colonoscopy

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

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

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

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

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

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

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

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

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

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

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

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.