Chocolates

Jason bought a box of sugar-free chocolates and ate some today. He says it didn't give him any problems eventho he's technically still supposed to be on a puree diet till January 19.
For the past few days, he has had pimento cheese, pureed beef ribs, mashed potatoes, soft scrambled eggs, turkey spam and refried beans.
He does need to get some vegetables into his diet tho.

Starting on the Puree diet

Jason started on his puree diet today. The book says he should consume a 1/4 cup three times a day.
In the morning he had grits. And turkey spam+ mayo mush (ewww) in the afternoon and evening (eww, ewww)
He refuses to eat baby food and thinks it's gross (apparently turkey spam + mayo mush is not gross).

In between meals, he has been drinking his protein shakes (he blends his liquid vitamins into his shakes because he says those vitamins are nasty, but I think half of those vitamins ends up going down the drain)
Also, G2 and Isopure has been his source of hydration.

He has been feeling bored and edgy and impatient with everyone. Tonight, we went to the grocery store and he rode in the electric cart.

I'll try to make some Shepherd's pie tomorrow. That would make a decent puree.

God help us get through this Christmas!

Post surgery update

It's been 6 days since the surgery.
Jason is doing great and healing well. He feels strong and thinks he can do everything by himself which drives me up the wall sometimes.
We still monitor his blood pressure and temperature every few hours. Blood pressure still looks a little high so we may need to call the doctor's office tomorrow and ask for advice.

Yesterday was his first time out of the house. He got a haircut and we went to the pharmacy. Both places were less than 5 minutes away so he did not have to ride in the car for long.
He is also walking a little more every day which is really good. We visited some neighbors across the street and we took a longer slow walk around the neighborhood yesterday (in the rain!)

Other than that, I think he's getting bored staying at home.
He's still on a liquid diet - drinking lots of water, G2, Isopure protein drinks, broth and an occasional jello. We have to measure every amount of liquid intake he gets because he needs atleast 1440 cc to stay hydrated so he needs to be sipping liquids every minute.

He's also still taking his pain medication (Loratab) every 6 hours.

On Tuesday he gets to start on a puree diet but he feels he can start that tomorrow. So we'll see.

As for me, I am just exhausted.

The big day

We arrived at the hospital at 8.30am. Checked in. Waited.
They called Jason in at 9am and got him all dressed in the hospital gown and all ready.
Then they called us in at 9.45am to be with him. We met his anesthesia doctors, nurses, CRNA, Dr. Kuwada's assistant and Dr. Kuwada himself. And Jason was wheeled in at 10.30am.

We waited in the waiting room.
At 12.30pm, the hospital staff told us that the Operating Room called and informed that they were still working on Jason.
We waited some more.
Three more hours passed. No news yet.
It was the longest and most nerve-wrecking moment ever. I was scared to death because we weren't expecting the surgery to take this long. Negative thoughts were going through my head at this point.

Finally, Dr Kuwada walked in at 1.50pm. He looked tired. I was terrified at what he was going to say. Then he smiled and I was relieved. He told us the surgery went well. His liver did not shrink as much as he wanted it to, but it did not cause him any trouble.
He told us he'll be in recovery for the next two hours. So we went upstairs and waited in the recovery room.

At 2.30pm, we were informed they had moved Jason to the ICU because of breathing problems.
We were allowed to go in and see him around 4pm.
He was hooked up with all sorts of wires, machine and tubes and electrodes. We watched his readings on a monitor. Each time his breathing dropped to 5 the alarm would go off, and if he doesn't wake up, the number would drop further and we'll see a flat line on the screen when it reached zero. That was scary. We kept trying to wake him up every 2 minutes because the alarm kept going off as his breathing dropped.
Finally at 6pm, his breathing stabilized at around 20.

The nurse that was on duty at that time was annoyingly useless. I don't think I could have trusted her to wake Jason up at all. She kept trying to tell us how busy she was and that she had her reports to finish up before she goes home. I don't care about her stupid reports. I just want my husband alive.

Being in the ICU, we had to leave at 11pm because they did not allow visitors from 11pm-8am.
I could not sleep at all that night.
My mind kept saying "wake up Jason! Wake up!"

The night before surgery

Dr. Timothy called up to check on Jason and asked him if he was all ready.
Jason is.
I am not.
I am just scared and nervous as can be.

Jason will not be allowed to drink or eat anything after midnight.

We are packed and will be at the hospital before 9am tomorrow morning. His surgery is scheduled for 11am.

The system here

This is strange. Almost ridiculous that nobody can tell us how much this surgery would cost.
We asked the hospital what our out-of-pocket expenses would be for the surgery. They told us we need to call and ask the Insurance company and gave us a CPT code as reference.
We call the Insurance company and they cannot give us an estimate figure but that we're responsible for 10% of the allowed charges which would be billed after the Insurance Company handles the claim.

So, how can one know if they can afford the surgery if they are not told what the cost would be?

No eggs

So I emailed the nutritionist and asked if eggs were allowed.

She replied "No".

I rest my case.

Liquid Diet - Day Two

Day Two was similar to yesterday. Except, he added an egg into his chicken broth for dinner. Egg was not listed as an "OK" to have on the liquid diet.
Ofcourse he says he hasn't broken any rules and doesn't see why an egg is not allowed since eggs are basically protein and he is allowed protein.

But here's what I found :

One chicken egg contains :

Carbohydrates	1.12 g
Fat	10.6 g
Protein	12.6 g
Water	75 g
Vitamin A equiv. 140 μg	16%
Thiamin (Vit. B1) 0.66 mg	51%
Riboflavin (Vit. B2) 0.5 mg	33%
Pantothenic acid (B5) 1.4 mg	28%
Folate (Vit. B9) 44 μg	11%
Calcium 50 mg	5%
Iron 1.2 mg	10%
Magnesium 10 mg	3%
Phosphorus 172 mg	25%
Potassium 126 mg	3%
Zinc 1.0 mg	10%
Choline	225 mg
Cholesterol	424 mg

I think the fat content in an egg disqualifies it from being OK to have on the liquid diet.

I wish he would just follow the rules.

I've cleaned out the pantry and the fridge. Made sacrifices with my own personal diet. And I am making sure I won't cook anything that might make it hard for him to resist.
But I have not gone as far as keeping the fridge free of eggs. I hope I won't have to. That is a HUGE sacrifice to make. I love eggs too much.

The Liquid Diet

Today, Jason starts his liquid diet. He had already lost 5 lbs prior to this because he and I both had the stomach flu and was not eating anything for almost 2 days.
His day started out with a protein shake.
For lunch he had another protein shake and a can of cream of onion soup.
For dinner he had a plate of raw salad with Soy Ginger dressing, and another protein shake.
Between meals, he snacked on 3 packets of carrots, a cup of yoghurt and a jello pudding.

From reading other people's experiences, most say these 2 weeks are the most difficult.
Hopefully, Jason will be able to make it. He had endured 5 days of the lemonade diet a few months ago so hopefully this will be a breeze for him.

Pre-op appointment

Jason had a pre-op appointment with the surgeon today. This will be the last meeting before the surgery. The nurse went through his file to make sure all the paperwork is in order, checked his weight and blood pressure and we spoke to Dr. Kuwada briefly.

Blood lab & Dietician appointment

Today, Jason had his final blood work drawn before the surgery. He managed to ask the nurse a few questions about whether or not to continue his blood pressure medication and was told that he should stop taking the Vasotec 3 days before the surgery and not to take any Aleve (or painkillers) 10 days prior to the surgery.

Later that afternoon we all went with him to the briefing with the Nutritionist/Dietician.
He was reminded again of what to eat/drink before and after the surgery and what foods to avoid that would cause dumping syndrome.
He will be on a liquid diet 2 weeks prior to the surgery. This is to help shrink the liver which would make the surgery less complicated, as the liver is sitting on top of the stomach pouch.

Briefly, he should be taking atleast 25 grams of protein with each protein shake, 4 times a day. Each scoop of protein powder should not contain more than 5 grams of carbs, and less than 4 grams of fat. He will also need to take daily multivitamins (500mg 3 times a day) and 1000i.u of Vitamin D3.

After the surgery, he can only drink water on the first day. And clear liquids for the first week.
He can start a puree diet after the first month (after Jan 15, 2009). (Yogurt, grits and mash potatoes might work)
Each meal will be portioned into 1/4 cup per serving.

On the second month (February 2009), he can start a soft food diet. (scrambled eggs, canned tuna, mashed vegetables, cream soups)
Each meal can be increased to 1/2 cup per serving.

He should be able to try normal food on the 3rd month (March 2009), not more than 3/4 cup per serving.

What NOT to do:
Use a straw

What foods to avoid:
bread
rice
spicy food

What foods are prohibited forever:
caffeine
carbonated drinks
Sugar
chewing gum

Support Group Meeting No. 2

... which we missed.
It was not marked on my calendar because I had forgotten there was one today.
My mom-in-law had reminded Jason the night before but he obviously had not remembered either.

Is my husband really ready for this surgery ?

The EGD

The husband had his EGD done today. EGD is an upper gastrointestinal scan. They put a tiny little scope and camera down the throat and take pictures of the esophagus, and different sections of the stomach to check for abnormalities or growths, polyps, etc. They need to do this because it would be the last time a scope or camera can be put through the stomach.

I wasn't sure if the clinic had informed him earlier that he would be sedated but he was of the opinion that he would not be and could drive himself home.
I asked him again just to be sure. Because it was a Thursday and I usually have a full day of meetings at work. He said they'll just numb him. Ok.

At 9am, he sends me an email at work and tells me that they do not necessarily have to sedate him but they will if necessary and therefore, might require someone to be there before they do the procedure.

I talked to my boss and got the green light to leave at 1pm.

There was no way I could drive 25 miles home to pick Jason up and drive 20 miles up again for his 1pm appointment. But I could meet him at the clinic. I got there at 1.25pm. He was dressed in a hospital gown and fancy shower cap slippers. I regret not having my camera with me.

The procedure was over in 15 minutes but he had to be in recovery for about 30 minutes.

The doctor then talked to me and showed me the report and pictures of the scan and told me it was all good except for a slight inflammation. (It was from the stomach bug he had last week).

He woke up about 30 minutes later, they wheeled him out in a wheelchair and I drove the car up to the entrance.

He was whoozy and said he felt like he had a couple of drinks and could not remember a single thing.
But he needed food because he had not eaten breakfast nor lunch so we went to the buffet.

Got home and he fell asleep till late evening. And we drove back to the clinic to get his car.

The CPap machine

So the Sleep Study shows that the husband qualifies for a CPAP (Continuous Positive airway pressure) machine because he has sleep apnea.
The CPAP machine blows air at a prescribed pressure delivering a stream of compressed air via a hose to a nose mask when the upper airway becomes narrow and breathing becomes shallow.

He collected his machine from the CPAP company a few days ago and got it hooked up and working.

Now, I sleep with Darth Vader every night.

The dietitian

Another one of the prerequisites before the surgery.

Because what you eat, how you eat and how much you eat changes after gastric bypass surgery, the dietitian has to walk you through in creating this gastric bypass diet, which includes what type and how much food to eat with each meal and the required consistency and texture of the food.

The stomach pouch will be reduced to the size of a small egg and portions of your small intestine bypassed so a specific diet has to be followed after the surgery.

After surgery: The first three months

You won't be allowed to eat for one to two days after the surgery. Then you consume specific foods according to a diet progression. The purpose of the gastric bypass diet progression is to help in the healing process, minimize stress on surgical sites and allow time for your body to adapt to the new eating patterns.

The following are common phases in the gastric bypass diet progression:

• Liquids — foods and fluids that are liquid or semiliquid at room temperature and contain mostly water, such as broth, juice, milk, strained cream soup and cooked cereal. In most cases, you stay on a liquid diet for one to two days.
• Pureed foods — foods with a consistency of a smooth paste or a thick liquid. Pureed foods contain no distinct pieces. The pureed diet is generally followed for three to four weeks, or as recommended by your dietitian or doctor.
• Soft foods — foods that are tender and easy to chew, such as ground or finely diced meats, canned or soft, fresh fruit, and cooked vegetables. You usually eat soft foods for eight weeks before progressing to eating foods of regular consistency with firmer texture as recommended by your dietitian or doctor.

During the diet progression, you eat many small meals a day and sip liquids slowly throughout the day (not with meals). You might first start with six small meals a day, then progress to four meals and finally, when following a regular diet, decrease to three meals a day. Typically, each meal includes protein-rich foods, such as lean meat, low-fat dairy products (yogurt, cheese) or eggs. Protein is important for maintaining and repairing your body after surgery.

Lifelong changes: New eating habits

The changes in your digestive system restrict how much you can eat and drink with each meal. To avoid problems and to ensure you're getting nutrients you need, closely follow these guidelines:

• Eat small amounts. Just after surgery, your stomach holds only about 1 ounce of food. Though your stomach stretches over time to hold more food, by the end of three months, you may be able to eat 1 to 1 1/2 cups of food with each meal. Eating too much food not only adds more calories than you need but also may cause pain, nausea and vomiting. Make sure you eat only the recommended amounts and stop eating before you feel full.
• Eat and drink slowly. Eating or drinking too quickly may cause dumping syndrome — when foods and liquids enter your small intestine rapidly and in larger amounts than normal, causing nausea, vomiting, diarrhea, dizziness and sweating. To prevent dumping syndrome, choose foods and liquids low in fat and sugar, eat and drink slowly, and wait 30 minutes before or after each meal to drink liquids. Take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid. Avoid foods high in fat and sugar, such as regular soda, candy and candy bars, and ice cream.
• Chew food thoroughly. The new opening that leads from your stomach into your intestine is very small, and larger pieces of food can block the opening. Blockages prevent food from leaving your stomach and could cause vomiting, nausea and abdominal pain. Take small bites of food and chew them to a pureed consistency before swallowing. If you can't chew the food thoroughly, don't swallow it.
• Drink liquids between meals. Drinking liquids with your meals can cause pain, nausea and vomiting as well as dumping syndrome. Also, drinking too much liquid at or around mealtime can leave you feeling overly full and prevent you from eating enough nutrient-rich foods. Expect to drink at least 6 to 8 cups (48 to 64 ounces) of fluids a day to prevent dehydration.
• Try new foods one at a time. After surgery, certain foods may cause nausea, pain, vomiting or may block the opening of the stomach. The ability to tolerate foods varies from person to person. Try one new food at a time and chew thoroughly before swallowing. If a food causes discomfort, don't eat it. As time passes, you may be able to eat this food. Foods and liquids that commonly cause discomfort include meat, bread, pasta, rice, raw vegetables, milk and carbonated beverages. Food textures not tolerated well include dry, sticky or stringy foods.
• Take recommended vitamin and mineral supplements. After surgery, your body has difficulty absorbing certain nutrients because most of your stomach and part of your small intestine are bypassed. To prevent a vitamin or mineral deficiency, take vitamin and mineral supplements regularly. These generally include a multivitamin-multimineral, calcium, iron, vitamin B-12 and vitamin D. Talk to your health care provider about recommended vitamin and mineral supplements following gastric bypass surgery.

The Fitness Assessment

This is another part of the requirements to qualify for the surgery.

I won't post much about this assessment since I wasn't there to capture any information.
The husband said he did well and has posted about it here.

I am proud of him!

The Sleep Study

Yesterday night, the husband had his sleep study done at the clinic. A Sleep Study or Polysomnogram (PSG) is a "multiple-component test, which electronically transmits and records specific physical activities while you sleep. The recordings become data, which will be "read" or analyzed by a qualified physician to determine whether or not you have a sleep disorder."
In short, this study is to find out what is happening while you sleep.

In order to get a C-Pap machine, a sleep study has to be done.

They gel Jason up, and stick electrodes all over his body. By attaching the electrodes to your body, the recorded electrical signals generated by your brain and muscle activity are sent back through the wires and recorded digitally and on continuous strips of paper.

He said it was an uncomfortable night and found himself grasping for breath a few times because he had to be sleeping on his back.

He came home at 8am the next morning.

The Support Group meeting

We all went to the Support Group meeting today at the hospital. This meeting is for all those who have vested interest in the surgery.

A speaker gave tips and advice on dieting prior to the surgery.

There would be support group meetings every month.
We were also told that they would be getting different speakers and people who have undergone the surgery to share their experiences with everyone.

The Psychological Assessment

One of the qualifying steps for this surgery is to undergo a Psychological Analysis.
They want to make sure you want this surgery for all the right reasons.

Since I wasn't there at this appointment, I can only post what I know from the husband. And all he told me was that it went well and the psychologist will write up a report to be sent to his doctor.

Meeting the Surgeon

The husband had his first consultation with the Doctor who would be doing his surgery today.
Questions were answered and the procedure was explained further.

Nothing much to blog about.

Weight-Loss seminar

There was a seminar at the bariatric hospital for the Lap-Band and Gastric Bypass and we signed up for it. It was very informative and after the seminar, we were able to ask the doctor any questions.

It was after this seminar that Jason decided that perhaps the gastric bypass was what he wanted. So we brought our files home and continued reading and researching on the gastric bypass.

Honestly, I am still scared and hesitant about having him go through either procedure. I wish he did not have to do this.

These are some of the complications of gastric bypass. How can I feel okay about this whole thing after reading the complications? But the husband is stubborn and also optimistic.

I, on the other hand, is the worry-wart and the pessimistic one.

What are some of the possible complications of gastric bypass?

• Over one-third of the people who have gastric bypass surgery develop gallstones.
• People who have had this surgery are more likely to develop liver problems.
• Between 10 and 20 percent require a second surgery to repair a complication. The most common complication is a hernia. It is also possible for the staples to pull loose (so there is no longer a pouch).
• It is possible for a leak to occur from the stomach or intestine into the abdominal cavity. This will result in a serious infection called peritonitis.
• There is a very small risk of death from the surgery. About 1 in 2,000 (0.5%) people die from the surgery.
• Complications of a laparoscopic approach include leaks in the abdominal cavity and a blocked bowel. This approach has not been used long enough to draw significant conclusions.
• Other risks associated with major surgery include infection in the incision, an abscess inside the abdomen, deep vein thrombosis, and pulmonary embolism.

The first consultation

We went for the first consultation at the first bariatric center here. At this stage, Jason was more inclined to do the Lap-band ( Laparoscopic Gastric Banding). The PA met with us and made us watch a video presentation of the Lap-Band system and explained the procedure and details. Then, we met with the nutritionist. We were supposed to meet with the doctor too but was told he was not available and had left the building.

We were under the impression that this was just an initial consultation to find out what Lap-band was all about. We had made it clear that no decision had been made on our part. But upon check-out, they collected $250 from us. They did tell us that if we were to decide not to do this surgery with them, they will refund the $200 (but not the nutritionist fee).

Fair enough, but it still felt like daylight robbery to me because we were not told of all these charges in advance.

In the car, we had the same opinion that this center did not make us comfortable and they were very unorganized. (PA also could not find her files and had misplaced her scope)

More researches later, and we found another place.

We called the first center to tell them we have decided not to do the surgery but was then informed that the $200 can NOT be refunded., blah blah blah.

What the $%^& ??

After a complaint letter, some more calls, and a few bad reviews written about them, we finally got our money back.

The decision

When Jason told me he wanted to do the lapband or the gastric bypass, it scared me. I've heard of horror stories and I am afraid of the complications that might occur during or after surgery. It is also a life-changing situation. And I'm not too fond of big changes myself.
I remember my response to that was "It's ok to just stay fat" or "why don't we try something else instead of surgery" or "Call Jenny!" or something, anything but surgery!!
But the husband had made up his mind.

I had questions. Lots of it. So I started reading up on anything and everything I could find on google.

And we made an appointment for a "free" consultation to one of the bariatric centers here. Ofcourse it wasn't free but more on that later.

So, the journey begins...