On Food. Again. Part 5: What to expect when you're expecting (bariatric surgery)

During the past couple weeks, I have had 4 dreams that I was having a baby.  After the first one, I awoke with a start-- practically hyperventilating.  Don't get me wrong.  I love babies.  I love my babies.  I love other people's babies.  Rubbing my lips over their perfectly soft baby hair on their sweet-smelling baby heads.  Man.  It's the best.  But I can love all of those things and at the same time be at the place in my life where I know that my own personal having babies stage is over.  Thus, the night terror of being pregnant. But the dreams have persisted.  And so, I looked online to see what dreams about pregnancy mean.  (Because, you know, the internet is full of reliable scientific information about things like dream interpretation).  I found this article that talks about what pregnancy dreams could mean and this paragraph stuck out to me.

"Dreams about being pregnant might be about a different kind of birth, so to speak. “Pregnancy can be a metaphor for other kinds of creativity,” says Deirdre Barrett, a psychologist... Pregnancy dreams may represent your excitement around a creative project in your home or at work, she says. You’re “giving birth” to this project, in a sense, and that could show up in your dreams as a bump or baby."

That made sense to me immediately.  I am now in the home stretch of the prep for my bariatric surgery and it's something that is occupying a lot of my time and attention these days.

Since there is pervasive misinformation about bariatric surgery, and since I am a big believer in sharing information and story, I thought I'd share a little about my process.  I got numerous messages and comments and questions after my last post. Some people are considering the process for themselves, some people have already been through the process, some people had questions or suggestions.  But most people just wanted to be supportive.  I think I got more comments and messages on that post than I ever have on anything else I've written. I thought that by sharing my experiences people might be able to see what it's like for someone going through this process. Obviously, this is just MY story.  I don't speak for anyone else. Your mileage may vary.

Today's post is pretty informational in nature boring and has very little about the emotional journey that is the biggest piece of the puzzle--  rather, today I am talking about the process leading up to surgery.  One piece of misinformation is that bariatric surgery is "taking the easy way out."  I used to think that.  Now, I don't agree.  No one considers bariatric surgery as their first thought when considering weight loss.  In fact, most of us see is as a "last hope."  Even the process of even being approved for weight loss surgery is a lot of work. It's more than just someone desiring to have the surgery and popping in to have it done.  It's a long process, and that length is mostly determined by your insurance requirements.  If you are self-pay, you can get through the process in about 2.5-3 months.  But most insurance companies have a prerequisite of being a certain BMI and require a certain amount of months of medically supervised weight loss before they approve a surgery.  And this is where things get tricky-- because two people can have the same insurance company and yet have different coverage.  The reason for this is because bariatric surgery is apparently a rider that employers need to add onto their insurance offerings.  Essentially, a company can decide that bariatric surgery is too expensive and decide not to cover it.  There are no appeals.  There are no options other than self-pay if that's you.  And so many people in that situation travel to Mexico to have their surgery there, where it is much less expensive-- about 1/10th of the price of the US.  Crazy, right?  And while I have been tempted to judge that as an unwise choice, many people on the bariatric forums I've been following have had great experiences in Mexico.  So what do I know?  (Incidentally, with the amount that my insurance company is covering, my payments will end up being almost exactly what people pay to go to Mexico for the surgery).

My insurance policy requires 12 months of supervised weight loss visits before approval.  (Which seems to be the highest requirement I have seen-- most of them are about 6 months).  That is frustrating to a lot of people, but there really are good reasons for it.  This surgery is a tool that helps people lose excess weight.  But there is still work required, and there is even more work required in order to maintain weight loss. It's best to begin work towards these goals pre-surgery in order to maximize weight loss after surgery, since the biggest benefit from the surgery in terms of rapid weight loss will be in the first 9 months or so. 

For me, since I'd been meeting with my nutritionist for a year and a half before I started seriously thinking about the surgery, the important work that helped me the most had to do with my mindset.  I was able to overcome a lot of the shame I felt about my weight and size. This was important because for so long, I felt like my weight was sinful.  It's just the culture I was a part of in evangelical life. I even did a few "Christian" weight loss programs that basically asserted that extra weight was a heart not fully devoted to God.  (*cough* spiritual abuse *cough.*) The first part of all of this for me was adjusting how I felt about being fat.  That was even before my nutritionist appointments. Once I started those, I became able to understand hunger and fullness.  I became able to stop turning to food as my first coping mechanism.  I learned about how to properly nourish my body in ways that weren't just low-calorie/low-fat/low-carb diets.  I learned what a body needs for fuel and how to provide that with food. It helped me develop the most healthy mindset about food that I have ever had.  Additionally, one silver lining for me, was that it also counted towards my insurance requirements-- so I went in with that requirement already met.

In addition to the insurance requirements, there are also surgical requirements.  (And each practice is different in what they require, but they are all similar).  You have to have extensive blood work to check all the things-- CBC,  vitamin and nutrient levels, cholesterol, blood sugar-related things, lipids, and they also test for illicit substances, pregnancy, and nicotine.  Nicotine use is not recommended for patients that have this surgery and so one of the requirements is quitting smoking before surgery.  Apparently they test you on the morning of surgery and if there is any nicotine in your blood, they will cancel your surgery.   You also have to do an EKG to check your heart, a chest x-ray to look at your lungs, and an EGD to look at your esophagus, stomach, and duodenum (the first part of your small intestine). Another qualifying test is a psychological evaluation.  You take about an hour of psychological tests and then meet with a psychologist for another hour to go over your results to make sure that you're emotionally stable enough for the surgery. Finally, you need to go to a bunch of classes and nutrition seminars to learn about the different diet changes to anticipate at each step in the process, and the vitamin regimen you need to follow.  You then have to follow a pre-surgery diet in the months leading up to surgery and turn in your food log to the nutritionist to approve.  She is looking to see that you understand the nutrition piece well enough to proceed.  And then there are also conversations with the financial counselors to discuss the costs and how/when to pay each one. It's a lot.  But it's really thorough.

Once you've met all your requirements and gotten clearance on all of the various tests, your case is sent to the insurance company for final approval, and a surgery date is set.  But keep in mind that the results of these tests can necessitate other necessary pre-op steps.  For instance, my vitamin D was low and so I had to do an 8 week course of prescription-strength vitamin D to normalize that level before surgery.  Some people discover a heart condition and have to have further cardiac evaluation. If you have sleep apnea, you have to do a sleep study, etc.  The average amount of time this all takes is usually about 6 months it seems from the forums I am on.

Once the surgery date is set, you come back in for another education/nutrition appointment about two weeks before surgery to learn about the pre-surgical diet and process, learn about all the risks, sign all the forms and releases, and learn about the post-surgery requirements for staying nourished on a liquid diet for the first 2-3 weeks after the surgery when you have a stomach the size of an egg,  and you go to the hospital for all the pre-op things you need done.

After that, you go home to start your pre-op diet, which is two weeks long and basically at least the first two levels of hell.  (That's where I am.  I am on day 9 (of 14) of my liver shrinking diet and surgery is coming up next week).

While that's the particulars of the process, there is also a huge emotional and psychological component.  Stay tuned for more on that.


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