Meeting with the Psychologist

1_Messy-Desk-More-Creative-750x400This is about to get real, my weight loss surgery.  We make up all sorts of scenarios in our minds about how it’s going to be.  Here was some of the inner dialogue that raced through my mind before my meeting with Dr. Klein.  “What will I have to say for him to disqualify me for surgery?” “Oh boy, I hope I don’t say something stupid.”  I made it to my appointment a few minutes early, rode the elevator to the 7th floor and as I looked inquisitively out of the elevator toward Dr. Klein’s office, a man was standing just outside and because I must have looked disoriented and lost, said, “Where are you headed?” He guided me to Dr. Klein’s office.  As I arrived there was a clipboard of paperwork to fill out. Oh, yay! Then a questionnaire on a scale of 1-5, which related to my quality of life ranging from activities to relationships.  As I was taking it, I was worried that I was psyching myself out about how I should answer the questions on the scale, but finally decided to go with my gut instinct.   As it turned out, as I walked into his office, the man at the elevator who guided me to Dr. Klein’s office, was Dr. Klein himself.

He put me at ease right away, with his less-than-tidy paperwork habits.  It seemed like he’s the kind of guy to keeps everything, because someday he might use it. Or, maybe he’s just so busy focusing on patients he doesn’t have time to sort through the paper on his desk, or in the water damaged box on the floor with heaping papers spilling out.  Regardless, as I sat in the 1992 Lazy Boy rocking chair, ready to be barraged with questions about my history, I suddenly felt like a little girl again.  My feet weren’t touching the floor and somehow this made me feel small.  Maybe this was another element in his office to make me feel at ease?  Ironically, in the midst of feeling small, I felt comfortable at the same time.

First question, “So, what diets have you tried in the past?”  (Again, I have to go through this?)  Weight Watchers, Atkins, Curves diet, personal trainer & diet, that’s all I could think of in the moment.  There’s more.  I ended that question with, “I haven’t done any diets, of late.”  I’m so over it.  This was followed with questions about my medical history and family history.  “Does anyone in your family have mental illness?” Well since you asked, “Yes, my youngest sister has schizophrenia, which is why I have her daughter.”  This resulted in dialogue about recent events with the San Bernardino shooting and mental health and gun violence.  He listened intently and seemed genuinely surprised that my sister has been at a locked psychological facility for almost a year.  He said, “That’s virtually unheard of nowadays.”  I agreed that we’re so grateful that she was able to receive treatment in this way.  Needless to say, my belly has taken a back burner to the pressing events of raising a third child unexpectedly and dealing with the challenges we faced as a family.

As we moved along to the reason for the visit, the main reason he thought I’d benefit in addition to the weight loss, was that I have Type 2 diabetes and the likelihood that it would be cured post surgery.  (There’s a 78% chance, I read later, Link here.)  He said that the reason the FDA hasn’t approved gastric bypass as a remedy for Type 2 diabetes is that there hasn’t been enough research in the U.S. to satisfy the FDA’s guidelines.  Interesting.  In some countries, gastric bypass is used as a way of treating Type 2 diabetes, not to mention the fact that living longer is an added bonus.

There is now enough evidence to state that bariatric surgery may reduce mortality in patients with diabetes. In the analysis by Adams et al., deaths attributed to diabetes were reduced by 92%. Thus, there can be little doubt that in very obese patients with type 2 diabetes, bariatric surgery in general is a highly effective means of treating type 2 diabetes.

Consequently, conventional bariatric procedures are being used worldwide to treat type 2 diabetes in association with obesity, and increasingly among less obese or merely overweight patients.Link here.

Contrary to the idea that gastric bypass will cure diabetes, some studies indicate that diabetes goes into a dormant state.

Patients should be counseled that bariatric surgery alone does not reliably “cure” diabetes. Obesity and diabetes are chronic diseases that may be placed in remission. Article here

Whether it’s in remission or cured, it’s better than the consequences of being on medication for diabetes. So far, I’m not taking medication, but that is in my foreseeable future if I don’t have the surgery.

As the visit came to an end, he said he’d forward his report to Dr. Lamar, my surgeon.  As I was about to leave he said, “Have you considered…(he paused, like he’d lost his train of thought)”  I finished his sentence “…going to the support groups?”  “Yes, I’m planning to go to the next one.”  Then, “Great, I’ll see you there. I run those meetings.”

Anytime you’re going to go through something intense and life-changing, it’s a good idea to have support.  If you can have the support of others who’ve gone through the experience, well, that kind of insight is worthwhile.

August 5, 2015

The Symposium

How did I get here?  It sounds like a symposium should be in a gradual slanted college hall with a panel of experts arranged on stage.  Actually it was a room of rectangular tables and cushy conference chairs filled with people who were as unsure as I was.  Some with knee problems & hip problems. Many much older and much heavier using walkers to balance.  All of us with struggles with food and many beaten down by this struggle we call not-so-affectionately, obesity.

Hard facts: I qualify for bariatric surgery because I have a BMI over 35 and I have sleep apnea and diabetes. Many insurance companies will not pay for the surgery unless you have 2 other health issues in addition to a BMI above 35.  For example, high blood pressure, arthritis and other diagnoses would also be approved as conditions for becoming a bariatric candidate.  All that to say, my Darth Vader mask and inability to control my sugar have made it possible for me to have this surgery.  Blessings do come in unexpected ways.

Dr. Troy Lamar began his presentation with a short video of testimonials of 3 people who have had success with Gastric Bypass and how it changed their lives.  His presentation continued with many facts and details about what to expect with either the Roux-en-Y Gastric Bypass (RYGB) or Gastric Sleeve.  He does not perform Lap Bands, as the long term effects are not as effective for many reasons.

The fascinating and eye-opening fact that I did not know was how ghrelin, an appetite hormone, functions in our bodies.  “The normal response is that ghrelin levels are higher when you are hungry and they go down after a meal, but people who are diabetic or obese have the opposite response,” she said. “They tend to have lower fasting ghrelin levels and then after a meal ghrelin levels don’t go down like they should.” Ghrelin Article.  So basically, gastric bypass changes how this hormone functions.  This, in turn changes appetite and how your gut functions.  Over 200 gut hormones are altered post RYGB so the acid in the lower part of the stomach can no longer reach the top part.  Dr. Lamar referenced this article, Dr. Adams New England Journal of Medicine, on quality of life post-RYGB.  Another hopeful outcome post laparoscopic surgery is, many patients are back to work within the week.  I assumed the recovery time would be much longer.

How do I feel?  What are my feelings about possibly having this surgery?  I abhor before and after photos, especially the ones where the person is frowning at the heavy weight and smiling profusely in the ‘after’ photo. Sure, losing weight will help me fit in smaller sized clothing, but it won’t change my history with food, my feelings about often being the heaviest female in the room, or who…I…am.  I need to say this, my love for myself is not contingent on the number I am on the scale.  This has taken me MANY years to come to terms with how much I weigh.  I realized that navel gazing (literally and figuratively) is just that, navel gazing.  When you are constantly commiserating and wishing you could be something else, you’re rarely content.  I decided long ago to become others-centered rather than self-centered because that’s where the real ‘Joy’ is.  Another phrase that has always irked me is ‘letting myself go’.  “She let herself go,” you know you’ve heard it, or said it, or thought it.  Guess what, letting self go isn’t always a bad thing. The world might be a lot better if we let go of self.

That said, living longer and healthier is my ultimate goal in proceeding with RYGB.  I feel fine now, but I was able to look into a window of the future of what I might be in 20 years if I don’t have the surgery.

I’m on this path.  Symposium finished.  Next step, six months meeting with a nutritionist, following that a psychological evaluation and shortly after, RYGB surgery.