Summer.

I haven't written in about two months. It has been a crazy summer. Where to start . . . oh yeah the Wallow Fire.

Wallow Fire

The Wallow Fire started during Memorial Day weekend. Cam and I drove our kids to Farmington and met my mom so she could take the kids to her house early for our annual family trip. On the way home we heard on the radio that a fire had started in the mountains south of us. Cameron has been saying for at least the last five years or so that if they didn't clean up the forests in that area then it would burn like the Rodeo-Chediski Fire back in 2002. The fire grew immediately. It was called a viral fire. In the first week it had eaten up thousands and thousands of acres. With the department I work for part of our job is to assist the Emergency Management Team in certain ways. For the fire we ran call center that provided fire information for both Navajo and Apache Counties. We started the call center on June 2, 2011. It is the first time that our team has activated the call center. We took calls from many concerned citizens and tried to give out the most accurate information on the condition of the fire. It was very stressful. Several communities had to be evacuated and there were 32 home and 4 commercial properties lost. The truly amazing thing is that there were only 16 injuries, most were only minor and no lives were lost. It was the largest fire in Arizona history, burning 538,048 acres. It is sad that we lost so much of our beautiful forest, here is AZ we don't have many more to lose.

 

Family Vacation

During the fire I was lucky enough to be able to take a trip to my mom's house. She had taken the kids and we had to pick them up. It was so much fun. My mom and Bruce, aka Pops, got an above ground pool. The whole family really enjoyed it. We had BBQ's and went to Bananas, it is a great place with go carts, bumper boats, a whole place with jumpy houses and slides, laser tag, and tons of video game. It really is fun for the whole family, especially if your family is a crazy as mine. We also went fishing; the kids that fished all caught fish and even Cam caught a little catfish, really little ha-ha.

 

Reunions

When we got home the Bond family, courtesy of Odessa, had a fun reunion. I unfortunately had to miss the majority of it due to working the call center. The kids and Cameron got to enjoy a long weekend of fun and food with his family. I made it just in time to be in the family picture. Thanks Odessa.

My family all got together over July 24th weekend. It was so good to see most of my aunt and uncles. It was a fun time. I got to spend almost the whole week with my aunts Shayla and Lisa and their kids. We had BBQs and spent lots of time at my Grandma's house. On Saturday Morning I was woken up at 6:10 am. Brenna wanted to run in the race, she got herself up and ready and Cam and I took her, she got signed up for the 5k with her cousin Alex. I have to say I am so proud of my family. My Aunt Lisa, her husband Brad, and her daughter Lizzy, my cousin Jacob all ran the 10k. My aunt Shayla, cousins Jaclyn and Ben and Alex and Brenna all participated in the 5k. We also went to the parade, Cam rode a horse for the Sheriff’s Posse and CJ rode with his Cub Scout troop. It was a great weekend.

 Surgery

All of my paperwork was submitted to the quality control person at my doctor's office. She called me and told me that I had one more thing to complete. I know . . . right. It was only lab work, easy peasy. I went to my doctor's office to have blood drawn for the test; they did not have all of the needed stuff for the test, so I went to Show Low. I went for a separate appointment and thought I would just swing by the office of the lab that the Dr. had written the order for. They were closed. I went to the other lab, they did not have the right test that I needed, they sent me to the hospitals offsite lab, they again did not have the tests that I needed, the tech called the hospital lab and they did have the test I needed, unfortunately it was a fasting test and nobody told me to be fasting. So I made and appointment and went to the hospital the following week. It was interesting, the front desk couldn't read the orders, they had been faxed to my doctors office and weren't very clear. So the surgeon's office re-faxed them to the hospital and they test were different on the new order, the lab and I decided to just do the tests on both forms to cover all of the bases, so 13 vials of blood, one urine dip, and an h. pylori breath test later I was done. No, I was officially completed and ready for insurance approval. Seriously, done. I had to wait a week for all of the test results to go to my doctor, but I am done!

Insurance

I actually know very little about how insurance works. I go to the doctor, pay my co-pay and the insurance does the rest. In some cases I have had to enlist my HR department to urge the insurance to pay what they are supposed to, but generally that is how it works for me. I have learned that insurance is a complicated world of pass the buck. I pay the insurance and they pay some else to do what I would consider their job. I have learned that my insurance uses a separate company to pre-approve on stuff like surgeries. Stupid if you ask me, the insurance has the information, right? Well because of this I was denied for my surgery. No really! To hear that you have worked for 2+ years, made sure to cross your Ts and dot your i's. I was devastated. I wanted to cry when I found this out. It seems that I was not covered long enough by the insurance company for them to approve. I was dumbfounded. I have been on the same insurance for nine years, seven and a half under Cameron and one and a half under my own policy. So wait, this is where it gets me, the other company that does these pre-authorization, was not given the information from Cameron's coverage, yes if the insurance would have just done this themselves they would have had this information.  It only took 2 phone calls and a couple hours of waiting, but come on. I did finally get the approval. That was the only thing keeping me back. So yeah!!!! Now just to schedule.

Going Somewhere . . . Finally

Well...I haven't been on in a while. I had some bad news and instead of depressing everybody on here I decided to take a stand. So here is what happened.

After my sleep study I was soooo excited to be done with all of my requirement for my surgery. I celebrated until about 4 days later when I got my results. They were normal. I have mild obstructive sleep apnea (which just means that I am so fat that it blocks my breathing when I sleep and I stop breathing for short amounts of time) and hypoxia (low O2 saturation in my blood when asleep, they don't know why it happens). The sleep lab report said that I need oxygen when I sleep. Fine, I can adjust to this. I faxed these results to my advocate and called her to make sure that she had gotten them. When I talked to her she said that she had gotten them and that Dr. Schlessinger would require me to be on oxygen for at least 6 weeks before he would allow for insurance approval. I was devastated. I cried that I was being put off again.

The next day I went to see Travis, my PCP. I have been having more problems with my abdomen, I had a seroma, fluid buildup, and he wanted me to keep an eye on my temp and if I got over 99 degrees, I had to go see my surgeon, Dr. Greco, again to make sure the infection had not come back. Another hit. If I have another infection I have to have the mesh that was used to repair my hernia removed. Major surgery, recovery and my DS would be put off until cleared from my surgeon.

So I decided to act. I had been taking an antibiotic for a respiratory infection and knew this could help if I was starting to get another infection from the mesh, bonus. And I called and made an appointment with Dr. Schlessinger, it was time to get things straight from him and let him know all the not so professional things my advocate had been doing. I also had an appointment with the pulmonologist and spoke with him about getting on oxygen at night, but he decided that I needed to be on a CPAP machine. This forces air into my nose at night so that I don’t stop breathing at night when I sleep. I have to have another test to get the titration(?) for the CPAP. So we got scheduled with the hospital.

I went in for the titration test at Summit, not White Mountain this time, and did another test that was exactly like the test I had before, no CPAP was used. I asked about it and the tech said that I had to do a split night first and that the titration would come in the middle of the night. After another sleepless night I got up with no CPAP at all, all night. I was a little upset and asked the tech about it. He said that I did not have my first apneac episode until 3 am and it was too late to get a titration. I thought that meant that I would not need a CPAP. Yeah! Not so.

I called my pulmonologist’s office and let them know that I had completed the test and that I had not gotten titrations because they had done a split night. This made the nurse mad. They did the wrong test. It was the exact test that I had done at the other hospital. Agggh. I wonder who prayed for me to have patients, well I am getting a major lesson right now. So we got things cleared up with the hospital and scheduled the correct test for June 1^st.

I went to see Dr. Schlessinger and spoke to him about the advocate and he told me that I was on the right track and told me that I was almost there, I had to get him a copy of one of the tests that I had back in December and get the titrations to him. He also wants me to be on the CPAP machine for 4 weeks before the surgery and then I was set. I have felt so much better since seeing him. So I am back on track for my surgery. WooHoo. I don’t want to get too excited yet.

Sleep Study

So I completed my sleep study test last night. It is kind of a joke. First off, I had to sleep at the hospital. I don't really sleep well when I am not in my bed. I even took a Benadryl before going in. I had to be at the hospital at 9:00 p.m. I arrived a little early and got to read a little. When I got back the room it was larger than I had imagined, there was a full size bed. I changed into my jammies. The tech came in and hooked me up to all kinds of wires. Ok tell me on what planet can a person that has major problems falling and staying asleep, get to sleep hooked up to a bunch of wires? She even put a sensor in my nose. Well let me tell you, I did not sleep. I dozed a little, you know where you are aware of your surroundings, but not totally coherent, and yet not all the way asleep. When I finally got to sleep all the way, the tech came in and said that my O2 sats were low, in the 70 and put me on oxygen. Now remember I already have sensors in my nose, now I have a nasal canula for oxygen as well. Yah, I’m gonna fall asleep now. I tossed and turned and when I finally fell asleep for the second time of the night, it was 5:00 a.m. and time to go home, or in my case work. So again I ask. How is this test relevant at all? How can my sleep be observed if I did not sleep at all. Well, I have major episodes of my oxygen dropping into the low 80s and high 70s for most of the night, but the tech said she did not observe any signs of apnea. BUT I have now completed my entire requirement for my surgery. I just have to wait for my Dr. to receive the Sleep study results, put in for insurance approval and schedule the surgery!!!!!!!!!

ANYWAY . . . I just want to tell everyone that I did something amazing for Easter with my kiddos. We went to El Morro, or Inscription Rock. It was really cool. I had gone once before with my Aunt Lisa when I was about 10. It was neat to see it again and to take my kiddos and hubby too. But I also did something really amazing for me, I hiked the whole thing. It is a 2 mile trail that goes up a 200 ft. rock and comes back down. I know can you believe that. Well you better, I have pictures.



At the top of El Morro



The DS Surgery

I have had a lot of questions about the surgery that I have chosen. So I thought that I would explain it to the best of my ability. Here Goes. I am having a Biliopancreatic Diversion with a duodenal switch (BPD/DS). This surgery works two ways: restriction and malabsorption. Below is a picture of what my anatomy will look like after the surgery.

BPD/ DS                                Gastric Bypass

So basically what will happen is that the doctor will make a sleeve out of my stomach and the rest (about 75%) will be taken out. This is the restrictive portion of the surgery; it will restrict the amount of food I can ingest. I will not have a “pouch” like with a gastric bypass (GB). Then the doctor will work his magic with my small intestines. My digestive loop will be shortened, and a bilopancreatic loop will be reattached at almost the large intestines (this is called the common tract). Because of the way that this surgery reconstructs the small intestines, I will only be absorbing food in the small portion of the small intestines from the site that attaches the BP loop to the digestive loop. There will be less absorption with the DS than with the GB. Because of the severity of the malabsorbtion I will have to take a lot of supplements. I will also have to eat a lot of protein because of the way it is absorbed.

Set Backs

So I thought that I was done with all of the testing and just waiting on insurance approval. I called my patient advocate and didn’t hear back from her. I finally called back and spoke with a different advocate on Thursday. I was informed that I had some more information that they needed.  Here is what I had to submit for my insurance approval:

Certificate of Seminar Attendance and class attendance- I got this way back in November when I attended the Seminar (my third or fourth I can’t remember anymore).

Must be a member on the plan for a minimum of 24 months- My insurance is trying to give me grief over this because I have only had my own insurance coverage for a little over a year, but I was on Cameron’s for 8 years before this.

5 years of medical records (must include documented weight history.  2-3 office notes per year. I was told that I only had to get from 2007 on.

BMI of 35 or greater with TWO co-morbidities ** If you are over the age of 50 or have a BMI of 50 or more, you must obtain both a cardiac and a pulmonary clearance. My current BMI is somewhere between 51 and 54 (it varies on by which doctor I visit).

6 month physician supervised diet.  They must be consecutive and within the last two years. Your doctor must put you on a specific diet and exercise program (if medically capable.)  You must follow up with your doctor once a month for 6 months without missing any months.  All visits must be documented and signed by your physician.  Please follow your doctor’s instructions your; insurance company wants to see that you can follow a weight loss regimen.  A letter summarizing any of the previous information will not be accepted. Because I did not stop my monthly visits I now have 11 months worth of visits.

2 Doctors Letters to support diagnosis of morbid obesity (Medical necessity) I thought that I had several doctors that said that they would write one for me, but found out that only Travis, my PCP, had actually sent one in. So I found myself one short.

Psychological Evaluation (must include MMPI) I got this completed at the surgeons office, it was in my file.

Cardiac Clearance (required by your insurance company) I had the echo test and the clearance, but the advocate said the doctor wanted the actual EKG and Stress tests for my file.

Pulmonary Clearance (required by your insurance company) The test was in my file and I was told that I was good on this.

My doctor also requires that I see a dietician, which I did about three weeks ago. So I had to get five years worth of medical records that include weights, 1 letter from a doctor confirming a diagnosis of morbid obesity, tests from my cardiologist, and I had the dietician fax over her notes. All by Monday. Not bad, right. I was feeling really good. The advocate told me that it would take 48 hrs for my file to get through quality control, 1-2 weeks for insurance approval and I could have my surgery scheduled by the end of April. Awesome, right?

I called the alternative advocate back on Monday. She didn’t have the second letter from the doctor or the notes from the dietician. So I talked to the dietician, and started to call the other doctors that might be able write the letter. I had left a message for another doctor. A small set back, but still moving right along. I also spoke with the dietician and she got her noted faxed right away. Great on the right track. Until. . .

I got a call today from my advocate, not the nice one so willing to help me that has been so great to take all of my calls and help with a pleasant attitude, no it was the advocate that I had called three weeks ago and needed help from, and guess what. She hadn’t completed my file and the doctor needs more stuff from me. I have to get a sleep study (I have been trying since like October for my insurance to ok one and I still haven’t gotten approval for this). I had to get medical records for 2006, because 07-11 isn't five years(who taught her math). I also have to get a release from a rheumatologist that I saw one time to see if she could figure out what the heck was wrong with me back in November. She couldn’t help me, I had an infection causing joint pain and a good long dose of antibiotics and surgery fixed that. AND I have to get a clearance letter from my pulmonologist, you know, the one they said was completed. So yeah, it looks like I will not be getting my insurance approval anytime soon. I don’t know how long it will take to final convince my insurance that I have to have the sleep test. I think that what makes me the angriest about the whole situation is that if the dang advocate would have just called me back three weeks ago, I would be three weeks ahead of where I am now. Sometimes I feel that I am not supposed to be getting the surgery; if I was it would just fall into place and be done. I have seen my coworkers sail through with 6 months worth of work and bam they are done. I sure hope my surgeon is worth the headache that I have after having to deal with all of this. I am ranting, and feeling sorry for myself, I know, but sometime I feel like there is no point to this. Cam is worried that I will give up. But I really do want it to bad. So onward and upward. Things can only go up once you hit the bottom. Right?

My support system

Today is a really big milestone for me. It is my 10th wedding anniversary. As most people that are reading this know, I have never done anything for a solid 10 years. I never lived in the same house for 10 years, not even growing up; heck I never lived with the same person for 10 years straight. So for me this is truly an amazing event. This exciting day has gotten me thinking of my support system. One thing that has really been emphasized to me throughout my journey this far is having a really sturdy support system.

My Support

I have to say that I am very lucky, I have found an overwhelming amount of support; from my friends, family and coworkers. I was worried about telling people that I was thinking about bariatric surgery. I was concerned about telling my family. I didn't want anyone to think that I was weak and not able to accomplish this on my own. My weight has been a topic of discussion between myself and members of my family for some time now. I think that I projected my own feeling of not being strong enough to lose the weight by diet and exercise onto what other people thought of me.

My husband has been my biggest supporter. He is a rock for me to lean on when I do not have the strength. He has always told me that I am perfect in his eyes. I only wish I could see myself the way he sees me. I have to say that when he realized how I saw myself he wanted to do everything to make me see myself the way he saw me. He wants me to be happy and if this will make me happy he was willing to support me. He still tells me I am perfect to him.

I also have a unique experience in that so many people in my life have had bariatric surgery. Two of my biggest sources of inspirations, information and support come from Tracy and Kellie. They are friends and more. Cameron works with Tracy and Kellie is my boss.  I got to know Tracy when she and Cameron became friends at the sheriff’s office. She is truly a one of a kind person. She tells it like it is and would give the shirt off her back to anyone in need. She had gb surgery about 2 years ago. She has been open and honest with me about the whole process. Kellie, who happens to be Tracy sister, is also a great support. She had gb about 6 months before Tracy did. The honest information that the two have shared with me has helped me to make an informed decision. I know that I can go to them with any question and they will give me an honest and straightforward answer. I am very lucky to have them in my life. My support system is really great.

Next Steps

I have also reached the next step in the long process toward my surgery. I received cardiac clearance yesterday. I am now waiting for insurance approval.

The Begining

I decided to start a blog because I have been trying and failing to lose weight seriously for about 4 years now. After 2 years working with my doctor and not having any significant results, I made the decision to undergo bariatric surgery. I guess the start to every story is the beginning.

I started getting heavy in high school. I didn't overeat too much then, I just didn't eat the right foods, and while my friends and I basically shared the same diet, lots of soda (the sugared kind), I started to gain weight. I gained about 40 lbs. in my four years of high school.  I really started to put on the weight with my first pregnancy, about 80 lbs., and didn't lose, or rather, try to lose any weight. I thought that breastfeeding would take it off. Now add in 2 more pregnancies with more weight going on than coming off, you get the end result, 330 lbs. Really.

For the most part my weight didn't bother me too much. My family would talk, lecture and plead with me to lose weight, and I would give it a half hearted effort. I didn't have a full length mirror in the house to see what was really happening to my body. Why worry about it if my husband still found me attractive and I felt pretty good, what did it hurt? Well I found out.

It started in little ways, as the kids got older and much more mobile I had a hard time keeping up with them and became a couch potato mom. , more directing them from the couch than actually interacting with them. We still did family activities, just most of them revolved around the couch and the TV. I began to realize that the kids needed me to be more involved. This is when I became big and beautiful or fat and fabulous. I know it sounds crazy, but I started working outside the home, I dressed nicer and fixed myself up more. I felt better and was really healthy. I did try to slim down and my weight would fluccuate about 20 up and down. It was a constant yo yo. Still I wasn't all that worried.

The breaking point for me was an accident at work. I went running down a flight of stairs at work and missed the last step and fell hard. I had to be taken to the hospital in an ambulance. It took three men to lift me onto the gurney. Ouch. I also found out that my injuries would not have been so severe if my weight was not so high. At this point, I realized that my enormous size was not so fabulous. I had torn 2 ligaments and damaged a tendon and needed surgery to repair the damage. I started to work with my doctor on creating a diet plan. I spoke with a nutritionist and we set up a diet for me to follow. I was also in physical therapy three times a week.

I followed the diet and gained weight. I went to PT religiously for over a year, the doctor put me on medication, phentramine. Nothing! I didn't lose a pound or inches the whole time! I didn't feel better either. My knees and ankles hurt, I had back pain, and my cholesterol levels went into the high range. The good health that I thought I enjoyed was gone. I continued to work with my doctor about my options, different diets to try. Nothing worked. So we decided that surgery was the best option. It took two years to come to this decision.

I had to decide on a surgery, there were only two options that I knew about, the lap band, and the gastric bypass. I had some experience with the lap band and was considering this option. I attend a webinar from the first doctor that I wanted to use. I learned about the gastric sleeve and decided that that was the right surgery for me. It was restrictive, like the lap band without the ability to cheat around it, but didn't have the malabsorbtion like the gastric bypass. I was set.

I started to work towards my insurance requirements and hoopla. I had to complete a 6 month doctor supervised diet plan with consecutive monthly visits. I had to get cardiac clearance, pulmonary clearance, 2 doctor’s letters confirming the diagnosis of morbid obesity, a psychological evaluation, and meet with a dietician.

I had a hard time with the 6 monthly visits with the doctor; I think this is a requirement for the insurance to weed out those that want an easy fix. I would get four or five months in and miss an appointment and have to start over. I didn't know what else to do so I worked with my doctor and he gave me a reference to a doctor that he had worked with before. I opted go to a different clinic on the advice of a friend who had the surgery and recommend them.

I had five months of visits under my belt and decided to do another seminar with the new doctor. I went made the four hour drive to the clinic and had the seminar with the nutritionist and did not feel quite right about it, I also had a consult with the doctor. He told me about this great surgery that is less common than the gastric bypass, which he claimed wouldn't work for me because I was super morbidly obese. It was the biliopancreatic diversion with a duodenal switch (DS), and it was the only one that would work for someone my size. I had an even worse feeling about the doctor than I did the nutritionist. After leaving the office my husband and I didn't feel that this doctor was the right fit for me. I decided that I would contact the doctor that mine had suggested in the first place. (I am one of those people that have to learn the hard way). Then I missed another appointment.

I started my appointments with my doctor again in July 2010. I set the seminar with Dr. Schlesinger in October, on my birthday, as a present to myself. This was cancelled and rescheduled for November 2010. I wanted to find out more about the DS procedure. I researched it on the internet and listened to what was said about it at the seminar. The doctor required that anyone wanted this surgery had to wait 2 weeks between the seminar and a consult. I found out the pros and the cons of the surgery. My husband and I decided that this was definitely the surgery for me. I met with the doctor in December and had my consult. I really liked Dr. Schlesinger. He was honest with me. He told me in frank terms the risks of the surgery, which can be serious. We decided to move forward with the surgery. I had actually made it through my six months with my doctor in December as well. One step closer.

I have had ups and downs with this, especially with my health. Due to my weight I developed a hernia in my C-section scar and had to have it repaired. I have had constant ankle problems since my injury. I developed a seroma, or a fluid filled pocket, due to the hernia that was massive and had infection. Finding this took months of being sick, many blood test, three specialists, an ultrasound, a ct scan and surgery to insert a drainage tube that I had for 2 months to drain the fluid. I was also on antibiotics for four months. This delayed moving forward with the surgery.

I am now back on track. I have had my pulmonary consult, in which I learned that I have asthma (this could very well resolve when I lose weight), and possibly sleep apnea (another test that I will have to take). I have had my cardiac consult. I had to have more extensive testing that just an EKG; I have yet to get my results on my echo and stress tests (coming in April). I have had my psych testing, and contrary to popular belief I am not totally crazy.  Lastly, I have met with a dietician and am starting on a new meal plan (I am not calling it a diet).

Why, you might be asking yourself, have I rambled on about all of this junk. Well let me tell you. I have been told that I am taking the easy way out by having surgery. I wanted everyone to see that this is not the easy way out. I have made an informed decision that to live I have to do something to change and I have tried other options that have not worked. I want people to see that this process is hard work and takes dedication.