were S/MO?

7 months post-ops

2007-06-14T17:46:00.000-04:00

Well, I am 7 months post-ops. I am glad to say, I have no cpmplications or negative side effects whatsoever. I do not experience diarrhea or constant flatuence issues as many state. I think, it has to do with what you eat and consume. I know almonds are a bad choice for me, since I am compared to a lethal gas chamber. So, no almonds for me. Still, cannot eat poultry. I will give it time, for I might one day be able to tolerate it and not regurgitate it. I cannot do any carbonated beverage. It give me pain from hell in my belly. Other than that, I am doing very well. I don't have any skin issues to worry about. My inner thigh skin isn't that bad and seems to be sorting itself out. As for my breast, well, At this stage, I have lost some volume. They are still full, but not as volumptous filled out like before. I still have mass and all. But, not as perky and out there. I am content and it isn't so bad. I can go braless and my mass and volume still looks good.

I have lost about 70 lbs and weigh 180 lbs. I am currently wearing a size 9-10 and some 11-12 clothes. It depends on the brand, how it is cut and the style. I still have my big latin booty on me. It has not shrunk, gone down in size or sag on me. Ok, it has gone down in size, but it is proportional to my body frame and not dragging or sagging on me. My tummy has gone down alot and is not saggy or have any loose skin. I am currently wearing sleeveless tank top and spandex type biker shorts and those are nicely fitted on me, since my skin tone looks good.

Other than that, I am going through a phase that I know it is normal, but still. I am going through bouts of not being hungry at all and don't want to eat. Right now, I am forcing myself to eat my food. It isn't bad, but I make sure I do eat and have my fluids intake. Since, I am battling with eating, I consume food that has high protein intake, in which I eat on a daily basis either salmon, shrimp, fish, lobster, crab or steak. At least make 2 of those my daily intake for lunch and dinner. I do keep myself focus and in control to what needs to be done to avoid any deficiencies and other related health problems. That's all for now.

food intake

2007-05-25T15:58:00.000-04:00

I wanted to write this since this is important to anyone reading this. I have all my life been conscious of my health and what I do. Prior to having bariatric surgery, there would be times I wasn't up to eating and didn't eat for the day. But once you become post-op, you cannot have that mentality or even let such action take into play. Having this surgery means you have to comply and take the daily regime serious. Sure you can miss a vitamin or supplement here and there. But when it comes to food intake, that is your life line and source to getting your nutrient to nourish your system and you HAVE TO get your protein in your body.

Not eating can cause your body to go into starvation mode and also cause certain organs to not function as it should. One being your brain and its cell as well as the blood supply that run through all your sytem from beating your heart to helping your organ do what it needs to supplying your brain via the spinal cord. Blood also has electrolytes and those electrolytes is what gives your heart that power to ignite and pump. If your electrolytes are low from not eating and nourish your body, you will get dizzy and even pass out. Headache is also contributing to poor or not eating as well as consumption of alcohol will deplete your nutrient intake. So what if you had all your vitamins and supplement, drank over 64 oz of water and taken your protein to what is needed. When you drink anything with liquor, you are depleting all you work for the day and it does dehydrate you as well. So think, before you take that drink with alcohol in it.

So, remember to eat if you are post-op and if you can't then find something that you can and make it smaller portion that you may eat throughout the day. I personally eat smaller meals and not the typical 3x a day meals. I have 4-6 x a day meals. I am not a snack person, but will have a yogurt or a banana or just drink milk with Unjury protein powder. I don't use a whole scoop in my milk. My taste buds have changed and I now can only add about 1/3 to 1/2 scoop into my glass of milk. I do use Unjury when I eat cereal. Again add 1/3 to 1/2 scoop. WIth bariatric surgery protein is prevalent. Just wanted to add this here to let other know, if you do experience like me to have bouts with no feeling up to eating anything at all. Just do what you must and do make sure you eat and DON'T skip a meal.

6 1/2 months post-op

2007-05-23T15:59:00.000-04:00

I am 6 1/2 months post-op. Things are going well for me. Let me update here, since some like to read what's going on with me since I had DS surgery. I have hit my half way point for the year and lost a total of 62 lbs. Overall, I have lost a grand total of 120 lbs.

I am honestly doing well, no complaints or negative effects from having DS. My blood work from a few weeks ago came back within normal range with no red flags. I need to do another bloodwork for my 6th month update which is now. I haven't lost any weight by checking the scale, but I am losing since my clothes are falling off and needed a safety pin to tighten my pants. Pants size depends on maker and style. I am in some pants size 9-10 and in other pants 11-12. Have to take into account I do have a booty on me and do not like wearing tight pants. I can fit into medium pants. In total going from size 20-22 right before I had surgery to now a size 11-12, don't want to say 9-10 just as yet. That is a total of 10 sizes down. Not bad and I am taking my SWEET ASS TIME with my weight loss.

I am in no hurry or rush to lose weight and want to prevent my skin from sagging or hanging on my body. My skin is firm and tight on me. I am 6 months out, have lost over 60+ lbs and don't have that condition and may not see it, since I only have 40+ lbs to go till I reach my goal of 140 lbs. That is a good note in my book. I do not think I will need plastic surgery on my tummy, side or to have any upper or lower body lift. The only noticeable that I see are my inner thighs. The skin is a bit loose, but it isn't bad to be honest. If I wear stocking it won't show and with pants on, you don't see any "defects". With clothes off, it isn't really that bad at all. I do wear a lot of shorts and especially black spandex biker shorts that hugs and contour my body with a tank top over it and my body isn't disproportioned. Sure, my tummy is still a bit swollen, but it isn't bad at all. As I lose more weight, I will see how my body will morph. I have less than 45 lbs to lose until I reach my goal of 140 lbs. I want to look healthy and appealing, not a bag of bones protruding out of my skin or looking like a twig. My breast are still there and haven't deflated after 60+ lbs lost. They don't have that great significant puffy volume as before, but it is looking very nice and healthy and I still have the "twin girls". Yet, they do look mighty fine. My arms look ok as well. Bear in mind, I have gone from 305 lbs to 165 lbs on my own, to gain back 85 to be 250 prior to my bariatric surgery. I do not have stretch marks on my skin or have any other concerns with my skin due to weight loss and I am glad about that. My skin I can say is firm, very smooth and what I consider tight. Time will tell, since I still have as I said another 40+ lbs to lose.

Regarding food, I am able to eat pasta that I make and its good. I use italian sausages or ground beef to make my marinara sauce and that gives me good protein intake. Sometimes, I just eat the marinara and meat and lay off the pasta. I made sauteed corned beef with potatoes, onions and tomatoes and had that with some white rice. I can't eat much of the rice, it does fill me up fast, but Libby's canned corned beef has a lot of protein and that is what I did eat a good portion of. I will have ground beef made into a burger, add some mozzarella to melt on it and some marinara sauce and that is my pizza burger. It does taste good. I will change the cheese to monterrey jack or fontina cheese. I will also make an italian sausage with grilled onion, green and red peppers. Italian sausage is very hearty and filling for me. I can only have 1/2 of it. But will eat my veggies, oh yeah, love eating veggies. Seafood is great for me. I do have my weekly share of seafood. Still, can't eat poultry. Let me make a list of what I am able to eat:

* ribeye steak
*filet mignon
* pork tenderloin
* lamb
* ground beef
* italian sausage
* ham
* salami
* corn beef

* shrimps
* codfish
* mero fish
* king fish
* grouper
* tilapia
* salmon
* crab
* lobster

* rice (long or short, but only a few teaspoons)
* pasta (freshly made or boxed angel hair or size 9)
* potatoes (mashed, fries (very small amount), baked, salad)
* any type of vegetables
* bananas
* watermelon

* milk (fat free/lactose free, 1 qt Lactaid fat free milk daily)
* tea (prefer ice tea with lemon, ready made with sugar or splenda)
* water of course
* coffee (caffeine free and I only like and drink swedish mocha)

* Special K with berries
* Cherrios
* whole grain bread and has to be toasted
* mini bagel and it has to be toasted (takes a long time to digest though)
* Pillsbury biscuits you make at home (has to be the buttermilk, the other one doesn't sit right with me)
* cinnamon rolls you bake in the oven with frosting
* Chef Boyardee spaghetti with meatballs
* soup
* chili
* yogurt (prefer blueberry or strawberry & banana)

* eggs
* any type of cheese
* butter
* cream cheese
* olive, vegetable, sesame, peanut oil (won't make me sick)

not able to eat, tolerate or digest
* chicken or turkey (any part or cooking methods)
* english muffin (painful to digest)
* almonds (gives me a bad digestion problem)
* carbonated beverage (digestive pain from HELL)
* untoasted bread (any type)
* pizza crust or any heavy dough breading

Regarding snacks, I can eat cheese nips, but not too many. I am able to eat 1 twinkie. I can eat cookies, cake and ice cream. But as I said, I don't eat these regularly. Yet, it is there as a choice. I don't need to be deprived of food or make any food a taboo for me. The option is there if I ever want it. Just have to have things in moderation, know what you are eating and not binge on it. Eventhough, I gained to be SMO, I was never much of an eater or over ate to begin with. It is nice that I can have snacks and certain food if I want it at my disposal. I don't crave it, have guilt trips or think it is bad for me. It is there if I want it and that is all I have to say about it.

The idea is to live as normally as you can and understand that any type of bariatric surgery is only a tool to work with, not a sole remedy or solution to your dilemna. You are in control as to how to utilize it and how to live with it. Also, the main focus is on health and it is accomplished through weight loss. This is not a contest to see how much or how fast you lose weight. Remember, the focus is on health and you improving your lifestyle to not be limited or disabled due to the cause of morbid obesity disease.

Regarding vitamins and supplement here is my daily regime tally count

2 Ferro-Sequel Iron pills
8 Calcium Citrate, but will be changing to liquid calcium citrate
3 ADEK
3 Centrum liquid vitamins (6 tbsps total) got tired swallowing pills
1 400 IU vitamin E
1-2 Biotin
1 Drisdol prescribed 10,000 IU vitamin D (once a week)

I do change my method from swallowing pills to having liquid forms. Gotta remember this is for LIFE and you HAVE to take your vitamins and supplement with this surgical procedure. So, every once and awhile I change from pills to liquid form.

6 months post-op

2007-05-14T16:00:00.000-04:00

Today, I am 6 months post-op. I had not had any complications whatsoever in my outcome with my bariatric surgery. I am healthy and doing well. Have to remember, anyone reading this blog of mine. I do not have gastric bypass, also known as RNY. I had a bilio-pancreatic duodenal switch which means, I still have portion of my stomach (only the outer curve of my stomach pouch was removed) and I do have my pylorus valve that allow food to pass from the stomach to the duodenum. In a RNY, this muscles is missing, hence it is called a gastric bypass. With the DS, you have this muscle and your stomach functions regularly. Therefore, there is no gastric bypass with this method of surgery and your digestion does function as normally as possible except there is a switch and with that a 2nd intestinal tract meant for your digestive juices to process, which then meets at a junction known as the common limb at the end of the small intestine.

Have to also remind those reading this, that with the DS, you have greater chance of malasbsorption also with it being a restrictive. You must live the rest of your life, taking vitamins and supplements. I take 10-12 pills a day and sometimes it is tiring and my tummy too full to digest, even if I haven't eaten much. I do swap to liquid vitamins to help me meet my quota of intake. This is something that is a must and you ignoring or not taking your vitamins and supplements can endanger your health. There are times, I am not up to par with it, but I do my best and consume what I can daily.

Moving along, I am still having difficulties with bread and can only eat toasted sliced bread. Multigrain is more better for me than white. I like toast with alittle butter and either vegetable, salmon or chives and onion cream cheese. I don't have toast every day, just whenever the moment hits me, it is there as an option to have with my eggs and bacon. For breakfast, I will have either western omelet with just some toast or an egg over easy with an Italian sweet sausage. I don't do english muffin. I have issues digesting it and takes a long time, so I avoid that. I can have a cinnamon bun, cornbread and am careful with the biscuit. Other things I have for breakfast is Special K with berries cereal with milk and 1/3 scoop of Unjury protein powder. I drink a lot of milk, about 1 quart a day or ice tea. For lunch, I eat a lot of seafood, either crab, salmon, shrimps or fish. I do eat potatoes, either baked or mashed. I can have a few fries, maybe about 5. Veggies are staple in my food intake. I will have a burger with no buns and do enjoy placing mozzarella, monterrey jack, fontina, cheddar or american cheese on it as it cook and melts. I also like adding marinara sauce on it. That in itself is a meal for me for lunch or dinner and drink my milk with Unjury protein powder with it. I still can't eat pizza, just can't digest the dough. I am able to eat spaghetti but has to be size 9 or angel hair. Chef Boyardee spaghetti with meatballs is something I can eat, tolerate and digest. I also make some meat sauce or marinara and lots of cheese, for my pasta, lol. I only eat ribeye steaks or filet mignon, no other. I cannot eat chicken or other poultry. It still makes me sick.

I went to my 6th month follow-up post-op visit. The surgeon told me my progress has been great and very steady. The weight is slow as it should be. I do not have skin issues on my stomach or arms. My neck and face have great tone, as per his words. I am only 40 lbs away from my goal and he prefers the weight loss to be slow. As of now, My tummy is still a bit puffy and asked him to check to see if I have a hernia. He examed me, told me to cough and then said no, it is still puffy and can take upto a year for it to go all down.

Another thing, we talked about stall. I am at a stall and he told me a stall is actually a very good thing and should not be seen as anything negative. With stalls, your body rest, isn't going thru any saggy or loose skin issues, since the muscles and other part are being re-distributed within. He told me the one with obssession with the scale and stalls, he tries to divert their attention from that and look at the overview of it, that the body needs to rest since continuous weight loss also deprives your body of the nutrients. With a stall, the body begins to take the nutrients and this is the time to up the protein and all. He told me, I am doing very well and will see that my body will start losing weight very slowly now and with frequent stalls since all I got left is 40 lbs to lose and my skintone has been very good. l follow my doc advice and let the loss from here till my 1 yr anniversay be slow and remember stalls are a good thing and actually a good thing for your health and safety which many don't see. Some whine and complain about it. But, with stalls the body rest and distributes itself. With rapid weight loss, it is muscle more that you are losing, not the fat product in your body, hence saggy or loose skin. Also, the amount or length of time you have been overweight does have a factor in your skin elasticity and how it shrinks as you lose the weight.

7 months post-op

2007-05-08T15:56:00.000-04:00

I am almost 7 months post-op. This weekend I went to buy summer clothes. I refused to buy any clothese during my first 6 months, since I did have clothes from previous weight loss in my storage room and was feasible during the winter and cold months. Now, the weather is warn and I never went out much. I purchaased 6 pairs of short, 1 cpari pants size 10 , a nice strapless summer dress and a few tank tops. I bought the pants size large and they are big on me. I do have a butt, but miscalculated that I am a medium, although I feel bigger and bought a size large. I've also bought a sewing machine as an actual necessity since my clothes will need to be taken in here and there. i was wearing pants with safety pins on it and realized it is time to buy clothes. Other than that, I had a nice time shopping.

Regarding Memorial Day, I relaxed and enjoyed my time. I made chicken and decided to taste test a wing to see if I can now tolerate eating chicken. NOPE!!!! Threw it up as previous times. Maybe, on my 9th month post-op I will be able to eat chicken again. Doesnt' hurt or harm me to try it again. I am still having occurrence with not being hungry, but will eat since that is my source to protein intake and helping my body sustain it vital organs. I am at a stall and to me that is not a bad thing. My body needs the rest and to redistribute its weight. I do not want to lose more than 10 pounds a month and work it to keep it steady pace. I have lost 65 lbs and am right on track with being almost 7 months soon and maximum for my criteria would be 70 lbs. I do not have skin issues as of yet, except for my inner upper thighs, but it isn't bad at all. Just a bit flabby. Due to not feeling much in eating, my protein intake is a bit slacking. I am reaching about 50 gms when I should be within the range of 80-120 gms of protein. I need to concentrate on my protein intake and am waiting on my vitamins and supplement deliveries.

WLS is like any other surgery

2007-05-02T16:01:00.000-04:00

I get a lot of messages from people on OH asking me to update my blog and wanting to know how I am and what is the latest on me. I guess, the only thing I have to say is, I am not like certain people that wake up every single morning thinking and talking about their WLS. It is not on my mind constantly or in my thoughts for topic every day 24/7. Although, I am just beginning my journey with only 6 months into it, I don't check the scale obssessively and I only think about the surgery only when I have to eat something and hope it digest well or remember to take my vitamins and supplements.

To me, WLS is like any other surgery. It was done for a specific medical purpose to help me regain my health. It is like having your appendix, tonsils or a tumor removed, surgically correcting a problem with one of your vital organs within or having reconstructive surgery such as an abdominalplasty or breast lift/repair. It is just another surgery to me to improve your health and life moves on. I don't talk about the surgery at all. If I need advice, have a question or am having a certain concern, I have 4 very close friends that had WLS and are all over 3+ years post-op that I can count on being my mentors. Beyond that, I don't talk with them about WLS, unless it is a topic of concern. That is the way I am.

I know some live every breath talking about it, even for years, but not me. I don't talk about my other surgeries, so why would I talk about this one. Just common sense to me. That is the way I feel about it. I will write on this blog about certain events that relates to my experiences having it since the 1st year is the one with the most impact from it. But honestly, I don't put much thought as to living as a post-op. I am living as a person, who had bariatric surgery to improve and help me with my health and one benefit from it was weight loss. But, I don't brag about it or push it on people saying, hey I had wls, blah, blah, blah.

So, it has been 6 months since I had the surgery. All I can say is, I live for life. It has been one of the many surgeries I have had throughout the years that help me improved my health. Like I said, I have had other surgeries and this one happens to be one of them. The surgery help me improve my health, since my life was getting limited and pretty bad as time was going by.

I no longer using the CPAP machine or wear a Darth Vader mask, eventhough, I upgraded last year to a nasal pillow mask known as Adam Circuit. But, I don't use the Cpap or mask anymore. I give credit to that to having bariatric surgery since it help take off some weight off my tiny body that was crushing my lungs and respiratory system with the weight I had on me. I've suffered from severe obstructive sleep apnea (OSA) with 110 apneic episodes which is extremely serious and dangerous, at a CPAP setting of 12. But, no more. I still have a collapsed oropharynx and hypopharynx that needs surgery to repair it. But, I don't want anymore surgeries, especially done to my throat, having them slice it open and digging in there leaving me a huge scar on my throat. I have been through hell with so many surgeries performed on me. I had abdominalplasty in which they stretched my skin down like a window blind to remove the scars on my stomach and repaired my stomach muscles, a few years back. I won't get into that or the details. Just wanted to say, I had reconstructive surgery which was abdominalplasty. I am just glad to be alive, breathe this free air and appreciate life for what it has to offer.

20 weeks

2007-04-14T15:18:00.000-04:00

I am 20 weeks post-op or 5 months out since having bariatric surgery. I am doing very well and have nothing to complain about life or the surgery. I am now able to eat and tolerate homemade pasta and certain breads. Not that I am going to make it a habit to eat it frequently, but it is there as an option when I want it. Can't have any carbonated drinks for it causes severe pain to my digestive tract. As I said, I can have bread, I have to be careful with certain type does cause a bad reaction to me (doesn't go down well). I am not talking about dumping syndrome since I don't have such symptoms due to having a fully functional stomach and the pylorus is intact, just digesting certain things takes a longer time to process. Still can't eat chicken. Hope when I am a year out, I will be able to, since it is a high protein food. All is still a learning process and doesn't bother me one bit. Just got to go through my trial and error. Although, there may be similarities, to each person it is unique and very different. What one can eat, another is unable to. Life is about eating to live, not living to eat. The mentality has to be set prior to all this and although I gained almost 200 lbs, it wasn't due to overeating. It was due to emotional stress from certain factors and conditions in life to cause an imbalance to my metabolism and system. It happened and I did my best to lose the weight on my own and succeeded well in that. But again, after I lost all the weight, due to certain stress from that time, I regained most of the weight back when something triggered it. Life can be unexpected and so unpredictable at times.

I have lost almost 60 lbs and that is great in 20 weeks. My skin isn't saggy or loose. As I said from the beginning when I started losing weight after I had surgery, I have slight flabby skin in my upper inner thighs and the back of my arms you can see a slight "batwings" when they are raise upwards. It doesn't bother me and as I said before I had surgery, I have no plans to have anymore reconstructive or plastic surgery done to my torso or any other parts of my body unless it is for health reason that needs to be done. Today was a nice day and I had white rice with black beans soup/stew made with chorizo, pumpkin and loads of other fresh veggies in it, ribeye steak and corn. Later on, as a dessert, I ate a small amount of french styled cheescake that is more airy and lighter texture than the NY cheesecake that is denser. I was skeptic to have it for fear I won't be able to tolerate it. But, I ate it and if I can't have it, my system will let me know that I can't. When I am able to eat something, my attitude is c'est la vie and bon apetite. I ate it and it isn't something as I said about other foods, something I will indulge occassionally or frequently. It is there to enjoy when the moment strikes. Now, on to my 1/2 year mark which is 6 months out, next month. Time does fly so quickly.

18 weeks

2007-04-02T15:55:00.000-04:00

I am 18 weeks out or we can say almost 5 months since having my BPD-DS surgery. The experience has been very positive and no negative side effects or complications from it. My hair loss has stopped, which is a good thing. I thought it would be alot or continuous, but it wasn't a significant situation at all. I think, I can contribute the small hair loss due to the shock to the system from the 5 hours being under anesthesia. Also, the high protein intake I have from food did help me keep me up to par. Other than that, still can't eat chicken, but am able to tolerate eating white toast with butter on it. Forget the pizza crust, as crispy or thin it can be, it is still a NO GO or any breading as in a sandwich or buns. I can eat the Chef Boyardee spaghetti with meatballs, which helps me out. Haven't tried real pasta yet.

Although, I am losing weight and looking to what I was prior to 1999, I am still the same person with the same personality within, with only one difference. I have always been a confident person to be who I am with the ability to speak my mind without fear. I am now, not distant myself from people as I used to, but cautious who I interact with. I am still very selective whom I associate with and who I will allowed to be friends with me. No matter how much weight I lose or how I look, my personality shouldn't change. Just gotta have common sense and remember whatever action you do in life will cause a reaction and even an impact on yourself and/or others, sometimes positive, sometimes negative. All depends on YOU. People just have to think before they do or carry out their thoughts into action. I've decided to take some pics today, so you can see how I look after almost 60 lbs lost. I have about 50 lbs to go till I reach my goal weight. I am taking it easy and doing it slowly. I am in no hurry to lose the weight fast. I don't want to lose my muscles, which does happens when you lose weight too fast. I only want to and concentrate on losing the fat bulk from my body.

Kinda cool

2007-03-26T15:09:00.000-04:00

Kinda cool, when you wake up from your sleep, go about your day and stop suddenly because something feels very strange. I venture to look in the mirror and yup, there it is...... collarbones. I have to say, my collarbones are very pretty and awesome looking. Just had to post that to this blog here. Ok, back to my world and productive life off this site. Just had to drop in for a moment and share this bit of info here since so many do message me and about how I am doing and my updates.

Overall, yeah, it sure is cool to see those collarbones sticking out and realize how pretty mine are on me.

-56 lbs

2007-03-14T15:15:00.000-04:00

I am 4 months out and lost a total of 56 lbs. Everything is going well and I do now have my energy level back. The first 3 months were the hardest. Just gotta take the pace and allow yourself to heal. Hair loss is minimal. I thought, I would be with little or thining hair on my head, but that isn't the case. Guess it depends on the individual. I am now eating Chef Boyardee mini microwaveable spaghetti and meatballs. It's just convenient, simple to deal with and I can tolerate and digest it with no issues. I drink a quart of fat free Lactaid milk with Unjury power a day. I have gotten such a taste for drinking milk. Beside, it does have vitamin D which is needed in my body. I do not have saggy or loose skin as I lose weight. My back skin is tight and is my belly. I am not eating pasta except for the Chef Boyardee. I am still eating ribeye steak, ground beef, salmon or other seafood daily, but no poultry. I regularly eat bananas for potassium. I don't get sick on the food I eat right now and with my surgery there is no dumping effect. I am able to eat whole wheat english muffin which is better than the regular ones that caused me difficulties to digest. Cant' do heavy dough, just can't digest it. I can eat a twinkie, lol.

Not much to say except I am doing well. Family and friends have noticed the significant difference in the way I look in person and on webcam. Kinda nice seeing their jaws drop and say how beautiful I look since all the weight loss. I was always beautiful, even as a morbidly obese person. The compliments are nice to hear. We ALL like hearing how nice we look. I am blossoming as time goes by and coming out of my shell slowly as well as have confidence to be me once again. I am content with my surgery and how it has helped me with my health improved, that was contributed negatively to having morbid obesity. Now on to month 5.

Twinkie

2007-03-08T15:16:00.000-05:00

You know, it was one of those days yesterday. We ALL have them, even the diehard true stick to the program post-op people have days like these. I saw a Twinkie in the pantry and wanted to eat it as a snack. I know it was a bad choice, but I will not go thru life deprived whether I should have had that Twinkie or not. So, I ate that one Twinkie. It didn't cause me any negative side effects. Beside that little incident, I did ok.

Having the DS means to live and move on being able to eat as normally as possible and if there isn't something I can't eat, it will let me know. We are all human beings and this is just one of those things that happens. Not like it will be a habit to go search and eat a Twinkie everyday or even make it a habit to go back making it an occassional thing to have. I won't hide the fact I did eat that Twinkie to look impressive or be accepted by anyone here or try to be who I am not. I am not picture perfect and never tried to be one. I had it, was able to tolerate to eat it and that's it. I know my choice was not great, but it is reality, this is life and it does happens. Not going to put myself down or be ashame I ate that Twinkie. It makes me aware for next time, but also I learn not to deprive myself either. I ate that Twinkie, am still losing weight and that is the end of the story.

14 weeks out

2007-02-22T15:04:00.000-05:00

I am almost 14 weeks out. I am holding steady at 197 lbs. I have used this Celebrity Look-alike program many times before since it was intiated back in the spring of 2006 and decided to see who be similar to me this time. Natalie Portman always come out in my list. Maybe, if I darken my hair, I might look a bit like her. But, there is a HUGE age difference. She is old enough to be my daughter! I'll might take another collage when i hit my 6th month, will see. The collage was taken during my 3rd month out.

- 49 lbs

2007-02-14T15:06:00.000-05:00

I am 12 weeks out. It has been 3 months since having my surgery. I now weigh 198 lbs. I am doing well and feel healthier. My energy is slowly returning. It is now time for me to start my workout regime of using the treadmill to walk on 2x a day. I did hit a few stalls since the last time, but it was quick and the weight dropped off after that. I am wearing a size 12 that fit a bit baggy, but not comfortable to wear size 10 yet. Most of my weight loss has been on my back, side torso, arms, upper thighs, hips and of couse my face. I have less than 60 lbs to go to meet goal at 140. I am doing it slowly what I can to make sure I don't have muscle loss. I am up to par with my protein intake and taking my supplements. Now, on to month 4 which will be week 16.

I did experience some hair loss and noticed it is NOT due to lack of protein intake. For me personally, that is a myth. I am taking my protein and meeting its quota with that. I now know, through logic reasoning, the contribution to my slight hair loss was due to shock into the system being under anesthesia for 5 hours. Anesthesia can do that. It isn't much hair loss, but did had my long hair that was up to my elbow cut off to now be shoulder length. That was a difficult step for me, since I hid behind my hair for years. I am doing ok with that challenge and even pick up my hair to be off my face. People do notice the changes that I am slimmer and that I do have a pretty smile once my hair didn't drape over me like cousin It. I have been compare in looks to a young Sharon Stone, Barabara Eden and even very young Catherine Deneuve. Kinda weird they say that, cause I sure don't see it.

11 weeks out

2007-02-08T15:08:00.000-05:00

I am 11 weeks out. Things are ok. I am still 2 lbs away from being in onederland. Let the weight stall if it must, I still lose inches and no saggy skin yet!! Want to lose the fat, not the muscle, so I am right on track. Ok, the upper inner thighs, but it isn't bad at all. Had an unfortunate episode happened yesterday with trying out eating a toasted english muffin. It didn't digest well and went thru hell with it feeling it stuck. It happens and we learn from it known as trial and errors. I even called the surgeon. I winged it out and it took 14 hrs (I am serious), for it to all pass thru. I couldn't even throw it up. It was just there with no avail remedy, biding its time to digest and eliminate. I like english muffins, but that is also scratched off my list and it was whole wheat too. I made an egg over easy, put a spat of butter on the muffin and melted some cheese on it. So for now forget about anything that resembles an Egg McMuffin.

On another note, here is something I want to share with all that read my profile here. Life is unexpected at times. Never know what will happen in the next 5 minutes that can change your life FOREVER. With that in mind, here are a few TIPS you might want to take in and think about. It is up to you. But, remember safety is important when you are aware of your surroundings. You can be a victim without ever knowing you are a target. It just happens and as I say without you ever knowing and can change your destiny in life. Self defense and awareness are prevalent when it comes to dealing with society.

1.
The elbow is the strongest point on your body. If you are close enough to use it, do!

2.
If a thief demands your wallet and/or purse, DO NOT HAND IT TO HIM. Toss it away from you. Chances are that s/he is more interested in your wallet and/or purse than you and he will go for the wallet/purse. RUN LIKE MAD IN THE OTHER DIRECTION!

3.
If you are ever thrown into the trunk of a car, kick out the back tail lights and stick your arm out the hole and start waving like crazy. The driver won't see you, but everybody else will. This has saved lives.

4.
Women have a tendency to get into their cars after shopping, eating, working, etc. and just sit (doing their checkbook or making a list, etc.) DON'T DO THIS! The predator will be watching you and this is the perfect opportunity for him to get in on the passenger side, put a gun to your head and tell you where to go or stick a gun to the window demanding you open the door or he'll shoot. AS SOON AS YOU GET INTO YOUR CAR, LOCK THE DOORS AND LEAVE.

5.
If someone is in the car with a gun to your head DO NOT DRIVE OFF, repeat: DO NOT DRIVE OFF! Instead gun the engine and speed into anything, wrecking the car. better to crash the car than expect something worst to happen to you. Your Air Bag will save you. If the person is in the back seat they will get the worst of it . As soon as the car crashes bail out and run. It is better than having them find your body in a remote location.

6.
A few notes about getting into your car in a parking lot or parking
garage:

A.)
Be aware. Look around you, look into your car, at the passenger side floor and in the back seat. Late at night, try to have someone with you that goes or can go in the garage when you do.

B.)
If you are parked next to a big van, enter your car from the passenger door . Most serial killers attack their victims by pulling them into their vans while the women are attempting to get into their cars.

C.)
Look at the car parked on the driver's side of your vehicle and the passenger side. If a male is sitting alone in the seat nearest your car, you may want to walk back into the mall or work and get a guard/policeman to walk you back out. IT IS ALWAYS BETTER TO BE SAFE THAN SORRY. (And better paranoid than dead.)

6.
ALWAYS take the elevator instead of the stairs. Stairwells are horrible places to be alone and the perfect crime spot. This is especially true at NIGHT!

7
If the suspect has a gun and you are NOT under his control, ALWAYS RUN! S/he will only hit you (a running target) 4 in 100 times and even then, it most likely WILL NOT be a vital organ. RUN, preferably, in a zig -zag pattern!

8.
As women, we are always trying to be nice or even sympathetic to strangers: STOP THIS CRAP! It may get you raped or killed. Ted Bundy, the serial killer, was a good-looking, well educated man, who ALWAYS played on the sympathies of unsuspecting women. He walked with a cane or a limp and often asked "for help" into his vehicle or with his vehicle, which is when he abducted his next victim.

9.
Another Safety Point: Someone hears a crying baby on their porch at night. It is best to call the police because hearing a baby crying outside at night is weird. The police usually will tell you "Whatever you do, DO NOT open the door." Even if it sounds as though the baby had crawled near a window and you are worried that it would crawl to the street and get run over. Just remember, the police will say they have a unit on the way, whatever you do, DO NOT open the door. It is for your safety. A serial killer has been known to have a baby's cry recorded and uses it to coax women out of their homes thinking that someone dropped off a baby. It is a mother's instinct to go check it out. DO NOT open the door if you hear crying baby, no matter how safe your neighborhood is. This should probably be taken seriously because the Crying Baby theory was mentioned on America 's Most Wanted when they profiled the serial killer in Louisiana.

Guys, if you love your mothers, wives, sisters, daughters, female, friends, etc., you may want to pass these tips along to them, as well. For any woman that may need to be reminded that the world we live in has a lot of unstable people in it and it's better to be safe than sorry. Appreciate life and that those you care about is safe and out of harm's way. Just some tips I want to pass along that can save a life from being a target and hurt.

before having my DS

2007-01-29T14:55:00.000-05:00

I just wanted to say before having my DS, I had quite a few medical issues, some which include intestinal problems. I don't like talking about it since it brings back sad memories of the conditions and ordeal I had been through. But, I was for years what was considered "pre-op in limbo", for 3+ years. The medical advancement (yes there have been in WLS) was able to give me a 4th chance to see if I can be a safe surgical candidate for the BPD-DS. I doubt it, but then I was only pre-op testing for the RNY since that is what my insurance only accepted back then and it was concluded it was not suitable for me to have.

So off I went, with no high hopes at all. But, guess what? After they reviewed all my medical results, I was informed I can have the BDP-DS. That left me in shocked and stunned after feeling I will be non-op for the rest of my life and with no hope to overcome this disease. I did lose weight on my own. I went from 305 lbs to 165 lbs in 2 years with diet and whatever exercise I can do. But, due to issues that occured, I did maintained it for awhile and it creeped back on me and gained about 80 lbs back to about 250 lbs. After that, I couldn't take the weigt off at all. I tried and tried, but it just wouldn't come off.

I had my surgery on Nov 14, 2006. I will admit the aftermath post-op pain I experienced was HELL. It was continuous for 27 straight horrendous days. It is rare for this to happen and I didn't expect that part to prolong. But, I overcame that step and continued on in my journey. I will be 10 weeks out tomorrow. My weight loss had now been slow, in which I see it as a good thing. I don't want to rush into losing weight fast. But, I will say this. I have hit a few stalls and with each stall I may not lose pounds, but have LOTS of lost inches. For 10 weeks, I have gone from a size 18/20 to my present size 12. That is a HUGE accomplishment. My skin is still tight and look good and toned. The only noticeable skin flabbiness I see, is in my upper inner thighs but everything else looks good. Have to give it time to see how all this weight loss and body morphing will take me. I feel healthier and beginning to get my energy back.

I thank the LORD for allowing to have this surgery and gaining my health back. I just wanted to share my thoughts and let others know DON'T GIVE UP! I waited over 3 years and although I lost weight on my own, I did gain it back due to factors. I thought I would be non-op forever and in 2006 I was given a chance and my prayers were answered and that means I can live alittle longer and combat this deadly disease known as morbid obesity. I started out as SMO with a weight of 305 lbs and BMI of 55.8 and am now 205 lbs with a BMI of 37.5. I have gone from a body fat index (BFI) of 51 on Nov. 2006 to a current BFI = 33.

So to summarize what I have experienced since having my BPD-DS surgery 10 weeks ago:

* from 247 lbs to current 205 lbs, from BMI = 45.2 to current BMI = 37.5

* from size 18/20 to current size 12, from BFI = 51 to current BFI = 33

In addition, I want to say I don't have any medical complications due to BPD-DS since having surgery and actually improved a lot of the conditions I had. I just wanted to share this moment with all here, that'sall.

Size

2007-01-25T14:57:00.000-05:00

I now wear a size 12. Pretty cool, considering 9 weeks ago before surgery, I was a size 18/20. Size 12 fits very nicely. Although, i had laparoscopic BPD-DS, my stomach is still a bit swollen (I look 3-4 months pregant) where they did surgery and I guess it is my swollen intestines. My tummy gone down ALOT. But, it isn't there yet to say it looks normal. You can tell since the swellingness is kinda lopsided so to speak and more pronounced on the left where most of the surgery was at. I give it time since internal surgery from within does take time to heal. I wish it was late spring and time already past by. My weight loss is gradual and slow paced which I am happy about. I don't want to lose weight fast as I keep saying over and over again. I have lost lots of inches. I am at a stall which I take as my morphing going through changes again.

I decided to now keep my hair off my face and be seen. Haven't had that confidence to do that in years. I am extremely selective who I turn my webcam on for and it is based on trust and respect. My girlfriends and I are on webcam and microphone to chat all the time and they see my transformation. Since, my closest friends are post-op veterans 3+ years and more out, they help me alot with being my mentors and helping me as I go through my phases. I know 2007 is going to be one heck of a year for me and will be more active to go out and see the world that I didn't feel comfortable to place myself prior to surgery. There are a lot of plans for this year and taking them all one step at a time.

scale is moving

2007-01-16T14:58:00.000-05:00

The scale is moving and weight is seen to be coming off again. I have to admit, I do eat regular food which is a blessing for me. I can have carbs, food with fats as well as fried, use olive oil and/or butter. I am able to eat rice and beans (only about 5 tsp) and it will not cause any bad reaction to me. But, one key note here is, I do eat these things but WITH MODERATION. Food is not my enemy, it is my fuel. Fat is not my enemy, you need fat to provide your body within with insulation and what will prevent you from feeling cold or having chills. There is no such thing as a human being with ZERO fat body mass. Reality is you need fat as you also need food. Just gotta know your limitation and to understand things are done with thought and moderation. This is a lifelong process and regime. It is a lifestyle. You have to understand yourself, what you are doing and the success to maintain your overall goal. Even now, I am still learning a lot about my body and self-being. Sure, I studied WLS for about 4 years, but once you experience it first hand, it is a totally different concept than having it theorized.

I don't have the classic symptoms that many have with this surgery. I don't have diarrhea, stomach pains or cramps from digesting milk, fats or sugars. I do get gassy and burp every now and then, but that is my limit. Yes, there is a distinctive odor from moving your bowels, but no diarrhea as others experienced. I don't emit offensive body odors as some warned me about. If you have offensive body or oral odor, it means you are in ketosis and you hardly have any carb intake within your system. You do need to have a certain minimal level of carbs for your body to function. With this surgery, I eat regular food, just not so much, which is a good thing due to the malabsorption as well as the restrictive part of it. Also, any carbonated drink (soda) will cause me to throw up, as well as poultry, wich I hope maybe one day I can try again due to its high protein value. Also, heavy dough (breads, pizza, pasta), is an issue to digest. But, beyond these, I am ok with life. I am losing and only 7 pounds away from being 200 lbs. I originally started with a BMI of 55.4 and weighed 305 lbs and now I am 207 with a current BMI of 37.9, this is a huge accomplishment for me since I lost most of the weight on my own, but gain alot back to 247 lbs. I do have slight skin issues along my inner thighs near my crotch area, but not on my stomach and hopefully my breast may stay intact. Only time will tell regarding these 2 areas. Well, that's it for now. My face has slimmed down alot as well as my body. I am happy to be able to live without the complications I had before. I slowly getting my life back in more ways than one - physically, mentally and emotionally.

It's only been 2 months, but the morphing is incredible. I look so much slimmer as time goes by. I have about 65 more pounds to lose to hit goal. I can assume, it may take me a year to hit my goal. Hope it goes slowly. But, I might lose it all and hit goal after my 6th month or around that time frame. It's also nice that I don't need to wear cosmetic and be plain and natural with my webcam on. I used to hide behind my long hair. Now I can pick it up and not cover myself with it. I had a lot of issues prior to surgery. I didn't feel my best or even felt that I was worth looking at. We all experience this type of self esteem due to our weight issues and kept me a bit withdrawn.

- 38 lbs

2007-01-14T15:00:00.000-05:00

Today, I am 8 weeks out of surgery or 2 months out. I weighed myself this morning and am 209 lbs. That means I am 9 lbs away from being 200 lbs. I am doing well overall. Last night, for dinner, I had a grilled ribeyed steak with steamed carrots and string beans and sauteed button mushroom and red peppers cooked in butter, olive oil and garlic with some seasonings. Ate about a 2-3 oz steak along with the veggies. I still haven't had any outside food, only homecooked meals. I don't want to get sick or anything while trying to enjoy my outing. Still need time to work on that. I did eat a very small piece of chicken the other day, only to regurgitate it. I will leave the chicken to when I am 6 months out, since I don't think at 3 months will make much of a difference.

I have been wearing a Medic Alert bracelet for a few years now. I have purchased an updated one that was made of stainless steel, but my skin had a terrible allergic reaction to it. Had to go and purchase another bracelet of sterling silver material. A Medic Alert whether bracelet or necklace, etc, is an important option to have in your possession. You can be in an accident or other situation in which for whatever reason with the inability to communicate. The medical staff might not know what medical conditon you might have offhand, have records on you, able observe what is unseen to the human eye or anything that can't be verified right away. The paramedics don't know you when they are giving you treatment, especially when it is an emergency.

With the Medic Alert, all information is kept on their database, including your identity, doctors, emergency contact, allergies you might have and most important your medical condition or conditions. I had mine updated right after surgery and told them what I wanted engraved on my bracelet and be the first thing they will see if something happens to me, which is to list in view my bariatric surgery and that I am allergic to latex. You can go to their website at http://www.medicalert.com to know what they are all about. I felt the most important info to display was my bariatric surgery and my allergy to latex. On the back of the bracelet or medallion, it list the toll free number to contact Medic Alert, as well as your membership ID.

2 months out

2007-01-12T15:00:00.000-05:00

On Sunday January 14th, I will be 2 months out. As I said previously, I experienced a stall and it is expected. I am now 215 lbs. It is perfectly fine with me since, I don't want the weight to drop too fast causing skin issues. Like I said many times, steady and with a gradual pace, although it isn't something I can control. If I lose weight too fast, let it be, but prefer it to be gradual. Still can't do chicken and the tuna just can't even now bare to look at the can. The other day, I ate some meatballs with marinada sauce (all homemade, no pasta for me). There was a bag mini croissants. I said it would be nice to have with the meatballs. It look very light and airy. I know bread, pizza and pasta dough makes me ill. The only way to know is to do a taste test. I unrolled the mini croissant (alittle larger than my middle finger), took a bite, waited to see if there were any reactions to it. I had none. I then proceeded to eat it with my meatballs and it went down fairly well. I didn't have any negative side effects from it. At least, I can have this with my meals. Only one though. I did get filled up rather quickly.

I need to go to my storage and find some updated garments to wear. The ones I am wearing are falling off of me, eventhough I was at a stall. You might not see any movement of pounds looking at the scale, but the body is morphing and getting smaller. I am getting my energy level back and feeling more active. At least, I dont' feel disabled or limited to daily activities as I once had. Now to keep on going and see how today compares to a month from now, when I am 3 months out of surgery.

I don't like talking about my personal life on here, except related to my wls. But, this is important to me because it deals with a human life. I want those that read my profile to know, I have a busy life, doing what is significant with my time and energy, which is to invest and spend it with family, close friends and those deployed overseas sacrificing their LIFE. I might not agree with the US Policy regarding sending our military to Iraq, Afghanistan, etc. But, that is their call of duty and the soldiers must do what's told.

Charles gave his life protecting our country. He was killed in action yesterday, Jan 11, 2007 at 8am Baghdad time, saving the lives of 26 soldiers. He took OVER 23 bullets to his body & STILL he fought on to save their life over his. He gave the ultimate price, his life. He was 20 years old. He was 20 yrs old. REST IN PEACE, FOR YOU WERE A TRUE MAN OF HONOR AND RESPECT!!! The tatto on his arm said INFANTRY in which he was very proud to be a part of. May he rest in peace for his courage and honor. Remember the soldiers deployed and hope they all can return home safe.

stall is gone

2007-01-06T15:02:00.000-05:00

Well, my stall is gone and back to losing weight. I know this is common and will expect another to occur in the next 6 weeks. It happens as the weight loss rest in order for the body to distribute and morph. Still having alittle difficulty with certain food that I cannot tolerate. I have been buying and eating mostly higher end priced protein food such as lobster, crab, salmon, shrimps as well as ribeye steaks. The grocery bill for these are up by $30 a week, but it is worth it. I don't waste my money on stupid things and this is well worth it, since it is food and most important helps with my health. On the 14th, it will be 2 months since I had my surgery and will hit the scale to see what the official weight will be at that time. I haven't been too keen with my vitamins and supplements regimes. There is so much that it keeps me full that I don't want to eat, eventhough it is spaced out nicely, but keeps my tummy full. The Calcium Citrate chewable are huge tablets. Takes me a long while to chew them down. I went back to the horsepill and can swallow it, eventhough I feel it is just hanging there in my tummy without disappearing.

I have to mention a small thing here and get it over it. What I write in my profile is what relates to ME and no other. If you come to read and it helps you in your journey, that is my way to pay it forward and give my support to you. If there is anyone out there that can connect or relate to my journey, good. Now, regarding my Dec 22nd entry, if anyone out there feels what I write relates to you about my concerns of being careful online and what info I provide on such an openly public site. If you think it is about YOU, that is your personal demons. My words were written based on my experience and like any other sites, I am guarded and selective with whom I interact with. That is my personal decision and will let you know what I think. If you take it wrongly, that is your mental issue, not mine.

I had a few people (some unknown to me) send me private messages over a person who plagerized my entry word per word to create a thread regarding it and be vindictive about it. For him to think it was about him was weird or that he thinks I am even thinking about him. Just odd to me. He could have been man enough and sent me a private message if he felt inquisitive. But no, he had to extract my words, exploit and create a thread to incite drama about it. Tells me about his character as a man and how low he can stoop to make it a GAME to entertain with. I ignored his thread, since to me it says alot about who he is to do that and what kind of person he is to target someone who has NOTHING to do with him. He even thinks he is the topic to discuss. Please get a grip, you are not all that or important to me. This is just a forum. Inciting and creating drama is who you are, but not for me. I ignore ignorance and although I am discreet, a callous insensitve post sort for me to disclose why I wrote what I wrote on my profile. He started with me for no apparent reason. I never went to a forum to cause drama with people since that is not my style and does not interest me to do that. There's more important things in life for me to invest in and think about than that. I mind my business and am a low key person. His intentions to put me in the spotlight proves his deceit to create drama and incite when there was NONE to begin with. I totally ignored him and lost respect for him due his actions. Do what you want, just don't bother with me if that is all you got to fulfill yourself. I've said what I need and this to me is now a dead issue, PERIOD.

end of the year

2006-12-31T14:46:00.000-05:00

It's the end of the year and what a trip I have had for 2006. I am glad that I FINALLY have been able to have WLS after suffering for so long. I will be on January 2nd, 6 weeks out. Now, as it is known, after a certain number of weeks, a stall is expected and I have hit mine. I may not be losing pounds, but I am losing inches. The updated clothes I am wearing are falling off of me, meaning there are inches being lost. I don't freak out as many do. I have researched and studied about WLS for a few years now and know the deal. I may have not had the surgery prior to Nov 2006 and just had it recently, but been around here and friends with those that are post-op veterans as many as 5+ years out. I know what to expect and what will happen.

You can clearly see the weight loss on my face. Still got the chubby cheeks there, but the fullness of it, is slowing saying bye-bye. I do have high cheekbones, but won't see those features for awhile. I will be in 2 weeks, 2 months out. Energy level is still not up there for me. I know it will take about 6-9 weeks to obtain, even more. Overall, I am doing well with no complications and that is what counts. Can't wait to hit the 3rd month and 6th month level. My pace is steady for weight loss and hope it doesn't rampage too fast. As I said, I want to lose fat, not muscle mass.

quick note

2006-12-24T14:48:00.000-05:00

Just dropping in to give a quick note. Was a bit skeptic eating
yesterday, but used a saucer plate for my food. I had rice with pigeon peas, roasted shoulder pork cooked in wine and a bit of mashed potaotes. All went down well with no bad reaction. Had to take a few breaks to burp along the way, but no complications. I even went about 1-2 hours later to get another serving since the portion I had was rather small. Shoulder pork, puerto rican criolle rice with pigeon peas (oh and the stuffed olives) and mashed potatoes are ok for me to have and digest. It was a nice time yesterday and glad the food sat well.

I had a wow moment. I wanted to dress up nice yesterday and decided to go to my storage and see if there might be something that fits me. Well, I had a silk suit and it fits. That made my day and feel great. I did look a bit tired and many were telling me I look very tired. I will be 5 weeks out tomorrow (Tuesday) and still need time to get my energy level that many notice that I look tired. I am just a bit weak. I am in compliance with intaking as much protein as I can.

Today, I had Alaskan crab legs and claws. Lots of protein there. Had some for late breakfast, had some more for lunch as well with a salad filled with lettuce, black olives, tomotatoes, feta cheese and some greek salad dressing. I am not checking myself on the scale, so not sure how much I have lost and if I have lost more. Here are 2 pics from yesterday event. The face is what I noticed the most regarding where do I see the weight loss at.

posting pics

2006-12-22T14:49:00.000-05:00

As I said before, I have issues posting pics or even information about myself on such a public and open forum that anyone off the streets can stalk or prey upon. Reality is, there are a lot of perverts and mentally unstable people out there. They give a persona to others that they are nice, cool folks and all about support, but you don't know who is who behind the screen, that includes members of OH and some can be said are well known and even regulars that post to this site daily. Some members can be sincere. But, there are those, I don't know what to say about them and won't, except, anything you put on such an open forum can have you preyed or stalked by looking at your pics and what info you say about yourself.

I am very selective with whom I meet as friends IN PERSON for I am old fashion and poised with my ways. I will avoid those that are into drama or be involved with people who are instigators, shit stirrers, play mind games, have sexual innuendos, warped minds, those that I am doubtful about their actual state and frame of mind or act in such a way with what I consider inappropriate, lewd or uncomfortable behavior towards me. ONLINE is ok, since it is out in the open, anyone can join in and it is just joking around and NOT to be taken seriously. But, privately, off the board or in person, don't need that carried or placed upon me. If you do, I will shut you down FAST.

Frankly, I will not meet such person in person or be sucked into any games, especially those that I see have ulterior motives, are known to attack, flame or pick on anyone whether in person or online. i am not into drama and avoid it. I like to joke around online (depends who you are and if I know you to allow you into my circle of trust), but IN PERSON, I am very serious and don't frolic that it is sexual or goes beyond what you think. The way I joke online doesn't get further than that and will not allow to take it to the REAL world of my life or to communicate privately. I have on this site a few very close friends and the rest are just distance acquaintances. So, I am careful about who I associate with on here.

Why do I say all this? Because a long time ago, a certain not so nice event happened without me even knowing. Now, I am guarded with things I post about myself, about my life and who I interact with. On my profile, I will keep it focus to weight loss surgery, the experience from it and nothing else. NOT about my life, friends, loved ones, significant other or family. I removed my surgeon's name to respect my privacy. But, those that are my friends here and interact with me regarding my surgery know who my surgeon is and he is a wonderful, highly respected, one of the top notch surgeons with great knowledge in the bariatric field.

I am 1 month out of surgery and 32 lbs is gone from me. I am just happy I am able to move on and have my health back after suffering for so long. For those denied surgery for whatever reasons, don't lose hope. It just means your time isn't right now and meant for a later date, even if you have been waiting for years. Time will come, just have faith and never give up. PROTEIN, LIQUIDS & SUPPLEMENTS FOR LIFE!!!!!!!

surgical incisions

2006-12-18T14:51:00.000-05:00

Although I am a very private and discreet person about showing pics of myself. I decided to show 2 pics of my surgical incisions. I have 7 in total. The surgery itself was textbook perfect. But, my pain as I keep writing since the beginning was extremely painful and horrible to deal with. It is as I repeatedly written, lasted 27 long days. I am glad I am over that. My tummy was very swollen from the 3 liters of carbon dioxide they pumped into me. I looked 9 months pregnant. All that swelling has gone down significantly. I am doing much better now. I ordered Calcium Citrate in wafer forms that will help me since the pills to me is what i call horse pills. just can't take swallowing it and the taste is so bitter makes me throw up. the wafers have orange flavor added to them. Since, I am so scare of ingesting pills, I am doing it slowly starting with my iron pills without crushing it and it went down very well.

Not much to say, except, I don't really feel the weight loss, although
my clothes are very baggy. The pic is pretty graphic to see, but this is reality and you can see the one incision that is bruised, that is the one that hurt the most, basically that was the only site that hurt within. The other sections or site around my tummy was pain free. I am glad i have no negative or serious side effects from this surgery. I do not have any medical complications due to surgery.

- 32 lbs lost

2006-12-14T14:51:00.000-05:00

Although, I am considered lightweight (I was day of surgery 238 lbs, but surgeons counts weight I started at and before my pre-op diet which was 247 exactly), I have lost a total of 32 lbs since having my surgery on Nov 14th.

The post-op surgical pain was living hell for me and lasted 27 days. Any movement or trying to get off a seat or bed was a killer. I didn't know about the post-op surgical pain which are localized to one section mid right center area of abdomen where my longest incision is located. Most likely, where all the connections was made. All I know on day 27 post-op, the pain stopped suddenly while I was awake and went OMG, RELIEF!!!!! I will admit, the pain had me weak, tired and unmotivated. I don't tolerate pain well and this was the worst I ever felt from any surgery I ever had. Glad that part is over with and I can move on with life.

I have had no negtive side effect since being discharged from surgery and being home. I am happy with that. But, there is something I would like to disclose that I find odd, I CAN'T eat any type of chicken, it makes me throw up. No matter how its cooked or what part of the chicken is it, I throw it up. I can eat ribeye, tbone, salmon (I eat a lot of grilled salmon lately), pork, beef, everything else but chicken. Also, the sight and smell of canned tuna gross me out now. I live all my life on canned tuna (LOVED it with passion), now I don't want it near me. I ate it while in the beginning stages of my post-op diet. But now, keep canned tuna away from me, can't even stand the flavor. I find that so odd. I am able to tolerate milk and all. But, I CAN'T eat any type of breading, just doesn't sit well with me whether dry toast or an english
muffin, etc. I can eat the topping to a papa john's superman pizza which is mushroom, green peppers, black olives, sausage, pepperoni, onion and cheese, but CAN'T eat the crust, made me feel blah. Eggs, cheese, yogurt, etc is ok with me. Haven't had diarrhea and my unpleasant flatuence hasn't been an issue at all. I do burp alot, that i will say.

Now, let get to what is troubling me. I have most of my supplements that are sublingual, liquid and chewable, some are capsule or pill form. I need to find a chewable based calcium ciltrate since I have the tablet form and crush it. Calcium ciltrate is very sour and terrible tasting to me . When I crush it and place it in my mouth, it makes me throw it all up every single time. The other vitamins are ok. Even my iron pill that I crush causes no problem, ONLY the calcium ciltrate. Hate that. Also, all these pills I have a slight difficulty trying to intake daily. I have a schedule when to take them, but for some reason I get overwhelm with it. I am doing my best. This is what I am intaking daily:

* ADEK - 3x a day

* Centrum liquid - 2x a day (planning of changing to Flinestone's)

* Calcium Citrate Plus- supposed to be 4x but haven't been doing well with this

* Iron pills (Ferro-Sequels) - 2x a day - now have a prescription for
stronger value

* Vitamin D med (Drisdol) - 1x a week

* Prevacid - as needed

* B-12 2500mcg - 1-2x a day

I need to find chewable calcium citrate, since this is an essential and even vital supplement for me. I have no hairloss yet but will be
intaking Biotin in a few weeks.

Regarding breakfast, I am doing well, either scramble or eggs over easy with cheese, even add alittle unflavor protein powder to it with some cooked thinly sliced salami or ham. If I feel very weak, I will make an egg with a very small piece of ribeye steak and that will keep me going till lunch. For lunch, I grill fresh alaskan wild salmon with some grilled medley of eggplant, green and yellow zucchini, to help me out. Salmon has a lot of protein and the omega 3 fatty acid. Other things for lunch is taking a thin slice of ham grill it with some cheddar cheese in it till it melts, roll it up and that is a protein based lunch for me. For dinner, I might have grilled salmon again or some sort of protein based meals. I do observe fat and base my food according to protein, fat and calories. Also, I struggle with food intake and don't want to eat. Have to force myself, hence the steak and salmon that has high protein. The steak and salmon do help alot. Other times, I just have some milk with protein powder or whatever else. I need to start taking my 25 and 42 gms of protein liquid, since I know I am not fulfilling my quota for daily protein intake and these first 6 months are crucial to me. Fluid intake has been soup, water, popsicles, mik, etc. Do I get in 64 oz worth? I am hoping I am.

I am losing weight, but working to not wanting to lose my muscles, just the fat. But, we know this is a grey issue since the lost will happen regardless. I am thinking as such as I exercise and want to tone as I lose weight. I want to lose weight at a gradual speed and am not one to be obssess over that I want to lose fast, just safely. I know I lost 32 lbs in 30 days. To reach my goal to 140, I have to lose 75 pounds, but want it not to be fast. I don't want to be a twig or looking like I came out of a concentration camp either, just look healthy and be healthy. I am tiny only 5'2" and my days of weighing 100 lbs doesn't do it for me now. 130-140 is just fine and acceptable for me. So speed here is not what I gearing at, I want to be healthy within my body mechanism, system, health and feel great.

Overall, too bad chicken and tuna (2 high protein sources) are not
within my means right now, but will taste test again every 3 months to see if I can tolerate to digest it. If not well, c'est la vie. Haven't
tried eating pasta and right now bread or dough based food is out as well. I have been able to tolerate rice but small teaspoons worth. I do eat my steamed or grilled veggies.

This is my update 1 month out of DS surgery. Hope my input can helps others along the way from my personal experience.

- 29 lbs lost

2006-12-10T14:53:00.000-05:00

Been almost a month and today is the day those surgical incisions
within finally stop hurting. I will admit that pain was the pain from
HELL!!! Everytime I moved or tried to get up I felt that horrendous pain like I was a stabbed victim. But, it is over and feel some relief now. To me, that was the worst part of the surgery since I am one that does not tolerate pain well. I was given Vicodin, but decided to stop taking them after about 2 1/2 weeks since they are known to be very addictive similair to morphine. I didn't want to depend on that and if I took one it was due to the pain that I could not bare anymore. But, good thing is I didn't have to take the pill and dealt with the horrible pain that I somehow managed although, very painful. Also, the taste of crushed pill is so YUCK!!!!

I am quite weak and haven't been able to exercise but now that the pain is gone, I will try to hit the Gazelle. I was told not to place
strength or emphasis on the arms since that will cause abdominal hernia. So, I will hop on the Gazelle and work my legs, thighs, back, butt and other part as I swing on it. I have lost since surgery a total of 27 lbs in total. Not bad at all, although I personally don't see it. I was swollen prior to surgery and can see my face has slim down some and my belly that was pump to the wazoo with CO2 is down alot. Believe me, when I tell you I looked like I was 9 months pregnant with all that CO2 they injected in me. But, my tummy has gone down ALOT and look more human like instead of having what looks like like an alien pod brewing in my tummy.

I am ok healthwise, just tired and feeling like blah. I am just glad
the freaking surgical pain is GONE GONE GONE.....

Been eating grilled fresh Alaskan wild salmon with grilled eggplant, zucchini and yellow squash every day. I alternate the veggies to sauted snow peas or other veggies. I LOVE veggies as you can see. For breakfast, I have either a protein powder with some milk for 30 gms of protein or settle making a jumbo egg over easy with 3 thin salami (heated on the griddle) and some of that Kraft cheese in a jar that gives me 31 gms of protein as my portion of real food. Salmon and my tummy have become good friends. Too bad tuna and my tummy has become arched enemies against my will. Gotta give it time to see how all this will shape up in my lifestyle.

8 days postop

2006-11-22T19:06:00.002-05:00

as for me, let me give you some update, since i was very much in pain to post and what not.

i was told to be at the 3rd floor OR waiting room at 5:30, sat at that desk, update whatever and was on the phone with my 3yr post-op best friend from Tx when at 6:45a was called to go to that holding area. from there went with Dr. Inabnet and the anesthesologist to the OR room. every one there was great with me. my surgery lasted 5 hours and have 7 incisional holes. the liver biospy was done and was at the recovery room at 1:30.

man, did i have pain like hell and was also on cpap machine. they got me up 4 1/2 hours later at 6pm to walk around. i was then sent to the 7th floor icu step down. still pain within was HORRIBLE and was on morphine pump every 6 mins. they also kept giving me heparin to prevent blood clots. i was also on potassium choride. my heart rate alarm was going off constantly but controllable, my respiration kept falling below 9, but that was also controllable. I was taken off the morphine on wednesday and taking lortab. that meds made me very sick, actually gave me fevers and felt like throwing up. in the morning, i was changed to Vicodin, had to crush it and it is very chalk and terrible tasting. on thursday i was transferred to a regular room. i walked at all hours that i can with the pain in my abdomen. on friday, my vitals were good and able to go home and left at 5pm.

regarding food, can't handle jello, puree chicken or turkey. i was able to drink aliitle bit of milk, puree sweet potato, applesauce and cream of wheat went done very well. mashed potato found to be alittle too harsh for me. at home, taking it slowly, soups, puree salmon and axelrod strawberry banana yogurt has been my best friend so far. it takes me a full day to eat 8oz of it, but it is good for me. drink as much water as i can. i am now off the vicodin since my pain is bearable and taking it one day at a time. hope you are doing well.

i have since surgery 11/14 lost a total as this date 11/22 9 lbs.

-19 lbs lost

2006-11-22T14:44:00.000-05:00

Surgery was Nov 14th at 7:30am. The entire surgical and medical staff was great with me. Surgery lasted 5 hours and have 7 incisional holes. A liver biospy was done and was at the recovery room at 1:30pm.

Did I have pain like hell and was also on cpap machine. They got me up and walking around 4 1/2 hours later at 6pm. I was then sent to the 7th fl ICU step down. Pain experienced within was HORRIBLE and was on morphine pump every 6 mins. They also kept giving me heparin to prevent blood clots and after surgery a shot injected in me to prevent throwing up from intaking the morphine at every 6 minutes. I was also on potassium choride that was more for the heart and keep an eye on me to make sure I didn't go and prevent going into cardiac arrest. My heart rate alarm was going off constantly since I was in tachycardia but it was under control and my respiration kept falling below 9, but that was also controllable. I had a RN at my bedside 24/7 during my stay there. I was very well taken care of.

I was taken off the morphine on Wednesday night and placed on Lortab. That med made me very ill, actually gave me fever and felt like throwing up. In the morning, it was changed to Vicodin, had to crush it and it is very chalky and terrible tasting. On Thursday afteroon, they felt I was doing well and transferred to a regular room. I walked at all hours that I can with the pain in my abdomen. On Friday, my vitals were good and able to go home and left at 5pm.

Regarding food, can't handle jello, puree chicken or turkey. I was able to drink aliitle bit of milk, puree sweet potato, applesauce and cream of wheat went down very well. The puree potatoe was alittle too harsh for me. At home, taking it slowly, soups, puree salmon and tuna with some mayo. Axelrod strawberry banana yogurt has become my best friend so far. It takes me a full day to eat 8oz of it, but it is good for me. Drink as much water as I can. I am now on and off the vicodin since my pain is bearable at times and usually take it at night when the pain is most highest. I am taking it one day at a time.

Due to experiencing tachycardia and respiration ceasing, I had to have a RN at my bedside 24/7 during my stay at the ICU stepdown. I was given Potassium Chloride to help regulate my heart as well as Heparin injections at certain intervals to prevent blood clots and a heart attack. My respiration was kept under close observation since I was averaging about 9 and had to alternate using the oxygen mask and cpap machine. My surgical post-op intestines were under extremely severe pain, beyond what can be imagined. This is not usual occurrence to postops after surgery. Depends on your situation. But, the pain I had was one hellraising experience. My nurse was a great caring person that helped me during my most critical moments during those first few days. I did experience a few rough moments after surgery. But, am ok now.

5 days postop

2006-11-19T18:02:00.001-05:00

if my grammar or spelling is off you understand. had the lap bpd/ds. surgery lasted 5 hrs for me. all went well, also had a liver and fat biopsy done. surgery was from 7:30am till 1:30pm. had me walking around the RR at 6pm. was sent to step down surgical ICU at 8pm. eating is an issue, can't tolerate jello or much of anything except cream of wheat, puree sweet potatoes and applesauce for now.

regarding pain killer was on morphine pump every 6 mins. Lortab gave me a bad side effect, made me very sick. was given tenotrol (sp?) shot, now i am on vicotin. slow progress for me. scared to death to eat. chicken and turkey puree didn't go well. mashed potatoes is so-so. been drinking water when i can, but not in the mood to eat.

my legs are swollen but going down slowly, stomach pain mostly in one section upper mid-right section. surgeon has been wonderful and caring. been resting, taking crushed vicotin pain meds (yuck) and walking when i can. been burping lots. all that really hurts is the incisional area that i said. i know with time it heals, but feel ughhhh right now. just taking small sips of water and applesauce what i can tolerate now. stomach is very swollen looks like i am 9 months pregnant.

Pre-admission

2006-11-02T14:45:00.000-05:00

Pre-admission testing done. Had to go over my insurance, contact information in case of anything, hand in my living will, update my health proxy since the last one was from 2004 and also update anything else. Had my EKG done and another bloodwork. No xray needed since I don't drink alcohol, smoke cigarettes or do any type of drugs. Regarding that, I avoided all my life.

Now, to wait for the phonecall as to what time my surgery will be and at what time to be at the hospital. I am going through the phase what if I die and at the same time thinking this is a life saving surgery and if I don't have it done, I will die sooner than expected. I am staying focus and postive and know these are just jitters as the day approaches. I have faith all will be uneventful.

5 weeks away

2006-10-08T14:42:00.000-04:00

I am 5 weeks away and all that I need now is the psyche evaluation to be done and hopefully just wait to bide my time till I have my surgical date here already. I have an extremely low vitamin D deficicency level and have been prescribed Drisdol which is some sort of heavy dosage of vitamin D medication. I take this 50,000 unit capsule once a week until day of surgery. This will not halt me from having surgery as per surgeon's words. I can still have surgery as set.

Pysche evaluation

2006-10-08T14:39:00.000-04:00

Pysche evaluation done. Took about 90 mins. Basically oral questions about:

* what caused me to gain weight

* how long have I been overweight

* lost any weight on my own

* what diets I have been on

* explain the procedure

* the risk and complications

* what do I expect

* why do I want this surgery

After the pyschological evaluation, she said I am a perfect candidate for WLS. That is all I wanted to hear and have done all my pre-op testings. She will fax the paperwork to the bariatric center and now to wait for my surgery.

BTW, my surgical date was moved from Nov 7th to a week later Nov 14th. Its ok, as long as there is no word that I can't have it. I have order my Medifast for my 14 days liquid only diet prior to surgery as well as my Protein drink. I chosen Profect since it is only 3oz and hopefully if I can consume 4 of those per day that is 100 gm in addition to my food intake. I do have a Vitamin D deficiency that was noticed from my blood result and on Drisdol that is prescribed vitamin d 50,000 unit. I take 1, once a week. I have to take this till the week of surgery.

So far this is what is needed for my pre-op testing and what I have done:

* sleep study - done

* colonoscopy - done

* upper endoscopy - done

* medical clearance from my PCP - done

* bloodwork - done

* psychological evaluation - done

Went to see the surgeon

2006-09-08T14:35:00.000-04:00

He reviewed my medical results, etc and I have a surgical date Nov 7th. That is 8 weeks away. I am still shocked and stunned. 8 weeks will be here before I know it, just right around the corner.

testing for Duodenal Switch bariatric surgery

2006-06-30T08:58:00.000-04:00

get the results, since I already had these test done:

* sleep study

* colonoscopy

* upper endoscopy

appt with nurse practioner and the beginning steps again, but this time it is pre-op testing for Duodenal Switch bariatric surgery

since 2003

2005-07-08T14:33:00.000-04:00

Starting weight: 305 lbs
BMI = 55.8

Current weight = 256
BMI = 46.8

lost so far without surgery = 49 lbs

I have been a member of OH (ObesityHelp) when it was called AMOS (Association for Morbid Obesity Support) since 2003, when my initial weight was 305 lbs. I have had my rollercoaster of being tested to be a candidate for bariatric surgery and due to my sensitive intestinal condition that I will not go into here has been declined to be a safe candidate to be able to have surgery. I had my struggles with my health and have had various surgeries and deemed non-op (non operative) meaning I was not able to have bariatric surgery. Back then, the only available bariatric surgery that medical insurance would accept was RNY (Roux-En-Y) which is gastric bypass. The DS (Doudenal Switch) was considered experimental. Time and advancement in medicine has given me an opportunity to be consider a candidate for bariatric surgery. My highest weight was 305 lbs with a BMI of 55.8. I have on my own lost weight that taken me over 2 years to lose following a strict regime of diet, exercising and follow-up with my physician. I was able to reach a weight of 165 lbs and all was great. Certain stress triggered my weight to increase and I gained over 80 lbs in 5 months. My physician told me to let's try out for bariatric surgery. I was skeptic my results would be the same. Well, it hasn't. My heart is stronger, my intestinal tract has improved with time and I am since time has moved forward as well as medicine able to be a candidate for bariatric surgery, not gastric bypass, but for the bilio-pancreatic duodenal switch.

I am a post-grad (advanced degree) Electrical Engineer; specialty in biomedical engineering sciences (clincal, diagnostic, surgical and therapeutic medical instumentations) as well as technical physic and microwave engineering emphasis (NOT OVENS! actually frequencies, waveguides, antenna and satellites propagations known as communication systems).

Another thing that needs to be said here in My Story is, I am who I am. If you don't like it, you don't have to be my friend or even associate with me. Many hide who they are and ashame or afraid they will lose their friends if they know or disclose who they really are. If you are afraid, closeted or don't want people to know the REAL you, that is your problem and your inner demons to deal with, until you set yourself free and accept who you are and whoever can't, too bad. Eventually secrets you made, will catch up, be disclosed and sometimes affect you and others that you care about and they didn't know.

I do NOT hide, lie, be secretive or deny what I do in life or who I am. Don't misjudge my looks for being vulnerable, naive, ignorant or weak. I have never been a follower and do not waste my time trying to impress anyone or try to fit into cliques or the in crowd in order to be accepted or have anyone talk to me.

I am not attention seeking and do not need anyone admiring me or form a bond. That is just not my thing, never was and never will be for me. I consider it low self esteem and insecurity whoever does that and has no personality to be their own person. I have my own set mind and speak what is within my mind without shame or fear. You like me or not, you accept me or not. To me, it doesn't matter. What does count is those that have compassion, sincerity and respect for their fellow human beings.

I am an open person and THINK before I do anything or any actions. This is life, you have one life to live. Make the best of it and the hell with those that judge, bash or gossip behind your back, since they are not superior to you or even better than you. People like that just want to look good to others, even play that "I am innocent" role, but can't deal with their own damn selves and who they are. I tell it like it is and straight to your face. That is who I am. I am Dominant, NOT submissive. I am not one to switch and rarely give up control or to be told what to do. I will be an equal, but am NOT one to be taken as a servant and will NOT allow or be consider less. WIITWD.

Don't f*cking challenge me, for I am very biting with my words and you are wasting your pathetic sorry ass time. Do act like a vindictive badass to me and you just proven you are a PRAG as well as a worthless piece of human flesh. So, there you go, this is who I am and what I am about. Straight forward and to the point with no innuendos or kissing anyone's ass to fit in.

I AM STRAIGHT FORWARD, VERY CONFIDENT AND BOLD
TO SPEAK MY MIND WITHOUT FEAR OR INTIMIDATION.

I do NOT have a morbid, negative or dark attitude. I am NOT cynical, vindictive or pessimistic. Although I am a no nonsense person, I have a positive, savoir faire and optimistic personality. I am easygoing, down to earth, compassionate and sincere, who loves humor, have fun and enjoy interacting whether you are male or female, bi, straight, gay, freak, confused, mentally lost or plain f*cked up. Can't deal associating with people in those groups, then don't bother with me. I don't judge or criticize people. I base who you are according to your attitude, compassion, sincerity, approach and intentions toward others.

We are ALL beautiful creatures on this planet, regardless of race, color, creed, lifestyle, characteristics, physical appearance or orientation.

YOUR PERSONALITY IS WHAT EMITS TO SHOW YOUR OUTER BEAUTY.

So anyone out there, I don't care who you are (as long as you are NOT judgmental, prejudice, closed/narrow-minded, a hater, player, user, hypocrit, deceiver, liar, fake or an instigator), I will be your friend and will interact with you. For those that has to criticize about others that don't appeal to you, don't tell me about it, keep it to yourself. Another thing....

DON'T BRING ME ANY DRAMA!!!!!
I am not into drama, gossip or trash like that
Leave me alone with that crap and
find someone that enjoys and feeds into that bullsh*t

bush countdown

2005-06-01T19:21:00.000-04:00

colonoscopy

2004-05-08T14:25:00.000-04:00

I had the testings that were required done. From findings and results on my colonoscopy and which I do not want to disclose, it has been determined due to certain intestinal disorder, the gastric bypass is not considered a safe treatment for my condition and will not be recommended. I am now pre-op in limbo since I cannot have gastric bypass surgery. Although I have tried my best and will refuse to give up on hope. Hope is all I have now. Only a miracle can save me now........

There is no need for me to write into my journal anymore about my journey. My chapter regarding my weight loss to have surgery journey has come to an end. All I can do now is give support to those who are seeking bariatric surgery, those inquiring facts about bariatric surgery and its procedure, those who had their surgery and are now postop, those that need a boost or even a shoulder to lean on if they want mine. As for me, I will need to find other means to help me lose weight and that is the conventional way that has no gaurantee to work long-term.

Maybe, with my good deeds and actions, I may be given a chance in having some other form of treatment to help with my severe morbid obesity disease. Time, hope and patience is all I have now and like I said, I will NEVER give up!!!!!!

Sleep Apnea report

2004-03-03T14:20:00.000-05:00

Just returned from my ENT visit. My doc read the Sleep Apnea report in front of me and all I saw were his eyes popped out. He said I had severe obstructive sleep apnea. From the report it stated, I had 110 apnea episodes per hour. He said that was extremely high. He told me it was like I stopped breathing about once every 32 seconds. He prescribed the CPAP machine and my sis will get it for me from one of our friends who owns a medical supply company. The doc gave me my letter with the diagnosis and it also stated I needed CPAP, bariatic surgery and possible upper airway surgery. I knew I had difficulties breathing. Thank God for the sleep apnea study that it was able to detect and provide information that the naked eye cannot see.

appt

2004-03-01T14:03:00.000-05:00

Received a call from the Orthopedic specialist. My appt needed to be rescheduled for Tues Mar 23, 2004. He is the best in the field and specializes in osteoarthritis, since my lowerback and hips hurt 24/7 and I think it is pinching a nerve that is causing numbness in my entire right arm as well as the inability to turn, twist, bend or rotate my torso.

So far I have been diagnosed with chronic airway obstruction (collapsed pharynx) and obstructive sleep apnea (OSA) which are co-morbidities due to morbid obesity. I need to be assess and hope there is treatment for osteoarthritis right now because the constant pain is killing me and if diagnosed with such it will also be a co-morbidity for MO.

I also need to be assess for my heart (cardiologist), lungs (pulmonologist) and have an updated gastro-intestinal testing performed (gastroenterologist).

I also need an

EKG
echocardiogram
pulmonary function test and
arterial blood gas

Once done, I can know what is going on with my body and plan if surgery will be needed or will there be other means that the physicians need to treat prior to surgery. So many test just to check if I am cleared and safe to have bariatric surgery. I know it is to most benefit me. Until then.

Sleep Apnea Test

2004-02-25T13:44:00.000-05:00

Went to Columbia University, CardioPulmonary Sleep and Ventilatory Disorder Laboratory at New York Presbyterian Hospital (NYPH) to have my sleep apnea test performed. You go to the room, get situated and then handed a pre-apnea study questionaire form to fill out. There is non-cable TV with VCR and a couple of intentionally boring movies to doze you off. I was not interested. I brought with me my favorite and cannot be without Sobakawa pillow to feel comfy as well as a sleeveless teeshirt and shorts to use as sleepwear. The pillow's filling is made of buckwheat (not feather, cotton or other down material) and if I don't have my pillow, I cannot sleep well. The technician and MD were both females and I felt very comfortable.

It took almost 1 hour to prep me up. They swab scrub with a citrus abrasive to kill the skin cells in order for the electrode to receive a good signals on your scalp, face, neck, chest and leg. They place a pasty substance to be used as a conduit and the electrodes as follows:

4 electrodes on the scalp
1 on the forehead
1 by each eye (2)
1 on the nose
1 behind each ear (2)
1 by each jawline (2)
1 on my neck
1 on the finger
2 velcro bands - 1 under my arms and another around my chest
1 on each leg (2)
a mic on my chest
2-3 external nose cannulas to meaure my breathing
5 EKG electrode to detect my heart activities

I think the technician said there were 23 electrodes, just can't remember if these are all or if there were others electrodes placed anywhere else. You are being monitored and recorded through a night vision video camera during the entire process. There is no clock whatsoever in the room.

All I remembered was, they came in and hooked me up to a CPAP right away. They said I was having too many episodes within an hour. CPAP was set to 12 and was not uncomfortable at all. I slept through the entire testing phase after that. When I awaken, I felt refreshed, not out of breath or lethargic. I don't remember the last time I felt that good. You answer another questionaire about how you slept and felt and how was it once you got the CPAP, then you can leave.

I was told, there is over 1000 pages of data (this is average) from my sleep study and it will be sent to my ENT doc. When I got home, I made an appt with my ENT/apnea medical doctor for Mar11 to review the results, diagnosis and prescribe the CPAP which I know I will definitely need. Why 2 weeks? That is what his office told me is the amount of time it takes to have everything analyzed (it's a huge hospital with many patients, I guess). Until then I gotta keep on with my breathing difficulties, use my homemade based camphor with Icy Hot mixture and wait until I get that CPAP.

Update

2004-02-24T13:49:00.000-05:00

WT = 280
BMI = 51.4

Well, as usually from Feb 1-19, I lost 13 lbs in 19 days. No special diet or excerises, just the usually dumpfest. Losing an average of 5-20 lbs per month is a norm for me. For some, it looks like a positive weight loss, but it is not. It is due to my medical condition and it weakens my body. I spent about 2-3 weeks with constant daily diarrhea, then my intestinal track calms down for about 1-2 weeks and the weight is gained back unnoticed, eventhough nothing has changed regarding my food intake or daily routine. If i am under stress, I gain weight rapidly eventhough I am not eating at all. It just happens due to Cushing's syndrome. I am under medical supervision for this disorder with my intestines.

I am trying hard to monitor this and not allow it to go into weight gain. Weird thing is I am on an almost no fat, under 1100 calories, high protein, under 10 carbs "diet" regime. I don't eat sweets or chocolate, anything with sugar, I don't like any type of candy and drink 2 quarts of water daily. I do not get diarrhea from drinking water. The water prevents me from dehydrating or go into low electrolytic shock.

Monday, I will have a full stomach exam with the works, biopsy colonoscopy (I know it's painful), etc.I have had a colonoscopy perforned a few times due to my stomach disorder. I don't want to disclose the details about it. All, I can say its been awhile and need an update on my intestines. I know the outcome from it might not be positive. I just hope it doesn't prevent me from having gastric bypass surgery since I am beginning to understand that there are certain medical conditions that will make it unsafe to have this surgical procedure done.

A pulmonary function and arterial blood gas (another painful test) done will be done on me as well. They want to check how my lungs are and if there is any threatening pulmonary/asthma complications or blood oxygen problems. This will also be used for my surgical pre-op. Since the Sleep Apnea Center did not call me on Friday, I will call them myself and see what the status is.

I am a person who has always taken control of my health and since it is my life, I should participate, make requests and decisions in its medical assessment. It is my legal right. While I'm at it, I will call the Sleep Apnea Center, instead of waiting for them to call me. As you can see, I like to take initiatives and get things rolling. I don't like to wait around, scratch my head and expect things will be done for me. I have awoken from the hell and trauma I have been in for the past 7 years and ready for what lies ahead of me.

GI Specialist

2004-02-23T13:46:00.000-05:00

Have to see my GI specialist who is also my PCP on March 16, 2004 at 3:30PM. It is the same day that I see the nurse practicioner that is at 10AM. Gonna be a busy day when it comes. Morning with NP and in the afternoon with my PCP/GI doc.

Received call from Sleep Apnea Center, I will be tested tomorrow from 8PM to 7AM, since someone cancelled their slot, it was offered to me and that's great news. Sleep apnea test cost $1000, I pay 20% which will be billed to me. They faxed to me a lot of paperwork, filled out what was needed and faxed it back to them. This saves me a lot of time when I get to the sleep center. Will let you know Wednesday how things go. This will also be the 1st time since 1999, that I actually stayed away from my home, being that I am homebound and still have slight agoraphobia. My hubby can stay with me in the room, while I spend the night there.

***Changed my profile name. It didn't occur to me before and now I feel uncomfortable that my personal information such as my full name, location of residency and journal of my life that I only want to share with other ObesityHelp members can be viewed and tracked by people that are not affiliated or even assocaited with this site or obesity via web search engines. I did experienced an event in which someone stalked my every move and eventually located me in person by information I have innocently wrote and posted elsewhere, including pictures of me. I don't need the nightmare that happened to be repeated in my life again.

Otolaryngology

2004-02-19T13:52:00.000-05:00

Went to the Otolaryngology/Head & Neck Surgery Dept to be assessed. Was seen by Director of Rhinology. He is an ENT, sleep apnea and rhinology specialist. A very gentle and kindhearted physician. I went with my sister and hubby. Gave him my history. Exam was performed on me by using a flexible fiberoptic laryngoscopy. The diagnosis were as follows:

Ears: normal

Nose: dns to the right side. (forgot what dns meant)

Oropharynx: increased gag and large

Hypopharynx: Hypopharyngeal collapse on inspiration, Oropharyngeal collapse on inspiration and Lingual Tonsillar Hypertrophy totally obstructing the vallecullar space.

He diagnosed that I have severe damage to my airway, hence my breathing problem. I have a collapsed airway. The middle and lower portion of my pharynx collapse when I breathe in. It causes me to gag and gasp for air when I breathe through the nose due to this collapse. Also it has cause part of my inner right nose to be swollen and irritated.

He referred to have a Polysomnogram (Sleep Apnea Test) done on me. I now have to wait for the Sleep Center to give me a call so I can have it done by next week. The sleep apnea study will determine what will be the setting for the CPAP machine that I will be using for now on and that after surgery, I will be on it for as long as it is needed. Things are going smoothly for me although it is severe. He said I can do the regime that I have been doing to help me breathe. I take a jar of Icy Hot and crush a block of camphor with some of the Icy Hot thats in it. It helps me breath better and he said it ok, since it acts as a humidifer. Its the only way I can sleep with a wall circulating fan blowing air and mind you....its winter.

-==¤¥¥¥¤==- WORDS FOR THE DAY -==¤¥¥¥¤==-

PHARYNX
The pharynx is a hollow tube passage about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe; tube that goes to the lungs) and esophagus (foodpipe; the tube that goes to the stomach). It connects the back of the mouth and the nose to the esophagus. This muscular tube, which is lined with "mucous membranes," is a part of the respiratory and the digestive systems. Food passes from the pharynx to the esophagus and air passes from the pharynx to the trachea. The pharynx has 3 divisons - nasopharynx (upper section), oropharynx (mid-section) and hypopharynx (bottom section).

NASOPHARYNX
The nasopharynx is the upper section of the throat (pharynx) behind the nose, connecting to the nasal cavity. It reaches from the back of the nasal opening to the soft palate. The nasopharynx lies above and behind the soft palate. It communicates with the nasal cavity and provides a passageway for air during breathing. The eustachian tubes (an opening on each side of the nasopharynx) connects the pharynx with the middle ears, through the walls of the nasopharynx. The nose and paranasal sinuses are sometimes referred to as sinonasal. On the back wall of the nasopharynx are the pharyngeal tonsils. Swollen or large tonsils may completely block the passage of air from the nose.

OROPHARYNX
The oropharynx is a passage for both air and food and ends below the tongue. It is the the middle part of the pharynx that includes the soft palate, the base of the tongue and tonsils. Food passes from the mouth to the oropharynx (back of the throat) to the esophagus.

HYPOPHARYNX
The hypopharynx is the bottom part of the throat. This lowest section is for food only and lies behind and to each side of the larynx (area of the throat containing the vocal cords and used for breathing, swallowing and talking). Larynx is also known as the voice box and merges with the esophagus.

SLEEP APNEA
Known as Obstructive Sleep Apnea (OSA), a significant medical problem affecting up to 4% of middle-aged adults. The most common complaints are loud snoring, disrupted sleep and excessive daytime sleepiness. Patients with apnea suffer from fragmented sleep and may develop cardiovascular abnormalities because of the repetitive cycles of snoring, airway collapse and arousal. Because many patients are not aware of their heavy snoring and nocturnal arousals, OSA may remain undiagnosed; therefore, it is helpful to question chronic sleepiness and fatigue.

It is caused by repetitive upper airway obstruction during sleep as a result of narrowing of the respiratory passages. Cardiovascular disease is common as well as psychosocial problems are common in patients who have sleep apnea. These patients often have depression, mood changes, poor memory, irritability and impaired concentration. Nocturnal panic attacks have also been associated with sleep apnea. The disorder is associated with hypertension, impotence and emotional problems. OSA often occurs in obese persons with comorbid conditions. The disorder has also been linked to angina, nocturnal cardiac arrhythmias, myocardial infarction, stroke and motor vehicle crashes. Even though OSA is fairly common, it often remains undiagnosed in primary care practice or by primary car physician (PCP). Because the disorder is associated with significant morbidity and even some mortality, family physicians need to be familiar with its clinical presentation and treatment.

Gastric surgery is a consideration in some morbidly obese patients with OSA. How weight loss causes a lessening of apnea is not clear, but it is presumably through a reduction in the adipose level of parapharyngeal tissues.

POLYSOMNOGRAPHY
A sleep laboratory is the gold standard for confirming the diagnosis of OSA; however, the test is expensive and not widely available. Home sleep studies are less costly but not as diagnostically accurate. Treatments include weight loss, nasal continuous positive airway pressure (CPAP) and dental devices that modify the position of the tongue or jaw.

Microscopic Colitis

2004-02-18T13:54:00.000-05:00

I have been diagnosed with 2 intestinal disorders. One is known as Microscopic Colitis in which I have had severe, uncontrollable and volatile watery diarrhea. I have severe abdominal bloating, fatigue and body aches, stomach quadrants sensitivity, super morbid obesity (BMI=50+) and lack agility. The diarrhea comes in sudden bouts, giving only seconds of warning. There does not seem to be a consistent dietary factor contributing to these types of diarrheal episodes.

After many tests performed and visits to the ER, not one MD referred a biopsy be performed for microscopic colitis because it is the least familiar to doctors. I just learned that the inflammation causing this within the intestine is of cellular level and can ONLY BE DETECTED with a microscope. I guess that is why my results returned as normal. The MDs always diagnosed as IBS – early and late dumping syndrome, but I always felt something was being overlooked and it has severely impaired my quality of life.

Living with unpredictable and volatile chronic diarrhea has been an ordeal, physically and mentally and has become very disabling. Without warning and within seconds of a first few bites, I have to go immediately and it cannot be held because the abdominal pain is very severe, becomes an ambulatory challenge and a paralyzing struggle. There were times that I do not eat, were outside and the attack occur without forewarning and incapable to find a bathroom to run quickly to. It cannot be held and waiting to search for a bathroom, the diarrhea cannot be controlled and forces out, although I try my best to control it to not expel. I live my life trying to figure out where all the restrooms of each place I go are located and pray when the attack arises that no one is in the bathroom. The "dump action" is very explosive and so loud it booms and NOT ONE BIT AMUSING.

It has caused me trauma, anxiety, panic attacks, agoraphobia and depression. I have taken Pepto Bismol and Imodium to calm the episodes, but it is temporary and doesn't help all the time, therefore these are not remedies. Hence, if I am nervous or stressed, these diarrhea assault will also occur, even on an unfilled stomach.

To prevent dehydration, I drink an average of 64 oz of water per day. For years, I avoided sugar, fats, sweet, chocolate and other things that might cause an incident, but usually anything I eat will get eliminated immediately, so it doesn't matter what type of food it is. Diet programs have not been successful for my state due to the diarrhea causing weight loss and regain and diet pill cannot be tolerated and has made me ill.

Since the stomach pouch after a gastric bypass roux-en-y surgery is small, I do not assume that this type of impulsive diarrhea that I have experienced will transpire. I understand that with a RNY, the dumping side effect is assumed milder than the unmanageable chronic symptoms I have now. I am hoping that a RNY gastric bypass surgical treatment will help as a mechanism and that the dumping would not be as devastating as it is now. The diarrhea causes me to lose weight quickly and then regain more than previously. RNY would help as a weight loss tool to reclaim my health back to normal level.

The chronic diarrhea and morbid obesity has been demanding, extremely traumatic and detrimental to my body. I know if I do not have gastric bypass RNY surgery to fix and treat my illness, I will eventually die.

WT = 284 lbs
BMI = 51.9

I have now lost a grand total of 21 lbs since Nov 2003. But, eventually, as always, I will gain it back and then some. My weight fluctuates due to this diarrhea condition. I have been a careful eater and very aware of my intake. I have always been on a low fat plan and currently counting carbohydrates as an eating lifestyle, along with my regular drinking of 2 quarts of water per day.

Otolaryngology Clinic

2004-02-16T13:56:00.000-05:00

I have made an appt for the Otolaryngology Clinic at NYP, since one of the MDs specializes in sleep apnea. My breathing is getting difficult and I can no longer sleep without getting up every few minutes to catch some air. I have become insomniac, yet cannot stay awake either.

I do not want to go into respiratory arrest or have any pulmonary damage, so I have an appt set for Thursday and hope things can work out for me. I am sure once the MD assess me, he will refer me for a sleep apnea study and most likely a CPAP machine will ensue. My chest is beginning to hurt alot and my breathing is very labored, but I HATE going to the hospital and especially to the ER. Thursday is only 3 days away. Hope I can make it. Yes, I am a bit stubborn when it comes to going to the hospital, I had a lot of bad experiences.

difficulties breathing

2004-02-14T13:58:00.001-05:00

I am certain I will need a sleep apnea test perform on me since I am having difficulties breathing and during sleep I am constantly awaken trying to catch my breath. Hope it doesn't get dangerous for me. Most certain I see the CPAP machine will be a companion for me until my tentative surgery.

I have been eating a 1000-1200 calories, low carb meals for 3 months now. I want to get use to eating food that are portioned and concentrate what I am consuming, then slowly start the meal plan that I am supposed to take, way before the 2 weeks surgery requirement. Eventhough I will gain the weight back, I am trying hard to lose weight in order that there will be no complication during surgery, especially since the liver needs to shrink in order for the surgeon to do what she need to do for a succesful bypass surgery - during and post-op.

Called COS to set an appt to see the nurse practicioner (I think the nutritionist as well, but not sure) on Mar 16, 2004 (you have to see the nurse practicioner before you see the surgeon). I needed time and set the date for a month from now.

Feb 2004

2004-02-08T13:42:00.001-05:00

Called and set up an appt for Mar 12,2004 to have an initial consultation with orthopaedic physician who specializes in adult spinal problems, joint replacement and trauma. He presently is Chief of Orthopaedics and Chief of the Orthopaedic Spine Service.

I have constant chronic pain at the lower lumbar area with severe swelling and pain at the hip/joint, ankle/feet, wrist/hand and neck area. I am unable to rotate my torso, have limited mobility and difficulties standing, walking, bending and even sitting. I might have osteoarthritis and fibromyalgia from researching the symptoms on-line and reading that morbid obesity causes severe aggravation of symptoms mentioned above.

I realize how fast and within a few years my body and health has deteriorated, I feel like a train wreck that came to a halt.

Seminar

2004-02-01T14:01:00.000-05:00

Seminar lasted about 2 hrs. It was divided into 3 parts, the nurse practicioner, surgeon and nutritionist sessions. Each person explain their role and information of what is and will be going on thoroughly.

First and important the initial fee schedule in order to get anything started after the seminar. You see the nurse practicioner first, then the surgeon.

...new patient medical practicioner's fee = $250 (no insurance accepted, this amount includes the nurse practicioner and registered dietian's fee)

...new patient surgeon's consult fee = $300 (insurance does pay for this visit)

There are 3 bariatric surgeons at the center and each have over 100 surgical case experience per year. (I actually ask that question). Each surgeon takes different insurance. The surgeon's fee is $14,000. They perform 3 type of surgeries

* gastric bypass
* banded gastric bypass and
* lap band.

I have taken after thorough consideration and decided on the gastric bypass. The banded type would not be feasible for me. I did not feel comfortable with the post routine and risks that are involved that includes erosion of band.

The pre-testing requirements are

* a letter from an MD stating you have been medically supervised trying to diet for at least 5 years with no long term results. This can include over the counter pills, shakes and food plan and to give examples like diet shakes, Slimfast, Weight Watchers, Jenny Craig, Nutrisystem or on a lowfat 1000-1200 calories a day meal plan.

* psychological evaluation - this can be done by a psychologist or certified social worker. In that letter it state that it ruled out any psychiatric contra-indication to gastric bypass surgery. They want it to state that you understand and can comply with the instructions as well as be able to deal with the long term effects of gastric bypass.

* laboratory blood work - the works

CBC with differential
chem 7
albumin
iron
vitamin A, B12, D, E, K1, folate, zinc
PTH level
homocysteine
thyroid profile
lipid profile
liver profiles

* pulmonary testing

* cardiology testing

* gastroenterology testings

I obtained alot about the post gastric bypass surgery dietary information.

The diet is divided into 4 stages which includes

...Stage 1 -
there is a daily meal plan to follow for 2 weeks before surgery that will help reduce the liver in order to prevent damage and decrease overall surgical risks.

...Stage 2 -
from the day of surgery to 24 hours after, there is no food or liquids. It prevents any complications.

...Stage 3 -
after the 24 hour period, you will be on clear liquids 1/2 to 1 ounce every 20 mins (it is equal to a small medicine cup). This will insure the gastrointestinal tract is working properly.

...Stage 4 -
pureed food and protein liquids. This will last 4 weeks after surgery or even longer. It provide the body with nutrients and the protein will help in the healing process as well as prevent hair (alopecia) and muscle loss (that causes sagging skin). In addition multi-vitamins/mineral are taken daily.

After all information was absorbed, you are required to take a post-seminar written multiple choice test, you hand it to the person at the seminar and it goes to their office to be graded. I did very well. Next step, call tomorrow and make an appt for the initial consultation, but it will have to be set for next month. I have considered who will be my bariatric surgeon.

WLS Criterias

2003-12-01T13:39:00.001-05:00

I spent most of the week performing intensive research and verifying

* physician's surgical background

* certifications

* how many surgeries of this type performed

* overall practice

* hospital privileges

* insurance acceptance

* pre-op requisitions

* verified any pending, active and decisions of medical malpractice and/or lawsuit

I decided to go with Center for Obesity Surgery at Columbia-Presbyterian Medical Center in NYC, NY. Name of hospital is also known as New York-Presbyterian Hospital (NYPH).

One of the criterias I choose compare to others is

* their phone etiquettes when calling

* very attentive

* detailed

* professional

* no run around and straight to the point

They had the best overall rating by my personal standards that I screened. I have place under scrutiny 15 different bariatric centers/hospitals/surgeon's office from Long Island, Westchester County, Manhattan, Queens and the Bronx.

The worse was Montefiore Hospital, Bronx, NY, they kept putting me on hold and did not picked up the phone to see if I was still waiting. I stated that I would like information about their bariatric program, they placed me on hold, without once ever asking why I was calling. I could have been the American Medical Association (AMA), National Committee for Quality Assurance (NCQA) or Joint Commission for Accrediation of Hospital Organization (JCAHO). What a nightmare!! Time wasted dealing with them about 45 mins. I hanged up and called again 4 separate times, they still put me on hold without even asking who or why I was calling.

Their office needs major overhaul on policies and staff re-engineering, especially in telephone etiquettes. I give them a very poor/failure rating and unacceptable standards when it comes to Montefiore and that is just the initial calling phase. There is NO EXCUSE for their action. I can imagine how the pre-op, surgery and post-op care would be, very scary and terrifying.

If you treat me with utmost respect and concentrate on the call with the person you are talking with, then I know I will be treated as such in person.

I will be attending the COS seminar regarding bariatric information. It seems it is an initial step before seeing the MD or having any clinical relationship (basically it is a requirement anywhere before making an appt to see anyone). I'll keep you posted after the meeting.

Co-Morbidity

2003-11-06T13:35:00.002-05:00

-==¤¥¥¥¤==-
CO-MORBIDITIES
-==¤¥¥¥¤==-

UPDATE AS OF 2007: This entry was written in Dec 2003. The co-morbidities requirements from medical insurance companies of today that are covered has since been revised and changed. As of April 2006, the co-morbidities that must be present with a person diagnosed with morbidi obesity has to include ONE of the following:

* sleep apnea
* diabetes
* hypertension

Always check with your medical insurance company for their critieria and requirements regarding bariatric surgery and which procedure they do cover.

Below was written in my OH journal in 2003

There are 6 medical related fatal co-morbidities that are view of extreme importance when it comes to morbid obesity. The MAJORITY of medical insurance companies only authenticate these primary diagnosis as medical necessity since morbid obesity (code 278.01) alone WILL NOT grant you approval for gastric bypass surgery. Listed are the 13 co-morbidities used by medical insurance companies and deemed medically necessary for bariatric surgical approval.

Many insurance companies require a minimum of 2 co-morbids associated with a BMI=40+. Some insurance companies will approve surgery if 1 co-morbidity has been diagnosed. In addition, I gave an explanation what each are for those not aware what exactly it means and also help if you may have any of these symptoms..

Treatment of obesity alone is non-covered by medical insurance companies, so co-morbidity must be documented, such as ONE or MORE of the following;

* diabetes

* Pickwickian Syndrome or sleep apnea

* hypertension

* cardiac disease

* severe venous stasis disease

* osteoarthritis aggravated by the obesity

There must be evidence, in addition, that the beneficiary has failed multiple efforts at dietary control of the obesity. Documentation of all the forgoing must be submitted with the claim. In other words, a time frame is not always be needed regarding diet history, only that a couple of attempts to lose weight through dieting failed. Do check with your insurance compannies for exact interepretation to this matter.

Gastric bypass surgery, which is a variation of the gastrojejunostomy, is performed for patients with extreme (morbid) obesity. Gastric bypass surgery for extreme obesity is covered if

(1) it is medically appropriate for the individual to have such surgery;

(2) the surgery is to correct an illness which caused the obesity or was aggravated by the obesity.

Patient selection criteria for surgical treatment of morbid obesity should be in concert with the current community medical standards of practice

* BMI > 40

* presence of associated medical co-morbidities

* absence of psychological contraindications and

* patient history of failed medical weight loss

1.ASTHMA (code 493.00 - 193.92)
An inflammatory disorder of the airways that causes airflow into and out of the lungs to be restricted. It is characterized by periodic attacks of wheezing, shortness of breath, chest tightness and coughing

2. BRONCHIECTASIS (code 494.1)
When listening to the chest with a stethoscope, the doctor may hear small clicking, bubbling, rattling or other sounds, usually in the lower lobes of the lungs. It is often caused by recurrent inflammation or infection of the airways.

3. CARDIOMYOPATHIES (code 425.4 - 425.9)
Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and loses its ability to pump blood. The heart rhythm is disturbed, leading to irregular heartbeats known as arrhythmias. Cardiomyopathy can be classified as primary or secondary. The ventricles becomes excessively "rigid," so it's harder to fill with blood between heartbeats. A person often complains of being tired, may have swollen hands and feet and may have difficulty breathing on exertion. The condition tends to be progressive and sometimes worsens fairly quickly and is a leading reason for heart transplantation.

4. CHRONIC AIRWAY OBSTRUCTION (code 496)
A blockage of the upper airway, which can be in the trachea (windpipe), laryngeal (voice box) or pharyngeal (throat) areas.

5. CHRONIC PULMONARY HEART DISEASE (code 416.9)
High blood pressure in the blood vessels of the lungs in which leads to heart complications.

6. CORONARY ATHEROSCLEROSIS (code 414.00 - 428.9)
Caused by insufficient blood flow to the heart muscle. Symptoms include chest pain, shortness of breath, weakness, tiredness, reduced exertional capacity, dizziness, palpitations, leg swelling, weight gain. Physical examination may reveal the following findings: tachycardia, heart rate irregularity, high or low blood pressure, diaphoresis, tachypnea, syncope, leg edema, heart murmurs, pulmonary congestion.

7. DIABETES MELLITUS (code 250.00 - 250.93)
A life-long disease marked by elevated levels of sugar in the blood. It can be caused by too little insulin (a chemical produced by the pancreas to regulate blood sugar), resistance to insulin, or both. To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested – a sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel. People with diabetes have high blood glucose. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally or both.

8. EMPHYSEMA (code 492.0 - 492.8)
A lung disease which damages the air sacs (alveoli) in the lungs. The air sacs are unable to completely deflate and are therefore unable to fill with fresh air to ensure adequate oxygen supply to the body. Cigarette smoking is the most common cause of emphysema. Tobacco smoke and other pollutants are thought to cause the release of chemicals from within the lungs that damage the walls of the air sacs. This damage becomes worse over time, affecting the exchange of oxygen and carbon dioxide in the lungs.

9. ESOPHAGITIS (code 530.11 - 530.19)
An inflammation, irritation and swelling of the esophagus (the tube that leads from the back of the mouth to the stomach). It is caused by backflow of acid-containing fluid from the stomach to the esophagus (gastroesophageal reflux). It can also be caused by vomiting, surgery, medications or hernias. The infection or irritation can cause the tissues to become inflamed and can occasionally cause ulcers. There may also be difficulty when swallowing and a burning sensation in esophagus.

10. HYPERTENSION (code 401.0 - 405.19)
A disorder characterized by high blood pressure; generally this includes systolic blood pressure (the "top" number of your blood pressure measurement, which represents the pressure generated when the heart beats) that is consistently higher than 140 or diastolic blood pressure (the "bottom" number of your blood pressure measurement, which represents the pressure in the vessels when the heart is at rest) that is consistently over 90. Blood pressure is determined by the amount of blood pumped by the heart and the size and condition of the arteries. Many other factors can affect blood pressure, including volume of water in the body; salt content of the body; condition of the kidneys, nervous system or blood vessels; and levels of various hormones in the body.

11. HYPERTENSIVE HEART DISEASE (code 428.0 - 428.9, 405.01 - 405.99)
High blood pressure increases the workload of the heart, and over time, this can cause thickening of the heart muscle and the symptoms of hypertensive heart disease. As the heart continues to pump against elevated pressure in the blood vessels, the left ventricle becomes enlarged, cardiac output (the amount of blood pumped by the heart each minute) goes down, and without treatment, symptoms of congestive heart failure may develop. It is a late complication of hypertension (high blood pressure) that affects the heart.

12. OSTEOARTHROSIS (code 715.09 - 715.96)
A gradual and subtle onset of deep aching joint pain of either or combination of hands, fingers, hips, knees, big toe, cervical and lumbar spine causing deterioration of joint cartilage that includes pain on weight bearing bones, after exercising, pain during rainy weather, swelling, limited movement, morning stiffness and grating of joints with motion

RENAL DISEASE (403.00 - 403.91, 404.00 - 405.91)_
Any disorder of the kidneys (renal) or the kidney/urinary tract (urologic). For bariatric insurance surgical approval, renal/kidney problems alone is not approve as primary diagnosis related co-morbidity for morbid obesity. The renal condition is secondary and must be related to hypertension which would be the primary condition co-morbid for morbid obesity.

13. SLEEP APNEA (780.51 - 780.57)
Repeated, prolonged episodes of cessation of breathing during sleep. In deep sleep, breathing can stop for a prolonged period of time (often more than 10 seconds). These periods of lack of breathing are followed by sudden attempts to breathe. These attempts are accompanied by a change to a lighter stage of sleep. The result is fragmented sleep that is not restful, leading to excessive daytime drowsiness. Obstructive sleep apnea includes episodes of heavy snoring that begin soon after falling asleep. The snoring proceeds at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which no breathing is taking place (apnea). The apnea is then interrupted by a loud snort and gasp and the snoring returns to its regular pace. This behavior recurs frequently throughout the night. During the apneic periods the oxygen level in the blood falls. Persistent low levels of oxygen (hypoxia) may cause many of the daytime symptoms. If the condition is severe enough, pulmonary hypertension may develop leading to right sided heart failure.

-==¤¥¥¥¤==- ICD-9-CM listings codes for support of medical necessity for gastric bypass (bariatric) surgery -==¤¥¥¥¤==-

Claims should include at least one of the primary diagnoses and the secondary diagnosis 278.01 (morbid obesity). Use of any ICD-9-CM code not listed in below will be denied. Obesity (278.00) is not in and of itself sufficient to be approved for surgery. The patient must have morbid obesity (278.01) AND another condition which was aggravated by the obesity.

Primary Diagnosis Codes

250.00 DIABETES MELLITUS WITHOUT COMPLICATION TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.01 DIABETES MELLITUS WITHOUT COMPLICATION TYPE I NOT STATED AS UNCONTROLLED

250.02 DIABETES MELLITUS WITHOUT COMPLICATION TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.03 DIABETES MELLITUS WITHOUT COMPLICATION TYPE I UNCONTROLLED

250.10 DIABETES MELLITUS WITH KETOACIDOSIS TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.11 DIABETES MELLITUS WITH KETOACIDOSIS TYPE I NOT STATED AS UNCONTROLLED

250.12 DIABETES MELLITUS WITH KETOACIDOSIS TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.13 DIABETES MELLITUS WITH KETOACIDOSIS TYPE I UNCONTROLLED

250.20 DIABETES MELLITUS WITH HYPEROSMOLARITY TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.21 DIABETES MELLITUS WITH HYPEROSMOLARITY TYPE I NOT STATED AS UNCONTROLLED

250.22 DIABETES MELLITUS WITH HYPEROSMOLARITY TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.23 DIABETES MELLITUS WITH HYPEROSMOLARITY TYPE I UNCONTROLLED

250.30 DIABETES MELLITUS WITH OTHER COMA TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.31 DIABETES MELLITUS WITH OTHER COMA TYPE I NOT STATED AS UNCONTROLLED

250.32 DIABETES MELLITUS WITH OTHER COMA TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.33 DIABETES MELLITUS WITH OTHER COMA TYPE I UNCONTROLLED

250.40 DIABETES MELLITUS WITH RENAL MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.41 DIABETES MELLITUS WITH RENAL MANIFESTATIONS TYPE I NOT STATED AS UNCONTROLLED

250.42 DIABETES MELLITUS WITH RENAL MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.43 DIABETES MELLITUS WITH RENAL MANIFESTATIONS TYPE I UNCONTROLLED

250.50 DIABETES MELLITUS WITH OPHTHALMIC MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.51 DIABETES MELLITUS WITH OPHTHALMIC MANIFESTATIONS TYPE I NOT STATED AS UNCONTROLLED

250.52 DIABETES MELLITUS WITH OPHTHALMIC MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.53 DIABETES MELLITUS WITH OPHTHALMIC MANIFESTATIONS TYPE I UNCONTROLLED

250.60 DIABETES MELLITUS WITH NEUROLOGICAL MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.61 DIABETES MELLITUS WITH NEUROLOGICAL MANIFESTATIONS TYPE I NOT STATED AS UNCONTROLLED

250.62 DIABETES MELLITUS WITH NEUROLOGICAL MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.63 DIABETES MELLITUS WITH NEUROLOGICAL MANIFESTATIONS TYPE I UNCONTROLLED

250.70 DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.71 DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS TYPE I NOT STATED AS UNCONTROLLED

250.72 DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.73 DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS TYPE I UNCONTROLLED

250.80 DIABETES MELLITUS WITH OTHER SPECIFIED MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.81 DIABETES MELLITUS WITH OTHER SPECIFIED MANIFESTATIONS TYPE I NOT STATED AS UNCONTROLLED

250.82 DIABETES MELLITUS WITH OTHER SPECIFIED MANIFESTATIONS TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.83 DIABETES MELLITUS WITH OTHER SPECIFIED MANIFESTATIONS TYPE I UNCONTROLLED

250.90 DIABETES MELLITUS WITH UNSPECIFIED COMPLICATION TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

250.91 DIABETES MELLITUS WITH UNSPECIFIED COMPLICATION TYPE I NOT STATED AS UNCONTROLLED

250.92 DIABETES MELLITUS WITH UNSPECIFIED COMPLICATION TYPE II OR UNSPECIFIED TYPE UNCONTROLLED

250.93 DIABETES MELLITUS WITH UNSPECIFIED COMPLICATION TYPE I UNCONTROLLED

401.0 MALIGNANT ESSENTIAL HYPERTENSION

401.1 BENIGN ESSENTIAL HYPERTENSION

401.9 UNSPECIFIED ESSENTIAL HYPERTENSION

402.00 MALIGNANT HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE

402.01 MALIGNANT HYPERTENSIVE HEART DISEASE WITH HEART FAILURE

402.10 BENIGN HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE

402.11 BENIGN HYPERTENSIVE HEART DISEASE WITH HEART FAILURE

402.90 UNSPECIFIED HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE

402.91 UNSPECIFIED HYPERTENSIVE HEART DISEASE WITH HEART FAILURE

403.00 MALIGNANT HYPERTENSIVE RENAL DISEASE WITHOUT RENAL FAILURE

403.01 MALIGNANT HYPERTENSIVE RENAL DISEASE WITH RENAL FAILURE

403.10 BENIGN HYPERTENSIVE RENAL DISEASE WITHOUT RENAL FAILURE

403.11 BENIGN HYPERTENSIVE RENAL DISEASE WITH RENAL FAILURE

403.90 UNSPECIFIED HYPERTENSIVE RENAL DISEASE WITHOUT RENAL FAILURE

403.91 UNSPECIFIED HYPERTENSIVE RENAL DISEASE WITH RENAL FAILURE

404.00 MALIGNANT HYPERTENSIVE HEART AND RENAL DISEASE WITHOUT HEART FAILURE OR RENAL FAILURE

404.01 MALIGNANT HYPERTENSIVE HEART AND RENAL DISEASE WITH HEART FAILURE

404.02 MALIGNANT HYPERTENSIVE HEART AND RENAL DISEASE WITH RENAL FAILURE

404.03 MALIGNANT HYPERTENSIVE HEART AND RENAL DISEASE WITH HEART FAILURE AND RENAL FAILURE

404.10 BENIGN HYPERTENSIVE HEART AND RENAL DISEASE WITHOUT HEART FAILURE OR RENAL FAILURE

404.11 BENIGN HYPERTENSIVE HEART AND RENAL DISEASE WITH HEART FAILURE

404.12 BENIGN HYPERTENSIVE HEART AND RENAL DISEASE WITH RENAL FAILURE

404.13 BENIGN HYPERTENSIVE HEART AND RENAL DISEASE WITH HEART FAILURE AND RENAL FAILURE

404.90 UNSPECIFIED HYPERTENSIVE HEART AND RENAL DISEASE WITHOUT HEART FAILURE OR RENAL FAILURE

404.91 UNSPECIFIED HYPERTENSIVE HEART AND RENAL DISEASE WITH HEART FAILURE

404.92 UNSPECIFIED HYPERTENSIVE HEART AND RENAL DISEASE WITH RENAL FAILURE

404.93 UNSPECIFIED HYPERTENSIVE HEART AND RENAL DISEASE WITH HEART FAILURE AND RENAL FAILURE

405.01 MALIGNANT RENOVASCULAR HYPERTENSION

405.09 OTHER MALIGNANT SECONDARY HYPERTENSION

405.11 BENIGN RENOVASCULAR HYPERTENSION

405.19 OTHER BENIGN SECONDARY HYPERTENSION

405.91 UNSPECIFIED RENOVASCULAR HYPERTENSION

405.99 OTHER UNSPECIFIED SECONDARY HYPERTENSION

414.00 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT

414.01 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY

414.02 CORONARY ATHEROSCLEROSIS OF AUTOLOGOUS VEIN BYPASS GRAFT

414.03 CORONARY ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT

414.04 CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT

414.05 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED BYPASS GRAFT

416.9 CHRONIC PULMONARY HEART DISEASE UNSPECIFIED

425.4 OTHER PRIMARY CARDIOMYOPATHIES

425.9 SECONDARY CARDIOMYOPATHY UNSPECIFIED

428.0 CONGESTIVE HEART FAILURE UNSPECIFIED

428.9 HEART FAILURE UNSPECIFIED

492.0 EMPHYSEMATOUS BLEB

492.8 OTHER EMPHYSEMA

493.00 EXTRINSIC ASTHMA UNSPECIFIED

493.01 EXTRINSIC ASTHMA WITH STATUS ASTHMATICUS

493.02 EXTRINSIC ASTHMA WITH (ACUTE) EXACERBATION

493.10 INTRINSIC ASTHMA UNSPECIFIED

493.11 INTRINSIC ASTHMA WITH STATUS ASTHMATICUS

493.12 INTRINSIC ASTHMA WITH (ACUTE) EXACERBATION

493.20 CHRONIC OBSTRUCTIVE ASTHMA UNSPECIFIED

493.21 CHRONIC OBSTRUCTIVE ASTHMA WITH STATUS ASTHMATICUS

493.22 CHRONIC OBSTRUCTIVE ASTHMA WITH (ACUTE) EXACERBATION

493.90 ASTHMA UNSPECIFIED

493.91 ASTHMA UNSPECIFIED TYPE WITH STATUS ASTHMATICUS

493.92 ASTHMA UNSPECIFIED WITH (ACUTE) EXACERBATION

494.0 BRONCHIECTASIS WITHOUT ACUTE EXACERBATION

494.1 BRONCHIECTASIS WITH ACUTE EXACERBATION

496 CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED

530.11 REFLUX ESOPHAGITIS

530.19 OTHER ESOPHAGITIS

715.09 OSTEOARTHROSIS GENERALIZED INVOLVING MULTIPLE SITES

715.15 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING PELVIC REGION AND THIGH

715.16 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING LOWER LEG

715.25 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING PELVIC REGION AND THIGH

715.26 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING LOWER LEG

715.35 OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING PELVIC REGION AND THIGH

715.36 OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING LOWER LEG

715.89 OSTEOARTHROSIS INVOLVING OR WITH MULTIPLE SITES BUT NOT SPECIFIED AS GENERALIZED

715.95 OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING PELVIC REGION AND THIGH

715.96 OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING LOWER LEG

780.51 INSOMNIA WITH SLEEP APNEA

780.57 OTHER AND UNSPECIFIED SLEEP APNEA

Secondary Diagnosis Code

278.01 MORBID OBESITY

What is Morbid Obesity?

2003-07-08T13:33:00.001-04:00

Morbid obesity, also known as clinically severe obesity, is a chronic, incurable medical disease. Unlike others who are able to lose weight through diet and exercise, these regimes are not effective once a person is morbidly obese. It is a major public health risk throughout the developed world. Nearly 5 to 10 million people suffer from this, chronic, life-threatening disease and approximately 300,000 Americans die every year due to obesity-related co-morbidities.

Co-morbidities prevents and severely interferes with daily basic function. These include ambulation, personal hygiene, bathing, getting dressed, walking, as well as persistent pain on weight-bearing joints and lower back, swollen ankles, back pain, sleeps apnea, tiredness, fatigue, to name a few. There is risk factor for cardiac dysfunction, pulmonary problems, digestive diseases and endocrine disorders as well as orthopedic and dermatologic complications.

Numerous studies have documented the stigmatization of obese persons in most areas of social functioning. This can promote psychological distress and increase the risk of developing a psychological disorder. The morbidly obese patient is at risk for affective and anxiety disorders. The obese often consider their condition as a greater handicap than deafness, dyslexia or blindness.

In a nearly 4 year study, utilizing a 2 drug regimen of Phentermine and Fenfluramine, behavior modification, diet and exercise, the initial optimistic results have not been successful, with a 1/3 drop out rate and a final average weight loss of ONLY 3 lbs in those who were followed for the 4 years of the study. This drug combination appears to have an unacceptably high association with cardiac valvular disease and has been withdrawn from therapeutic use because of these potentially life threatening sequelae.

Dietary weight loss attempts often cause depression, anxiety, irritability, weakness and preoccupation with food. The treatment goal for morbid obesity should be an improvement in health achieved by a durable weight loss that reduces life threatening risk factors and improves performance of activities of daily living. Temporary fluctuations of body weight from calorie restricted diets should be avoided.

21 JUNE 2003

2003-06-21T12:48:00.001-04:00

I hope to see better and more healthier days coming my way

FRI.....21 JUNE 2k3
HT......5' 2"
WT......305 lbs

Have problems with mobility, health and other daily functions due to severe morbid obesity. I have always been very athletic particpating in various and extreme sports as well as had a very active lifestyle, social life and productive career path. The contribution of this devastating disease of morbid obesity, has compromised my health. I have been diagnosed with cardiac (heart) arrthymia known as premature ventricular contractions which is my heart skipped 10-20 beats per minute. This is due to the excessive weight in my body causing stress to my heart chambers. The weight has also caused irregularities to my blood pressure to increase known as hypertension (high blood pressure). I am on heart medication known as Tenormin. The medicine will also prevent me from having a heart attack by decreasing the heart rate since there are symptoms of tachycardia (fast heart rate), as well as decrease the workload of my heart and reduce my blood pressure. In addition, I have an intestinal disorder that has been traumatizing to my health. The bariatric surgery emphasis is on the alteration of the digestive tract. Due to my intestinal condition, I may be or not be eligible as a candidate for gastric bypass surgery.

Went to my PCP and she spoke about a procedure that may help me in my treatment to my health and weight. Started my first step by verifying my status as to medical insurance approval for bariatric surgery. I was informed that I am covered as a medical necessity. I will start calling various bariatric surgical specialists. First, I need to make a list as to what questions I want to ask.

I was not obese until after my late 30s. As a youth, teen and college student, I was physically fit and very active in various sports, dance and daily living. As a teen, I weigh an average of 104 lbs, as a college student and upto my mid 30s - average weight 125-135 lbs. In 1999, I began gaining weight at an alarming rate, having intestinal problems and unable to control my weight as I previously have done. I was gaining and losing weight, but not due to food or lack of activities. my weight gain was caused by Cushing's syndrome. My before pics shows how my excessive body weight differs than a person with basic excessive body weight. although we both have viseral body fat, most of my weight gain can be seen on my belly, face and the top of my back that caused a slight hump below the neck. This disease is extremely rare and has to do with cortisol level in my body. The weight gain is caused by stress that triggers the cortisol to go out of control hence weight gain. In addition to this, I also have an intestinal condition in which my digestive tract has a disorder. I will explain this later since it is complicated and actually traumitizes me talking about it since it has cause so much hardship to my life.

Here's my history. My weight gain was due to a medical condition that made my weight very unstable. It didn't matter if I was dieting or exercising, it had no affect on it.

1998 = weighed 134 lbs
Feb 1999 = weighed 140 lbs
Dec 1999 = weighed 165 lbs (In 10 mths, I unnoticedly gained 30 lbs.)
2000 = weighed 198 lbs
2001 = weighed 210 lbs
2002 = weighed 250 lbs
2003 = weighed 305 lbs

I feared if I do not have a gastric bypass surgical procedure, my weight will keep climbing and since I am a petite person, the added weight is too much for my body to handle. By the above weights, by the end of 2004, my weight will be estimated 320 lbs. I am trying hard not to let that happen. I have always been a healthy person, but since gaining 170+ lbs in 5 years and categorized in the severe morbid obesity range, the 20-30 lbs. per year weight gain is causing serious co-morbidities that is detrimental to my health. I have to make this cycle stop before it kills me.